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11080034CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10565 SAN LEANDRO AVE CONTRACTOR: PROFESSIONAL PERMIT NO: 11080034 CONSTRUCTION AND OWNER'S NAME: SAN JOSE, CA 95128 PHONE NO: (408) 455-2999 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r 'd `U � �7— -7 -2-> License Class Lic. # F F r— Contractor (YU C)D 1r Date MECH RESIDENTIAL COMMERCIAL I hereby affirm that I aro licensed under the provisions of Chapter 9 JOB DESCRIPTION: CONSTRUCT NEW OUTDOOR KITCHEN WITH NEW (commencing with Section 7000) of Division 3 of the Business & Professions TRELLIS,RE-STUCCO ENTIRE EXISTING Code and that my license is in full force and effect. SFDWL(3,060SQFT) I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $50000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35705058.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ✓ DateZ • 1 • 2 pl' 77 / "�� Issued by: Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I aro exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed. if a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should 1 store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, l shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l mu0 GHe& forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional r--7m CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 10565 san leandro ave. DATE: 08/03/2011 REVIEWED BY: bobs. - APN: BP#: 'VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: -7 PENTAMATION 1GENRES PERMIT TYPE: WORK construct new outdoor kitchen with new trellis re -stucco entire exisiting sfd. SCOPE EEO s.f. Restucco $688.00 ISTUCOAPP NOTE. These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 1I-053 £; '. 7/1111) FEE Plumb. Plan Check 0.0 hrs $0.00 Elea Plan Check 1 0.0hrs $0.00 - Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT i ,11wi' Alo. 4. 174 -qt .. Other Plumb Insp. 0.0 �hrs$44.00 Other Elec. Insp. 0.0 hrs $44.00 Suppl. PC Fee: e) Reg. OT 0.0 1 hrs NOTE. These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 1I-053 £; '. 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $914.00 Covered Porch ICOVPORCH Suppl. PC Fee: e) Reg. OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 EEO s.f. Restucco $688.00 ISTUCOAPP Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. OT 0.0 hrs $0.00 0 # Plumbing $44.00 IPREPPIPE Piping, Drainage PME Unit Fee: $0.00 PME Permit Fee: $88.00 5 7# $44.00 Electrical IBREM ECEP Recep/Switch/Outlets C. `rirt tr uriv>r lir* Acoustical Fee: 0 Yes (F) No $0.00 Q E) Work Without Permit? 0 Yes •: No $0.00 Piannin Fee: $0.00 Select a Non -Residential Building or Structure 0 0 A Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISAfICR $5.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $139.001$1,690.00 TOTAL FEE: $1,829.00 Revised: 07/04/2011