11040154CITY OF CUPERTINO BUILDING PERMIT -1
BUILDING ADDRE SS: 11091 BUBB RD I CONTRACTOR: STONEPEAK I PERMIT NO: 11040154 1
OWNER' S NAME: 1 106 MERCURY WAY I DATE ISSUE D: 04/21/2011 1
OWNER'S PHONE: 9255229697 1 PLEASANT HILL, CA 94523 1 PHONE NO: (925) 787-8758 1
LICENSED CONTRACTOR'S DECLARATION
License Class Lic.# qZ_5 7Z_,4
Contractor
the provisionsof 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. _V__
APPLICANT CERTIFICATION
f 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 Datct� �1241 1
11 OWNER -BUILDER DECLARATION
I hereby 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm tinder 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 tile
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.
BUILDING PERMIT ]INFO: BLDG I— ELECT r PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: ADD ADDITIONAL 10SQ FT TO KITCHEN, MODIFY
EXISTING
GARAGE, RELOCATE FURNACE AT GARAGE LOCATION
Sq. Ft Floor Area: I Valuation: $4000
APN Number: 35620003.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued tt-y_"�' 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
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE'
I have read the hazardous materials requirements tinder Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Codi, 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.
Owner or
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of NAork'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.
Date I Licensed
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
19a
ADDRESS: 11091 bubb rd.
DATE: 04/21/2011
REVIEWED BY: bobs.
F7- T
APN: ___F
BP#:
"VALUATION: 1$4,000 I
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
1 0.0
PENTAMATION 1GENRES
PERMIT TYPE: A
woRK I
add additional 10 sq ft to kitchen, modify existing garage, r locate furnace at garage location.
SCOPEF_
NOTE. These fees are based on the prelindnary information available and are onlv an estlinate. Contact the Dept for addnl info.
FEE ITEMS (Fee Resolytioli 09-051 Eff, 711110)
FEE
QTY/FEE
I
F7- T
Plan Check Fee: Hourly Only? 0 Yes E) No
E3
hours Plan Check, Hourly
$252.001 isTPLNcK I
Li I
Suppl. PC Fee: E) Reg. 0 OT
1 0.0
1 hrs
NOTE. These fees are based on the prelindnary information available and are onlv an estlinate. Contact the Dept for addnl info.
FEE ITEMS (Fee Resolytioli 09-051 Eff, 711110)
FEE
QTY/FEE
I
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No
$0.00
hours Plan Check, Hourly
$252.001 isTPLNcK I
Suppl. PC Fee: E) Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feel@ Reg. 0 OT
10,61
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TaX
Acoustical Fee: 0 Yes (D No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Platming-ftL
$0.00
Select a Non -Residential
Building or Structure
0
0
Strong Motion Fee: IBSEISAffCR
$0.50
hrs Inspections
$630.00 IINSPMS Standard Inspections
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALST
$1,501
$882.00
TOTAL FEE��.50
Revised: 04/01/2011