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13090208 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10415 IMPERIAL AVE CONTRACTOR:,C,.-1), 8 PERMIT NO:13090208 OWNER'S NAME: BHAVESH PATEL DATE ISSUED:09/26/2013 OWNER'S PHONE: 4085156551 PHONE NO: 7 7p> LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB License Class, Lic.# A 7 MECH r- RESIDENTIAL r— COMMERCIAL Contractor Date JOB DESCRIPTION:BATHROOM REMODEL 120 SQFT-CHANGED TO 1 1/2 1 hereby affirm that I am licensed under the provisions of Chapter 9 BATHS (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two Aeclarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$16500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35719100.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes, (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 D YS FRO L CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per t",�,ertino Municipal Code,Section 9,18. Issued by: Date: Signature yDate OWNER-BUILDER DECLARATION BE-ROOFS. All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS.DISCLOSURE declarations. I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner or autl9xized agen - become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued CSqc 097 Ci correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT—'$DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used_-pwblic reco 9,18, Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building@cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#i PROTECT ADDRESS OWNER NAME f��J'"� 6�/�,✓ //�' PHONE ` E-MAIL , ✓ E-MAIL STREET ADDRESS / ,/, ) /1�/�.-'' j 4 CITY, STATE,ZIP CONTACT NAMETPH7f) �y„, E-MAIL STREET ADDRESS n ,ZIP�fj � r��qf FAX -yf„b�3 El OWNER ❑ O✓WNER-BUILDER 13OP OWNER AGENT -EI SONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT /®EtNrGINEER 11 El❑!TEENAANT CONTR to 1 CTOR NAME �j�S r 7Z,/�✓/? LICENSE NUMBER LICENSE BUS.LIC# COMPANY NAME C MAIL FAX STREET ADDRESS g/ , J CITY,STATE,ZIP iJ$ J ^-11 O 2- 17 ARCHITECT/ENGINEERNAME JL,17AXLICENSENUMBER BUS.LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF�WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL j AREA AREA AREA NET AREA ! BATHROOM KITCHEN ETHER REMODEL AREA f�/s REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLINGUNITS: 11ASECONDUNIT [,YES SECONDSTORY [ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF - IS THE BLDG AN ❑YES Y ,� TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? []NO f/('�ji 9 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construct' thorize L!2! tives of Cupertino to enter the above-ide 'fled prop for inspection purposes. Signature of Applicant/Agent: - Date: SUPPLEMENTAL INFORMATION REQUIRE Rou2404,si a'r , _New SFD or Multifamily dwellings: Apply for demolition permit for { . OVER TF�E COiINTER ❑ B13SLD[NG) AN REYIEY4 ' existing building(s). Demolition permit is required prior to issuance of building x , permit for new building. EXPRE3 �-f LA PLATY REVIEkS� � _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure3 STAND l2D i p PdLTowoRxs Form if any Hazardous Materials are being used as part of this project. t _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. S itYTTAR} rwER tDTSTRICT ° .� , CI..EINYIRONiti3Etv`TAT:N[EAL'rIT `"a, Bldg,4pp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ATADDRESS: 10415 imperial ave DATE: 09/26/2013 REVIEWED BY: larrys PN: BP#: 50 �j *VALUATION: $16, 0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: p PERMIT TYPE: woRK bathroom remodel SCOPE h?ch, Man('heck 1-hillib, Plan('fre;clr flee, 111an Check rLIE>t;kt. 1'€>r7aart Fee: I'It,rnb.lltr,rnit F�'s.° x>r<;E::. I'er~rent C1Hrer ik'kr' Izasp}. C iherY Ph'.1mb Insp. 011ier#>l;r,lnsj). _ire<.A Inso. Fee: phinlh. 1.sls Fee: I'l�>c.I a{= NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta . These.Lees are based on therelinzina information available and are onjE an estimate. Contact the De t or addn l in o. FEE ITEMS wee Resolution QTY'FEE MISC ITEMS Plan Check Fee: $0.00 120 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (D Reg. 0 OT 0.{} hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0 OT 0,0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0,00 Consla-trc°tion lac: ,ldirinistrrative Free 0 Work Without Permit? 0 Yes 0 No $0.00 G) Advanced Planning Fee: $0.00 Select a Non-Residential (E) Fra�>c�1loc,arrneaat.etrcra Fees: Building or Structure 0 A StrongMotion Fee: IBSEISMICR $1.65 Select an.Administrative Item BldStds Commission Fee: IBCBSC $1.00 SIURTOTA.LS $2.65 $626.00 TOTAL FU. $628.65 Revised: 08/01/2013 I n m �a 2&68 50 A/21f 2668 33 i trjt BuildingDepartment IF REVIEWED fz�OR CODE COMPLIAN(M 'figC J, J R viewed y � , iNzo 4 - . { i f. r._ ��i, ° 26C� 1� �� I 4 � r,. e.+�� j �� "..,� s'S�..•�„z 03 ! J f , ; �S t ( _ j 31 r i i t • 1 , r Aiz i w l�f r� ` l Y '-NT eeJ \\ ° `t SULIUNG:,zx a Yt.r,'*.$ J x Pp \ ♦ �8 e ,:.,,.: z\ �..' i. '•?''� / a c 15, i t ti „p 1� a`r � v F i Mk ` L96 4 v�Y v'titi Bip €4 "E,Wapproval 1 kt l4 d s ��+..f `:,. r F`r ;ay yy #•::��` - is, [S"f"af ,,' `{a'�1�`g arc' ? f 4.a(,,4 `f r BY LIVING AREA PErIMIT NO. LIVING AREA 112 sq ft 112 sq ft F I C m s SCALE.* !B: DRAWN BY DATE R EYdSEtd