Loading...
09020001CITY OF CUPERTllvO BUILDING DIVISION PERMIT C�1'�TRfT�t PERMIT NO. BUILDING ADDRESS: _ _ _ _ OWNER'S NAME: ARCHITECT/ENGINEER: Z p p LICENSED CONTRACCOR'S DECLARATION U) I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is n y in full form and effect. ? License Class Contractor ontractor t p ARCHITECTS DECLARATION ee I understand my plans shall be used as public records ?LU .4. y Licensed Professional 0, OWNER -BUILDER DECLARATION 2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the a O following reason. (Section 7031.5, Business and Professions Code: Any city or county K m which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Yhs (commencing with Section 7000) of Division 3 of the Business and Professions Code) or y3 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of trot more than five hundred dollars (5500)- 0 1, as owner or 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contracto's License Law. 0 I am exempt under Sec. B & P C for this reason Owner. Date y.. % OJT vti-�e�! t?r,_ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0O Z f1, G aZ UO w F. 0U U I have and will maintain a Certificate of Consent to self -insure for worker's Compen- ...cion, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. —1 I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, fru the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: -artier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE L PERMIT ISSUE DATE Job Description CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB MECH TUB RMS,"L & RPLC FIBERGLS & NEW TOILT & SINK (This section need not be completed if the permit is far one hundred dollars ($100) or less) 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 W rkers'Compimisation Laws of California Applicant _, JJCCI) NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 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 concoction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes (We) agree to saw, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGUL ONS. i _ �� a Signature or Applicant/Contractor t� Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0 Yes l�lvo Will the applicant or future building occupant use equipment or devices which t hazardous air contaminants as defined by the Bay Area Air Quality Management strict? 0 Yes �Nu 1 have mad the hazardous materials mquimments under Chapter 6.95 of the Califor- nia Health & Safety Code. Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must mel poor W issuance of a Ccrtif�te Qf Occupancy. Owner or authorized agent Date Sq. Ft. Floor Area 32635052.00 Issued t Re -roof Type of Roof 200 Occupancy Type Required Inspections All root's shall be inspected prior to any roofing material being installed. If a roo : is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class " , or better Date CITY OF CUPEkTINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPIJCATION FORM APN # oz 35 Date: a % a J 1 Building Address: Mailing Address (if different from building address': Owner's Name: TO + t, (i Phone # �lb$L�lS Zy Contractor: Phone #: S a.m\.k Fax #: Contractor License #: Cupertino Business License #: Contact: (,-6(, _J L Phone #: o VC Fax #: Building Permit Info: Bldg. ❑ Elect. ❑ Plumb.�. ' Mech. ❑ Hillside ❑ Job Description: Addition -What is being added? (Be Specific): \; o Pv e_ What is being remodeled (not including addition)? Tu 8 R,,m c vcJ f- %1�(� t(�@� e n Q r � 1Q S S t� P ;,,, ft k i e,+ + S j n k. Remodel Includes Re -Roof: Yes ❑ NojSa If yes list number of squares Remodel Includes Structural: Yes ❑ NoTIR Do you have the pre -application planning approval? Yes ❑ No S If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: _ Garage: Detached Attached Remodel: Kitchen Bath Y Other Type of Construction (Usage Class): Occupancy' /Type: V A 1-A, I -B ❑ II/III/V-A ❑ II/III B, IV -HT, V-13 tz Valuation: Please check this box if the project is a second -story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: 1 include in plan set & the sheet index. ***For Office Use Only*** ElRevised 01/07/09 Over -the -Counter CITY OF CUPERTINO ADDITO:v/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood) -Each B (Each) 1 DECKRAIL Deck Railing- Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up ti) 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame ip to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Me -:al up to 300 B SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered -Each B (Each) REMODELS 1R3SFDREM - 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check �s- ' 1REMRESBAT Bath Remodel up to 300 SF B 44 1REMREOTH Other Remodel up to 300 B " SF CITY OF CUPERTINO ADDITOINMEMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1MECPLNCK Stand Alone Mechanical Pln Ck (hourl y M 1PLMPLNCK Stand Alone I'lumbing Pln Ck (hourly) P 1BCBSC Cal Bldg Star. dards Commission I-ee B ALL PERMIT TYPES l 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel & Doc umentation B 1 BUSLIC Business License B