Loading...
10090232CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10313 E ESTATES DR CONTRACTOR: SPECIALIZED PERMIT NO: 10090232 RENOVATIONS, INC OWNER'S NAME: BEN LOMOND, CA 95005 PHONE NO: (831) 336-5980 ❑ LICENSED CONTRACTOR'S DECLARATIONk BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # l..0 41LJjate q ? 410 MECH RESIDENTIAL COMMERCIAL ContractorIAt /WV"t/A- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: KITCHEN REMODEL,NON-STRUCTURAL MOVING NON (commencing with Section 7000) of Division 3 of the Business & Professions LOAD HEARING REPLACE 2 WINDOWS AT FAMILY Code and that my license is in full force and effect. A ROOM, SERRVICEAKE UPGRADE, ELECTRICAL LIGHTING IN 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 Sq. Ft Floor Area: Valuation: $59075 permit is issued. APPLICANT CERTIFICATION APN Number: 36908015.00 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations pert Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. / Signature Date u I Issued b Dater ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property—,din exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. Owne or autho 'zed ent: Date: / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address 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. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEW FEE ESTIMATOR - BUILDING DIVISION imADDRESS: -z r. DATE: REVIEWED BY: �� �i'- °• - l APN: BP#: `VALUATION: 1$59,075 APERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P ;; PENTAMATION 1GENRES PERMIT TYPE: WORK PME Plan Check: SCOPE # $380.00 NOTE: These fees are based on the preliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (1,ee Resolution 09-05I Eff "1;'102 -z r. QTY/FEE Elec. Plan Check 0.0 1 hrs $0.00 �� �i'- °• - Plan Check Fee: Elec. Permit Fee: IEPERMIT 1 150 s.f. $570.00 Li T_ Other Elec. Insp. 0.0 hrs $42.00 Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs NOTE: These fees are based on the preliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (1,ee Resolution 09-05I Eff "1;'102 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 150 s.f. $570.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 # $380.00 Window / Sliding Glass Door I WINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee Reg. 0 OT 0.0 hrs $0.00 0 amps $42.00 Electrical IERT<200 Services PME Unit Fee: $0.00 PME Permit Fee: $42.00 20 # $63.00 Electrical IBREMFIXT Fixtures, Lighting Acoustical Fee: Yes 10 No $0.00 Work Without Permit? © Yes E) No $0.00 Planning Fee: $0.00 Select a Non -Residential BuSt t Building or Structure � Travel Documentation Fee: 1TRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $5.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $92.91 $1,055.00 TOTAL FEE: $1,147.91 Revised: 9/22/2010