13090212I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20085 CEDAR TREE LN I CONTRACTOR: AC CONSTRUCTION PERMIT NO: 13090212
OWNER'S NAME: GARRETT WADE I PO BOX 51302 1 DATE ISSUED: 09/26/2013 I
OWNER'S PHONE: 4086912427 1 SAN JOSE, CA 95151 I PHONE NO: (408) 422-4260
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # croq ffL
Contractor 0--0 i%( Ate x) C (ic/aI Datel6-4731—
I hereby affirm that I am licensed under the provisro s 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. Add' onally, the applicant understands and will comply
with all non -point source ratio r the Cupertino Municipal Code, Section
9.18. //
Signature
❑ 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.
Signature Date
BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r—
MECH r-, RESIDENTIAL r_. COMMERCIAL F
JOB DESCRIPTION: REPIPE INTERIOR, REWIRE, ADD HARD WIRED
SMOKE/CO2
DETECTORS
Sq. Ft Floor Area: I Valuation: $12000
APN Number: 31634604.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: -Date: Date: i
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
s,s
contaminants as d' med`'by the Bay Area Air Quality Management District I will
maintain complia ce. ' h the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety o;., ;,, _ections.25505, 25533, and 25534.
Owner or an red ge 2
Date: J
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildin-ga-cupertino.org
"LING ❑ MECHANICAL ELECTRICAL ❑ MISCELLANEOUS
MEP
MISC
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PROJECT ADDRESS .-� ^ V 5 / r "Pok
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APN #
OWNER NAME
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E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
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PHONE„ O
EMAIL _ /f /� 02
STREET ADDRESS. /i /� y�4`i/y•`r"•('
CITY, STATE, ZIP
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7ENGINEER T❑
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ►srCONTRACIOR ❑ CONTRACTOR AGENT ARCHITECT ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENS NUMB R
F—LICENSETNA,d
BUS. LIC 9
w v�
COMPANY NAME / Q_ _ e �t
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WII-DLAND ❑YES
PROJECT IN
YES
IS THE BLDG AN YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE
❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
• t—
TOTAL VALUATION:
R1 CEIVED$Y ��'
Cl
By my signature below, I certif-to each of the follow' g: I am the property owner or authorized agent to act on the property ownes behalf. I have read this
application and the information I have provided is c ec ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building con c ' n. authorize representatives of Cupertino to enter the above -i ntified roperty for inspection purposes.
Signature of Applicant/Agent: Date:
2.
SUPPLE ME ORMATION REQUIRED
N
_ DyER T, HE CO[1 IW -01M
STAND �
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MEPMiscApp_2011.doc revised 06/21/11
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#a'•w 46 x,h_ bJa �_ y,,�"4t%"
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FEE ESTIMATOR
VV1 .-•1_1 iiv
- BUILDING DIVISION
.RE
v "... ..3 f«. Sew .'—.=" e V ail {-hi �" ".
Elec. Plan Check 0.0 hrs $0.00
�19ectF. Plan ('heck
ADDRESS: 20085 cedar tree lane
DATE: 09/26/2013
REVIEWED BY: larrys
;Uech. Insh.
[eh.
APN: BP#:
0.0hrs $47.00Other
*VALUATION: $12,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Duplex
P
$0.00
PENTAMATION 1REAP7
USE:
Permit Fee:
$0.00
PERMIT TYPE:
WORK
1
r
SCOPE
S ,Ci C
PME Unit Fee:
$0.00
#a'•w 46 x,h_ bJa �_ y,,�"4t%"
Plumb. Plan Check
�'
0.0hrs $0.00
.RE
v "... ..3 f«. Sew .'—.=" e V ail {-hi �" ".
Elec. Plan Check 0.0 hrs $0.00
�19ectF. Plan ('heck
;tlech. Perr)rit Fee.:
Plumb. Permit Fee: 1PPERMIT
Elec. Permit Fee: IEPERMIT
;Uech. Insh.
[eh.
Other Plumb Insp.
0.0hrs $47.00Other
Elea 0.0 Insp. hrs $47.00
Insp. Fee:
Plunih. hap. Fee:
$0.00
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, Fire, Sanitary newer visrrict, acnoor
T:..t..:nf nsn Th— foot nro hnaod ns tho nroliminaru informntian availahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$139.00
Electrical
IBREMMISC I Conductors
Suppl. PC Fee: E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F 1-1 #
$14.00
Plumbing
IPRREPIPE Re -Pipe Interior
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
Construction Tax:
Administrative Fee: IADMIN
$44.00
0
0
Work Without Permit? ® Yes iq No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
1
0
0
Travel Documentation Fee: ITRAYDOC
$47.00
Strong Motion Fee: IBSEISMICR
$1.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
4=O,
$187.20
$153.00
� „ ��p
$340.20
Revised: 08/01/2013