12030081COVERSHEET
12030081-D
20912 FARGO DR
PERMIT #
PROJECT
ADDRESS
,(t
DATE
APN#�i-3 (GARAGE)
COMM. SQ. Fr. 0MW) T.I. SQ.FT.
CONTACT c� e �v � PHONE# ?Y -E /0IP— PAX
VALUATI,O
�N (Cost of Project) � �Q
NOTES: ,T/ / -/yf7%
REQD. PAID
CONSTRUCTION TAX (Y) (N)
SCHOOL FESS (Y) (N)
HOUSING NMG (Y) (N)
HEART OF THE CITY (Y) (N)
ISSUED BY DATE TOTAL FEES �S �'
la.
JA iggall MWp
ffAL
MAW
APN#�i-3 (GARAGE)
COMM. SQ. Fr. 0MW) T.I. SQ.FT.
CONTACT c� e �v � PHONE# ?Y -E /0IP— PAX
VALUATI,O
�N (Cost of Project) � �Q
NOTES: ,T/ / -/yf7%
REQD. PAID
CONSTRUCTION TAX (Y) (N)
SCHOOL FESS (Y) (N)
HOUSING NMG (Y) (N)
HEART OF THE CITY (Y) (N)
ISSUED BY DATE TOTAL FEES �S �'
la.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20912 FARGO DR CONTRACTOR: STRAIGHT LINE PERMIT NO: 12030081
CONSTRUCTION
OWNER'S NAME:
SAN JOSE, CA 95112 PHONE NO: (408)441-9660
❑ LICENSED /'
CONTRACTOR'S DECLARATION
License Class Lic. N�t✓(1 z2/ �`p r
Contractor raCy to' �t�nt."Ise Z'-3nr-/2
1 hereby affirm that I am licensed under the provisions of 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.
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 pe it. Additionally, the applicant and [ands and will comply
with all non-po urce regulations p Cu mo unicipal Code, Section
9.18.
Signature_ �
❑ 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 under 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 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. d
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 F ELECT F PLUMB r
MECH r RESIDENTIAL r— COMMERCIAL i
JOB DESCRLPTION: DETACHED 2ND UNIT (494 SQ FT 487 SQT, PORCH 7
SQFT.
Sq. Ft Floor Area: Valuation: 545000
APN Number: 326301.14.20912 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:
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 Appi
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) 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 & CJafety Code, Sections 2M05, 255339 and 25534.
L
AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork'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.
Date I Licensed
t7
NF%72
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 209 fargo dr.
DATE: 03/16/2012
REVIEWED BY: bobs.
PC FEE ID
APN:
BP#: Qs
"VALUATION: 1$45,000
' PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes No
PENTAMATION 1 R3SFD2ND
PERMIT TYPE:
WORK
construct new 1 story secondary detached unit.
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,111-B,IV,V-B
487
$2,420.00
IR3PLNCK
$1,519.00
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,519.00
Suppl. Insp. Feel@ Reg.
Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
487
$2,420.00
$1,519.00;
777777
`'::
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc-). These fees are hated on the nroHninary information available and are nn1v an eslimale rnnlafl yhe Deny for addn I info_
FEE ITEMS (Fee Resolution 11-053 L . 7/1,111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,420.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: E) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,519.00
Suppl. Insp. Feel@ Reg.
Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruction Tax: IBCONSTAXR
1
# new
units
$583.80
0
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannine Fee:
PLLONGRNGR
$63.31
Select a Non -Residential
Building or Structure
Q
Strong Motion Fee:
IBSEISMICR
$4.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
[7B'4?►Tr
$4,592.61
$0.00
TQTAL FSE:
$4,592.61
Revised: 1/19/2012