11020115CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1044 BUBB RD CONTRACTOR: VU NGO PERMIT NO: 11020115
OIVNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
r_1 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT f— PLUMB
License Class Lic. #.
Contractor
I hereby affirm that I am 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:
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
El \]So OWNER -BUILDER. DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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,
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.
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.
I certify that in the performance of die 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
become subjec�to the Worker's Compensation provisions of the Labor Code, I must
forthwith co Z� 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 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
with all non -poi rce regulations per the Cupertino Municipal Code, Section
9.18.. '" ,
Date (I
MECH r RE' SIDENTIAL J_ COMMERCIAL J_
JOB DESCRIPTION: REPLACE EXISTING PATIO WITH NEW COVER 2421 -PATIO
ROOF TO MATCH ROOF OF PRINCIPAL DWELLING IN
MATERIAL & COLOR (PLNG).
Sq. Ft Floor Area: I Valuation: $3000
APN Number: 36204016.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
/ 7-Z
Issued by:-- Date:'3 , _r
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: — Date:
ALL ROOF COVE, RINGS 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. 1 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505,25533, and 25534.
Ow, r
LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of i'mik's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
IS M" I FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 1044 Bubb Rd.
I DATE: 02/2812011
REVIEWED BY: A. Salvador
kfech. Perwil Fee'.
APN:
I BP#:
*VALUATION: 1$2,500
�IPERMIT TYPE: Building Permit _j
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE: I
I Phinih, hap. ree:
PENTAMATION 1R3SFDADD
� PERMIT TYPE: 'A
wowc I
To C1 ar Code Enforcement Case: Replace exising patio cover with new 16'-8" x 14'-6" patio cover
SCOPE
attached to existing house.
NOTE. These fees are based on the Preliminary information available and are on1v an estiniate. Contact the Dent for addnl into.
FEE ITEMS (Fee Resohition 09-051 Eff. ZIL10
A,kdi. Plon C. (,(-k
P11110), phrli Chock
Elec� Plan Owk
kfech. Perwil Fee'.
P/Ifnih. Permit Pcc:
Oec. pelmil rce:
Other Hech. Insp. EIF-L-
Other Phimb /nsp. E1__t_
Other Elce, hn:p,
AJecb. hisp, Fee:
I Phinih, hap. ree:
I Ele(, Insp, rcv:
NOTE. These fees are based on the Preliminary information available and are on1v an estiniate. Contact the Dent for addnl into.
FEE ITEMS (Fee Resohition 09-051 Eff. ZIL10
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
s.f.
$633.00
Patio Cover / Sun Room
IPATIOWOOD Wood
A
Suppl. PC Fee: E) Reg. 0 OTTO-OThrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
1 0.0
1 firs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consinlefion Tax
Acoustical Fee: 0 Yes (F) No
$0.00
G
Work Without Permit? G Yes () No
$633.00
Planajn�
$0.00
Select a Non -Residential
Building or Structure
E)
0
Travel Docionentolion
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee:, IBCBSC
$1.00
SUBTOTALS:
$634.501
$633.00
TOTALFEE-F
$1,267.501
Revised: 01/15/2011