14120013 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1160 SCOTLAND DR CONTRACTOR:CELTIC CONSTRUCTION PERMIT NO: 14120013
OWNER'S NAME: HARDEE PETER G AND FRANCES J TRUSTE 1094 HUNTERSTON PL DATE ISSUED: 12/02/2014
O NER'S PHONE: 4088915878 CUPERTINO,CA 95014 PHONE NO:(408)973-1224
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
REMOVE(E)MASONRY FIREPLACE,REPLACE WITH
License ClassLic.# �j g7 'Fa WOOD
Contractor �yrJb��/tutf7u,/Date !d/g((y FACADE AND INSTALL(N)GAS INSERT
1 hereby affirm that 1 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.
hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$6000
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
APN Number:36228007.00 Occupancy Type:
permit is issued.
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 WITAI DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save AYS A ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Z (�
granting of this mi Additionally,the applicant understands and will comply I y: Date:
with all non- int so ce regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature 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
:
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of ApplicantDate:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
1,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
1 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
1 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 th ay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with a upertiL5533,
icipat Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S do 25 05,2and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:l�
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 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 sliall 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
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 1160 SCOTLAND DR DATE: 1 210 21201 4 REVIEWED BY: MELISSA
APN: 362 28 007 BP#: VALUATION: 1$6,000
"'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK REMOVE E MASONRY FIREPLACE REPLACE WITH WOOD FACADE AND INSTALL N GAS
SCOPE INSERT
Plumb.Plan Check0.0 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $48.00Lj
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS LFee Resolution 11-053 yf 7/l/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes (F) No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00 1 1 # Plumbing
Permit Fee: Hourly Only? C)Yes Q No $0.00 $72.00 IPGASRES Piping,Gas<=4 Outlets
Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 0 # Chimney/Chimney Repair
PME Unit Fee: $0.00 $574.00 1CHIMNEYR Chimney Repair
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00 0
Work Without Permit? 0 Yes (j) No $0.00
Advanced Plannin Fee: $0.00 Select allon-Residential
Travel Documentation Fee: ITRAVDOC $48.00 Building or Structure
Strong Motion Fee: IBSEISMICR $0.78 1.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $143.00 ISTINSP Inspection, Hourly
SUBTOTALS: $142.78 $932.00 TOTAL FEE: $1,074.78
Revised: 10/01/2014