12040042It"�
CITY OF CUPERTINO BUILDING PERM
BUILDING ADDRESS: 7413 STANFORD PL
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date
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
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. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
❑ 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.
`" Date << j
CONTRACTOR: CLIFF W COUEY'-' _ '_"` PERMIT NO: 12040042
CONSTRUCTION
7608 WATERFORD DR DATE ISSUED: 05/04/2012
CUPERTINO, CA 95014 PHONE NO: (408)252-0753
BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL 1-
JOB DESCRIPTION: CONSTRUCT A 307 SQ FT ONE-STORY ADDITION WITH A
355 SQ FT OF REMODEL.
9/24/2012-REV#1 - EXTENSION OF GAS LINE TO RUN BBQ-
ISS'D 9/24/2012
Sq. Ft Floor Area: I Valuation: $61000
APN Number: 35932031.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAS,lT� CALLED INSPECTION.
Issued by:
�' e�� Date: ✓ .:
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
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
:Date:O^ j
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nnork'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
I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 7413 STANFORD PL I CON TR CT ON CLIFF W COUEY I PERMIT NO: 12040042
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 1 tBC—
(� _ Lie. # S4,
Contractor �� �� Date c) q Z-�l
I hereby affirm that I am licensed th er 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
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. Additionally, the applicant understands and will comply
with all non -point source regulations Per the Cupertino Municipal Code, Section
9.18.
r1t
® x® J ---Vf
❑ 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.
7608 WATERFORD DR DATE ISSUED: 05/04/2012
CUPERTINO, CA 95014 PHONE NO: (408)252-0753
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
CONSTRUCT A 307 SQ FT ONE-STORY ADDITION WITH A
355 SQ FT OF REMODEL.
Sq. Ft Floor Area: I Valuation: $60000
APN Number: 35932031.00 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:
RE,E-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
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 contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 255 5,3, and 25534.
"
Owner or authorized agent: Date:'
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date
RM��� CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
iaADDRESS:
*
7413 Stanford Place
DATE: 09/24/2012
REVIEWED BY: Sean
APN:
BP#: I /- 6 i"�
*VALUATION: j$1,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 RPGA
PERMIT TYPE:
WORK
Extension of gas line to run BBQ.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Piping, Gas <=4 Outlets
1PGASRES
1
#
$67
TOTALS:
$67.00
il,lcch. Play Check
Plumb. Plan Check 0.0 hrs $0.00
Elec. Plan Check
Lfech, Perntir Fee:
Plumb. Permit Fee: IPPERMIT
l le:c. Permit Fee:
Other 11lezh. hasp.
Other Plumb Insp. 0.0 hrs $45.00
other E/ec. hasp. ET
Hech. Lisp. Fee:
Phu ih. hiq). Fee:
Elec. Lisp, Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ Thece fees are haced on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef . 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek Fee:
Suppl. PC Fee.
PME Plan Check:
$0.00
Permit Fec .
Suppl. Lisp Fee
PME Unit Fee:
$67.00
PME Permit Fee:
$45.00
Consil•uction Tax:
r
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? Yes (j) No
$0.00
Advanced Plamring Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
r d�
t 4, ,
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$200.50
$0.00 TOTAL FEE:
1 yq*
Revised: 07/01 /2012