11060198CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 898 FERNGROVE DR
CONTRACTOR:"
PERMIT NO: 11060198
OWNER'S NAME:
'�� '' re "
PHONE, NO:
❑ LICENSED CONTRACTOR'S DECLARATION
f r
License Class a Lic.
BUILDING PERMIT INFO: BLDG ELECT PLUMB'
#51
MECH r RESIDENTIAL r COMMERCIAL
t `:Zili
Contracto " 1 o t ;'v i " mate
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: KITCHEN REMODEL(120SQFT)&MASTER BATH
(commencing with Section 7000) of Division 3 of the Business & Professions
REMODEL(50SQFT),HALL BATH NEW TILE
Code and that my license is in full force and effect.
FLOOR,TOILET&SINK FAUCET,NEW POCKET DOOR BETWEEN
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $85000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 37538032.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify ankeep harmless the City of Cupertino against liabilities, judgments,
costs, and ex onses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grantin is permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with non dint source regulations per the Cupertino Municipal Code, Section
9.1 .
S , Date
Issued by: Date:
E
❑ OWNER -BUILDER DECLARATION
,j
{
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall bei ted prior to any roofing material being installed. If a roof is
the following two reasons:
installed without f rst ` inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Appli Date: (t
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL R OF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will mainntain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Ad itionally, should I use equipment or devices which emit hazardous air
permit is issued.
co taminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
andptain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
nth & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
O finer or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
Date: a
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building gonstruction, and hereby authorize representatives of this city to enter
Lender's Name
upon the ab `ve mentioned property for inspection purposes. (We) agree to save
'`,d
indemnify keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs,
which may accrue against said City in consequence of thegrantis
permit.Additionally, the applicant understands and will complyARCHITECT'S
Jandeenses
with pint source regulations per the Cupertino Municipal Code, Section
DECLARATION
I understand my plans shall be used as public records.
SignatDate
Licensed Professional
CITY OF CUPERTINO
WIN FEE ESTIMATOR - BUILDING DIVISION
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7 1110)
ADDRESS: 898 ferngrove dr.
Plumb. Plan Check 0.0 hrs $0.00
DATE: 06/23/2011
REVIEWED BY: bobs.
Plumb. Permit Fee: IPPERMIT
APN:
BP#:
OtherPlumb Insp. 0.0 hrs $42.00
"VALUATION: 1$85,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
I
PME Plan Check:
PENTAMATION 1 R3SFDREM
I PERMIT TYPE:
WORK
remodel kitchen 2 baths hall bath onlyreplace
shower, water closet upgrade electrical meter, replace
SCOPE
windows and doors.
Suppl. Insp. Feer Reg. 0
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7 1110)
P/"';; {"hc; ';
Plumb. Plan Check 0.0 hrs $0.00
MISC ITEMS
Plumb. Permit Fee: IPPERMIT
$0.00
OtherPlumb Insp. 0.0 hrs $42.00
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7 1110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
120 s.f. Remodel, Kitchen (<=300 sf)
$570.00 IREMItESKiT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
= s.£ Remodel, Bath (<=300 sf)
$570.00 1REMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0
OT
0.0
hrs
$0.00
1 Tl # Window / Sliding Glass Door
$506.00 1WINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
1 #
$21.00
Plumbing
IPRSEWER Sewer, Sanitary
'°(1A,
Acoustical Fee:
0 Yes 0 No
$0.00
2,400 s.£
$312.00
Re -roof
IREROOFRES
0
Work Without Permit? 0 Yes G) No
$0.00
Plasmin&Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Documentation Fee: ITRAVDOC
$42.00
Strong Motion Fee:
IBSEISMICR
$8.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:-
$96.50
$1,979.00
TOTAL
FEET $2,075.50
Revise'd�_9 /1 /2011