11100153CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10074 E ESTATES DR
CONTRACTOR: PROVISION
PERMIT NO: 11100153
DEVELOPMENT, INC.
OWNER'S NANIE:
SUNNYVALE, CA 94086
PHONE NO: (408)245-0991
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT F,
PLUMB I
License Class Lic.#
( TJ
MECH RESIDENTIAL COMMERCIAL {
Contractor Date
JOB DESCRIPTION: SMILING HOUSE RESTAURANT- INSTALL ONE PREP
I hereby affirm that I am licensed under the provisions of Chapter 9
SINK
(commencing with Section 7000) of Division 3 of the Business & Professions
ONLY
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
(/
Sq, Ft Floor Area:
Valuation: $350
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36906005.10074
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
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.
Issued by: Date:
Signature Date
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being 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:
HAZARDOUS MATERIALS DISCLOSURE
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
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 &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
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, I 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
Health & 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, I must
Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I 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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10074 e. estates dr.
FEE ID
DATE: 10/20/2011
REVIEWED BY: bobs.
1191 APN:
I BP#:
—TPLAN
*VALUATION: 1$350
'PERMIT TYPE: Plumbing Permit
IBPFIXTURE
CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
#
PENTAMATION I CPFIX
PERMIT TYPE:
WORK
[install one prep sink only.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Plumb, Plan Check 1 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
Fixture set on One Trap
IBPFIXTURE
F
1
#
$9
Pcrm,it F*<:;'.,
PME Unit Fee:
$9.00
PME Permit Fee:
$44.00
Administrative Fee: JADWN
$41.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
F
Travel Documentation Fee: ITRAVDOC
$9.001
Strong Motion Fee: IBSEISAffCO
]VOYE: 771is estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the nrefininary information availahle and are M11V 1711 ONHM"YO- (MIMI-1 MO 1)17171 ;1JfA
FEE ITEMS (lee Resohition 11-053 Eff V/J/
j]
I
FEE
Plumb, Plan Check 1 0.0 1 hrs $0.00
MISC ITEMS
Plumb. Permit Fee: ippERMT
77;..11P( '.F(."(.,
Other Plumb Insp. F0.70Fhrs ] $44.00
F
Taw". P(11(11"
PME Plan Check:
eo.
]VOYE: 771is estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the nrefininary information availahle and are M11V 1711 ONHM"YO- (MIMI-1 MO 1)17171 ;1JfA
FEE ITEMS (lee Resohition 11-053 Eff V/J/
j]
I
FEE
QTY/FEE
MISC ITEMS
77;..11P( '.F(."(.,
PME Plan Check:
$0.00
Pcrm,it F*<:;'.,
PME Unit Fee:
$9.00
PME Permit Fee:
$44.00
Administrative Fee: JADWN
$41.00
Work Without Permit? 0 Yes 0 No
$0.00
11fJl , 1,011VIlf
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee: IBSEISAffCO
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$139.50 :
$0.400 TOTAL FEE:
$139.501
Revised: 10/01/2011