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12050211CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11508 CHARSAN LN CONTRACTOR: MCCLELLAN PERMIT NO: 12050211 DEVELOPMENT OWNER'S NAME: 1448 ENTRADA VERDE PL DATE ISSUED: 07/26/2012 OWNER'S PHONE: ALAMO, CA 94507 PHONE NO: (925) 944-9108 ❑ LICENSED CONTRACTOR'S DECLARATION F_ F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r F_COMMERCIAL F MECH RESIDENTIAL � �Contractor6 _ ,. 7 �Date .6L_1 "Y2_ 1 hereby of the Business & Professions SQFT WITH ATTACHED GARAGE 440 SQFT, TOTAL 3,123 Code and that my license is in full force and effect. SQFT 1 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: $245650 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36210052.1 1508 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 and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature & Date 7-2� JZ. Issued by: ��� / v C/� Date: 7 a�'l ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an 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 Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1 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 maintain 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. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants 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,) shall maintain 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 Health & 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 Ow Date:?— ^�Z 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 construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11508 CHARSAN LN CONTRACTOR: MCCLELLAN 1 56i�F DEVELOPMENT OWNER'S NAME: 1 1448 ENTRADA VERDE PL DATE ISSUED: 07/26/2012 OWNER'S PHONE: ❑ LICENSED CONTRACTOR'S DECLARATION License Class B Lic. # % 9 8 L!� � Contractor —�q,d.J\\�• Date 9 1_1 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 Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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) I, 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 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 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 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, ALAMO, CA 94507 1 PHONE NO: (925) 944-9108 JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL LOT A -NEW 2 STORY SINGLE FAMILY RESIDENCE 2,683 SQFT WITH ATTACHED GARAGE 440 SQFT, TOTAL 3,123 SQFT 8/21/2012-REV# 1 - ROOF TRUSSES- ISSD 9/7/12 Sq. Ft Floor Area: Valuation: $245650 APN Number: 36210052.11508 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA OM LAST CALLED INSP TION. Issued by: �� Date: 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 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. I 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. Owner or authorized agent�' Date: 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 Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION hA:PN: ESS: e �DA�-05/24/2012 REVIEWED BY: 362-10-052, Lot A B i7 'VALUATION: $245,650 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? 0 Yes No PENTAMATION 1 R3SFDW USE: PERMIT TYPE: WORK New Home Construction - Single Family Home SCOPE OCCUPANCY TYPE: TYPE OF CONSTIL FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 3,123 $2,833.53 IR3PLNCK $2,832.94 IR3INSP TOTALS: 3,123 $2,833.53 $2,832.94 NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dittriel. etc ). There feet are hated an the nreliminary infarnmWan available and are an1v an etdmate. Contaet the Dent for addn'1 info FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/11 ) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,833.53 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. OT FO.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,832.94 Suppl. Insp. FeelD Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new ,,,,;u $590.16 !,lrY]mi,1Infth'C1'c'c- O G Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: PLLONGRNGR $405.99 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: 1BSEISMICR $24.57 Select an Administrative Item BldgStds Commission Fee: IBCBSC $10.00 SUBTOTALS: $6,697.191 $0.001 TOTAL FEE: 1 $6,697.19 Revised: 04/01/2012 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 11508 CHARSAN LN [" DATE: 08/20/2012 REVIEWED BY: SUEW/LARRY PA APN: = BP#: 12050211 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY �^ USE: SFD or Duplex x7j (JI /�JY? PENTAMATION PERMITTYPE: 1GENRE i WORK ROOF TRUSSES -THEY ARE CHANGING COMPANY'S - LARRY SAID TO CHRG 4HR MIN PLAN SCOPE REVIEW TIME FOR EACH HOUSE AND WOULD BE 2 WK TURNAROUND TIME NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). 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 11-053 Ef. 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 4 hours Plan Check, Hourly $532.00 1STPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $532.00 TOTAL FEE: $532.00 Revised: 07/01/2012