Loading...
11070117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22085 LINDA VISTA PL CONTRACTOR: JAMES E & NANCY T PERMIT NO: 11070117 NEAR OWNER'S CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. !1 MECH r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BATHROOM REMODEL(54SQFT)-REMOVE (commencing with Section 7000) of Division 3 of the Business & Professions BATHTUB,TOILET,SINK& CABINETS &INSTALL WALK-IN Code and that my license is in full force and effect. TILE SHOWER, SINK, CABINETS, NEW TOILET, REWIRE I hereby affirm under penalty of perjury one of the following two declarations: l 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. Signature Date OWNER -BUILDER DECLARATION Xlhereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). rn I hereby affirm under penalty of perjury one of the following three V( declarations: I have and will maintain a Certificate of Consent to self -insure for Work '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. Signature Sq. Ft Floor Area: I Valuation: $20000 APN Number: 35608014.00 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 -ROOFS: AI I roofs shall I be inspected prior to any roofing material being instal led. 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: / I a� 0 I I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Mork'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 CITY OF CUPERTINO F-M-7- FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22085 linda vista DATE: 07/18/2011 REVIEWED BY: larry s APN: BP#: "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex USE: p 2nd Unit? Yes ' No OTC? 0 Yes 0 No PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK bathroom remodel less than 300 sq ft SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No � cc:j1u,"'.h. I ;.rr �, f-<'c+: NOTE: These fees are based on the prelindnary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Rff 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 54 s.f. $588.00 Remodel, Bath (<=300 so IREMRESBAT Suppl. PC Fee: 0 Reg. © OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT J 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construc: iuh Ta'. Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? C) Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i (i, el 0o"117nr:w'11iu;1 1 "ce" Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SU13TOTALS: $3.00 $588.00 TOTAL FEE: $591.00 Revised: 07/04/2011