13020094 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7806 BOLLINGER RD CONTRACTOR:MCCLELLAN PERMIT NO: 13020094
DEVELOPMENT
OWNER'S NAME: BOLLINGER VENTURE LLC 1448 ENTRADA.VERDE PL DATE ISSUED:05/08/2013
OWNER'S PHONE: 9259449108 ALAMO,CA 94507 PHONE NO:(925)944-9108
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
License Class Lic.#1 W7
M6 LOT 4-CONSTRUCT 2 STORY SFDWL 2,972 SQ FT,
,fin ( GARAGE
Contractor 1 �1 r ��IU. Date Ac 455 SQ FT PORCH 49 SQ FT
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions DEFERRED#1-TRUSS CALCS-ISSD 7/16/2013
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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. Sq.Ft Floor Area: Valuation:$356640
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this ATN Number:35922077.7806 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the r,/� �3
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signat Date �� l All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 'I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio2 50 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen . Dat
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which-may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting.of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 7806 BOLLINGER RD DATE: 0611012013 REVIEWED BY: MENDEZ
APN: BP#: "VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex PENTAMATION 1GENRE
USE: PERMIT TYPE:
WORK DEFERRED#1-TRUSS CALCS
SCOPE
Xfec h. Plan(.'heck Phurrb. Plan Check Ele0..Plan Check
,LteOh. Ilerrrrit Fee: Phan!). Pertnit Fee. Elec. Permit Fee:
Other iuleeh.Insp. Other Plurnb Imp. Lj Other Floc.Insp. Li I
31(07. Lash. Fee., Phrrnh. hal). Fee.- Elec.Insp.1 ee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS(Fee Resolution 11-053 Elf.' 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? C)Yes (D No $0.00 � hours Plan Check,Hourly
Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $266.00 ISTPLNCIC
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. Q OT TO.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
#new
Construction Tax: IBCONSTAXR ro units $0.00
Ailrnirtistt catiw�l'ect: C)
Work Without Permit? 0 Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Docurrrentation./ees: Building or Structure
A
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg>,Stds Commission Fee: $0.00
= SUBTOTALs: $0.00 $266.00 TOTAL FEE: $266.00
Revised: 04/29/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7806 BOLLINGER RD CONTRACTOR:MCCLELLAN PERMIT NO: 13020094
DEVELOPMENT
OWNER'S NAME: BOLLINGER VENTURE LLC 1448 ENTRADA VERDE PL DATE ISSUED:05/08/2013
OWNER'S PHONE: 9259449108 ALAMO,CA 94507 PHONE NO:(925)944-9108
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Classes Lia f LOT 4-CONSTRUCT 2 STORY SFDWL 2,972 SQ FT,
(��{ Date J -�' � GARAGE
Contractor 455 SQ FT PORCH 49 SQ FT
I hereby affirm that I am license r the provisions of Chapter 9
(commencing with Section 7000)o 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 declarations:
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. Sq.Ft Floor Area: Valuation:$356640
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35922077.7806 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18�Y�"O i� +RMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 D AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply ed1b Date:
with all non-point source lations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature '� }I Date All roofs shall be inspected prior to any rooting material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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,
Business&Professions Code)
I,as owner of the property,am exclusively.contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: . Health&Safety Code,Section 25532(a)should I store or handle hazardous
1 have and will maintain aCertificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the rtino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 255055,25533„plc 5534.
Section 3700 of the Labor Code,for the performance of the work for which this I Owner or authorized agent: r✓! �� / / Date:,) ' -_
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Ia. CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: Lot 4 DATE: 02/08/2013 REVIEWED BY: Mendez
APN: BP#: —3 *VALUATION: 1$356,640
"PERMIT TYPE: Building Permit PLAN CHECK TYP : New Construction
PRIMARY SFD or Duplex 2nd Unit? 0 Yes G No PENTAMATION 1 R3SFDW
USE: PERMIT TYPE:
WORK construct 2 story sfdwl 2,972 sq ft garage 455 sq ftporch 49 sq ft
SCOPE
TYPE OF FLR AREA
OCCUPANCY TYPE: CONSTR. (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID
R-3 (Custom) II-B,111-B,IV,V-B 3,476 $2,947.60 IR3PLNCK $3,022.90 IR3INSP
TOTALS: 3,476 $2,947.60 $3,022 90
k. .xria. r:
[,:��C^.�''. E..•.i is ti
i�
L
f.'Cat, c•..,,'f''r:f.': t:>riifY:b. ita7,7.1.Fee: 'e-
{ E17-- t
El
7`<'r':
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelitninar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f. 7jdD FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,947.60 Select a Misc Bldg/Structure
Suppl. PC Fee: ) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $3,022.90
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Pen-nit Fee: $0.00
Construction Tax- 1BCONSTAXR 1 un cs $6 9
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: 1 PLLONGR $451.88 Select a Non-Residential G
a--ei a t�3;'tE �E ;,i'i?D�� .t''F'f,�.5: BUllding Or Structure 0A
Strong Motion Fee: 1BSEISMICR $35.66 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $15.00
r >�;:1 F SUBTOTAL S ¢ $7,102.33 $0.00 „ TOTAL FEE $7,102.33
,.
Revised: 01/01/2013