10100059I CITY OF CUPERTINO BUILDING PERMIT
IBUILDING ADDRESS: 1040 TUSCANY PL I CONST UCTOOR: ANTHONY HODDER I PERMIT NO: 10100059
OWNER'S NAME:
1 CUPERTINO, CA 95014 1 PHONE NO: (408) 257-4317
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. #_,` (» _(� s
Contractor �%, �-�Hate
I hereby affirm that I al licensed under the provisions of Chapter 9
(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 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.
I 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
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. l 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,
costs, and expe s which may accrue against said City in consequence of the
granting of th p it. Additionally, the applicant nderstands and will comply
with all non o4source regulations per the C pe ino Municipal Code, Section
9.18.
{
❑ OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property,•am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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, l
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify an e p harmless the City of Cupertino against liabilities, judgments,
costs, and a ens s which may accrue against said City in consequence of the
granting o his ermit. Addit'onally, the ap licant understands and will comply
with all n-po source a ulatious p t Cupert' b Municipal Code, Section
9.I8. /
/ / Date &) /0
BUILDING PERMIT INFO: BLDG ' ELECT PLUMB
MECH � RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: REMODEL KITCHEN(360SQFT);NO RE -ROOF & NO
STRUCTURAL
ISq. Ft Floor Area: 3 6 v"'- I Valuation: $22000
APN Number: 35929040.00
Iss
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA/ S FROM C=2ZD
PECTION.
l
ued by: :
/v•�l v
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. if a roof is
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. l will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mainta mpliance with the Cupertino Municipal Code, Chapter 9.12 and the
Heal & afety Coyte, Sections 2,550$, 25533, and 25534.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FM__7 FEE ESTIMATOR — BUILDING DIVISION
FEE ID REMODEL
(s.f.)
1REMRESOTH 360
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Depifor addn'l info.
FEE ITEMS (Fee Resolution 09-0.51 Eff 7,,/ /0)FEE
[ADDRESS:
DATE: 10/06/2010
REVIEWED BY: gs
[APN:
BP#:
*VALUATION: 1$22,000
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Remodel, Other
PRIMARY Residential
USE:
PENTAMATION 1R3SFDREM
PERMIT TYPE: A
WORK
Permit Fee:
SCOPE
FEE ID REMODEL
(s.f.)
1REMRESOTH 360
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Depifor addn'l info.
FEE ITEMS (Fee Resolution 09-0.51 Eff 7,,/ /0)FEE
QTY/FEE
MISC ITEMS
A
Permit Fee:
$443.00
T7
Work Without Permit? Yes 0 No
$0.00
Strong Motion Fee: IBSEISMICR
$2.20
Select an Administrative Item
—1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$446.2=0$0.00
TOTAL FEE:
$446.201
Revised: 9/29/2010