Loading...
11040064CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21168 HAZELBROOK DR CONTRACTOR: JOHN MANSCH CONST PERMIT NO: 11040064 OWNER'S NAME: 245 FOX ST DATE ISSUED: 04/11/201 1 OWNER'S PHONE: KINGS BEACH, CA 96I43 PHONE NO: (530)546-8333 ❑ LICENSED CONTRACTOR'S DECLARATION r r ELECT r �_ �T) @— BUILDING PERMIT INFO: BLDG PLUMB License Class ` Lic. N l r r r p m\1 SC MECH RESIDENTIAL COMMERCIAL Contractor �S��h1 "x Date 1 hereby affirm that I am licensed under the provision of hapter 9 JOB DESCRIPTION: SFD KITCHEN REMODEL, ADD 6 CAN LIGHTS AND WALL (commencing with Section 7000) of Division 3 of the Business & Professions SWITCH IN LIVING ROOM 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. Sq. Ft Floor Area: Valuation: $16000 I have and will maintain Worker's Compensation Insurance, as provided fo by Section 3700 of the Labor Code, for the performance of the work for is permit is issued. APN Number: 32655026.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses whi may ac rue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting o penni Addition ly, the applicant understands and will comply with all n-po t sou ce regula 'ons per the Cupertino Municipal Code, Section 9.18. Issued b� ate: Signature Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereb of. . m that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the foil wi two reasons: inspection. I, as owner f the roe property, rty, 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, Signature of Applicant: Date: Business & Professions Code) 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 I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by 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 uditionall oul use equipment or devices which emit hazardous air permit is issued. contamin is as deft ed by Area Air Quality Management District 1 will maintain/lomplian9k wthe Cuper o Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, I shall ItIt Safety Code Sections 25505, 5533, and 25534. 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 Own `rized agent: become subject to the Worker's Compensation provisions of the Labor Code, I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LEN ING AGENCY APPLICANT CERTIFICATION I reby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date FEWN CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: �� (� } DATE: 04/11/2011 REVIEWED BY: BG/TC/BS APN: Oa-(-p BP#: 00 (�p "VALUATION: 1$16,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK sfd kitchen remodel add lights at dining room SCOPE ... Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT LiOther Elec. Insp. 0.0 hrs $42.00 w,:"h Inv? 1. c"! it i . Irr r cc{,. NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 09-051 F.. 7/1110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 168 s.f. $570.00 Remodel, Kitchen (<=300 sf) /REMRESKIT Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 0 $42.00 Electrical IBREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee,O Reg. 0 OT 0.0 hrs $0.00 © Electrical $63.00 IBREMFIA7 Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $42.00 Couslr^rtc.11(m Tat Acoustical Fee: 0 Yes (E) No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $1.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $86.60 $675.00 TOTAL FEE: 1 $761,60 Revised: 01 /15/2011 I