15030042CITY OF CUPERTINO BUILDING PERNIIT
BUILDING ADDRESS: 10784 JOHNSON AVE
CONTRACTOR: TITAN GENERAL
PERMIT NO: 15030042
CONSTRUCTION
OWNER'S NAME:
FREMONT, CA 94539
PHONE NO: (408) 883-8668
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL E]9
0-
CONSTRUCT 2 STORY SFDWL LIVING AREA (2663 SQFT);
License Class_ Lic. #7nn
ATTACHED GARAGE (420 SQ FT); PORCH/CARPORT (827
ContractoII [ L/Jg Date
SQFT)
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
Sq. Ft Floor Area:
Valuation: $580000
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.
APN Number: 37531003.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 YS FROM LAST CALLED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
l
5.
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date: e
with all non -poi rce re ons per the Cupertino Municipal Code, Section
9.18.
Z
Signature
RE -ROOFS:
Date ® r (
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.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectier , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent`~ Date:
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
ORE���� CITY OF CUPERTINO
FFF. FSTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10784 johnson ave
DATE: 03/06/2015
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#: 50,=:W
*VALUATION: $580,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: SFD or Duplex
2nd Unit? 0 Yes No
PENTAMATION 1 R3SFDW
PERMIT TYPE: i
WORK
construct 2 story sfdwl living area 2663 sq ft); attached garage 420 sq ft porch/carport 827 sq ft
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,111-B,IV,V-B
3,910
$3,273.15
IR3PLNCK
$3,488.45
1RMNSP
.$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,488.45
Suppl. Insp. Fee -(E) Reg. () OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
3,910
$3,273.15
.='
$3,488.45
# new
units
NOTE: This estimate does not include fees due to other Departments (Le. riammng, ruouc worics, rlre, aurucury Jervcr Liwu wy ua rsvv�
:inRty -4 nHIV On nct;math_ Cawact the Dent for addn'1 info.
LILSLrsut, GL(:. . Lri GJG luua ",/ IJUJGu V c
FEE ITEMS (Fee Resolution 11-053 Ef. . 7/1/13)
Xfech. Plan C.'heck
Phuttb. Plan Check
Elec. Plan Check
-Ilech. Penni! Fee:
Plumb. Permi7 Fee:Elec.
Permit Fee:
of/ter ,1/ec•h. Insp.ED-L-
Other Phcnsb Insp.E]_L_
Other Elec. Insp. Li
Wech. hasp. Fee:
Phunh. hlsp. 1•ee
Elec. Insp, h'ee:
hrs
.$0.00
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (Le. riammng, ruouc worics, rlre, aurucury Jervcr Liwu wy ua rsvv�
:inRty -4 nHIV On nct;math_ Cawact the Dent for addn'1 info.
LILSLrsut, GL(:. . Lri GJG luua ",/ IJUJGu V c
FEE ITEMS (Fee Resolution 11-053 Ef. . 7/1/13)
FEE
-- - -
QTY/FEE
___ ----
MISC ITEMS
Plan Check Fee:
$3,273.15
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
.$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,488.45
Suppl. Insp. Fee -(E) Reg. () OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXR1
# new
units
$670.76
Administrative Fee:
0
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee: IPLLONGR
$547.40
Select a Non -Residential
Building or Structure
0
0
A
Tnn;el Docurnentathni fees:
Strong Motion Fee: IBSEISMICR
$75.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$24.00
4.s
._ .
79.16 $8,0sBoAL$8,079.1
r%evisea: uu t4iw 16