11070182CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10405 MANN DR I CONTR CTOR: ALI'S CONSTRUCTION & I PERMIT NO: 11070182 I
(•" TIVS NAIVE.:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class— /�_f Is '( ldLie. # T)
Contractor _/'1 f C 'c�Date
hereby affirrm'that I am licensed under the provisionhapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
pertormance of the work fpr 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
permil 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 ahove mentioned property for inspection purposes. (We) agree to save
uxlewniP, and keep harmless the City of Cupertino against liabilities, judgments,
nst<. and expenses which may accrue against said City in consequence of the
"Taotin , ,f this permit. Additionally, the applicant understands and will comply
Mill ail non -poi t source regul ext pe the Cupertino Municipal Code, Section
Swnature DateIF to
U
❑ -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
L as owner of the property, or my employees with wages as their sole compensation,
wdl 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, 1
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
nify and keep harmless the City of Cupertino against liabilities, judgments,
Old expenses which may accrue against said City in consequence of the
gi-iting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
O19
681 E BROKAW RD
DATE ISSUED:08/31/2011
SAN JOSE, CA 95112 1 PHONE NO: (408) 898-6474
BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB r
MECH - RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: SFWL ADDITION, 108 SF, ADD MASTER BATH AND
CLOSET,
REMODEL HALL 60 FT
Sq. Ft Floor Area: I Valuation: $18000
APN Number: 32645021.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b ...... ... .. Date:
RE -ROOFS:
All roof's 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
1 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 1 will
maintain compy ce with the Cupertino Municipal Code, Chapter 9.12 and the
Hea"Or-a-
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
ARCHITECT'S DECLARATION
--— I understtumd my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
Fm--7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10405 mann dr.
DATE: 07/25/2011
REVIEWED BY: bobs.
im
APN:
BP#:
"VALUATION: $18,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: P
2nd Unit? Yes No
OTC? 0 Yes O No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
sfd add master bath and closet remodel hall.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
108
$994.00
IADDPLCK
$963.00
IADDINSP
TOTALS:
108
$994.00
$963.00
MECH, HOURLY Yes 0 No PLUMB, HOURLY 0 Yes (Q No ELEC, HOURLY 0 Yes 0 No
lxe, _
NOTE_ Those fees are hated an the nroliminary infnrmatian availahlo and are nnly an PetimalP. Cantart the DPW far addn'l infn_
FEE ITEMS (!ee Resolution 11-053 h; . 7/1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$963.00
Suppl. Insp. Fee-0 Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes (E) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$14.04
Select a Non -Residential
Building or Structure
0
0
Strom; Motion Fee:
IBSEISMICR
$1.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1,973.84
$0.00
TOTAL FEE:
$1,973.84
Revised: 07/04/2011