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10120122CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6783 CLIFFORD DR I CONTRACTOR: MCCLELLAN I PERMIT NO: 10120122 I OWNER'S NAME: BLANEY VENTURE LLC 11448 ENTRADA VERDE PL I DATE ISSUED: 03/10/201 1 1 OWNER'S PHONE: 9259449108 1 ALAMO, CA 94507 I PHONE NO: (925) 944-9108 I ❑ LICENSED CONTRACTOR'S DECLARATIONS License Class Lic. # ffne Contractor oZli 6y. Date I 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 permit. Additionally, the applicant understands and will comply with all non -point source r lations per the Cupertino Municipal Code, Section 9.18. Signature Date O I/ ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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. 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. r r- r BUILDING PERMIT INFO: BLDG ELECT PLUMB r r- r MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: LOT 4-CONSTRUCT 2 STORY 2,881 SQ FT SFDWL W/ ATTACHED 456 SQ FT GARAGE(ADDR CHANGED FROM 790 S BLANEY) Sq. Ft Floor Area: I Valuation: $333700 I APN Number: 36911064.00 I Occupancy Type: I 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, 1 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. 1 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, Sectio 25505, 25533, and 25534. Owner or authorized agent: Date: ro4L CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional Date CITY OF CUPERTINO BUILDING PEI[H' ' ' BUILDING ADDRESS: 6783 CLIFFORD DR OWNER'S NAME: BLANEY VENTURE LLC OWNER'S PHONE: 9259449108 ❑ LICENSED CONTRACTOR'S DECLARATION License Class ^ ) Lic. # 41 91 (& q Contractor W(!,U I' � TP.,(/ Date " ! I I 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. 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 4ich this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above inform n 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 t �! I ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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). 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. 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 vith all non -point source regulations per the Cupertino Municipal Code, Section 18. CONTRACTOR:MCCLELLAN DEVELOPMENT 1448 ENTRADA VERDE PL ALAMO, CA 94507 PERMIT NO: 10120122 DATE ISSUED:03/10/2011 PHONE NO: (925) 944-9108 BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH r— RESIDENTIAL r COMMERCIAL I — JOB DESCRIPTION: LOT 4-CONSTRUCT 2 STORY 2,881 SQ FT SFDWL W/ ATTACHED 456 SQ FT GARAGE(ADDR CHANGED FROM 790 S BLANEY) 4/7/1 I DEFERRED #1 TRUSS CALCS - 5/24/1 1 DEF'RD # I ISS'D 5/24/1 1 Sq. Ft Floor Area: I Valuation: $333700 APN Number: 36911064.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS O LAST CALLED INSPECTION. Issued by: C", Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. 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. Owner or. au edagent: / Date: ( I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk'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. nature Date I Licensed Professional CITY OF CUPERTINO BUILDING PEIMit BUILDING ADDRESS: 6783 CLIFFORD DR I CONTRACTOR: MCCLELLAN I PERMIT NO: 10120122 I NT OWNER'S NAME: BLANEY VENTURE LLC 11448 ENTRADA VERDE PL I DATE ISSUED: 03/10/2011 I O"ER'S PHONE: 9259449108 I ALAMO, CA 94507 I PHONE NO: (925) 944-9108 & LICENSED CONTRACTOR'S DECLARATION ,j I�ON License Class �6-1 Li.. # 4 I 8`� Contractor I c C(je%f otn DIN- Date 3 lf/ t ( I 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 370.0 of the Labor Code, for the performance of the work for which this permit is issued. , A APPLICANT CERTIFICATION N" 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 regul on r the Cupertino Municipal Code, Section 9.18. Signature Date ❑ 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) 1, 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. 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 r ELECT 1— PLUMB r MECH r— RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: LOT 4-CONSTRUCT 2 STORY 2,881 SQ FT SFDWL W/ ATTACHED 456 SQ FT GARAGE(ADDR CHANGED FROM 790 S BLANEY) 5/26/2011 - REV# 1 - REVISE WINDOW OPENING CHANGE TO FRENCH DOOR- 7/6/2011 REV#I ISS'D Sq. Ft Floor Area: ( Valuation: $333700 APN Number: 36911064.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued r 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 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 & Safe Co e, a ons 25505, 25533, and 25534. Ow r t r' a e Date: b 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 Address ARCHITECT'S DECLARATION Date I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO ICI FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 6783 clifford dr. DATE: 05/26/2011 REVIEWED BY: bobs. APN: BP#: -VALUATION: $400 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE:L PENTAMATION PERMIT TYPE: WORK revise window opening change to french door. SCOPE lfet dr. Pl;ary I Plur Check TV Fce, 0trror Al cIr ,,;.sl' j r r aFeJ;. hnr, Fee- 1';r;r; h t,r.,f.-. f ;,°. E,tee . frt o. ? er r. NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 Q E) Work Without Permit? 0 Yes (F) No $0.00 Planninp- Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i F e71`Rl1)c>c.runF:ntGrtic>J� T tes: Strong Motion Fee: IBSEISMICR $0.50 0 f$()150 (�0 Revision IREVSFDWL SFDWL Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $0.00 TOTAL FEE: TtTo b Revised: 04/29/2011 I CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 790 S BLANEY AVE LOT 4 1 DATE: 12/17/2010 1 REVIEWED BY: APN: BP#: `VALUATION: 1$333,700 1 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 1 )T1L PENTAMATION 1R3SFDW USE: l 1.,00R .4RE,4. PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA sJ PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 3,337 $2,787.16 IR3PLNCK $2,834.44 IRNNSP TOTALS: 3,337 $2,787.16 $2,834.44 I'lech. Plug C Phanh. Plror C'hcrc-k l_/"C..pkw Check lh�elr. Pew„ir f < �.:: Plemrh. Pei rrjir IT, lrrr�. I' -! w';r Fee Othe7IYl y. i�,'+�7 (''i" i ��.::i7" �Y75'7 ).Li 1 /111ce- EI1 c. ' a}'l). Li Mech. hasp. Fee: Pfionh. hzcp. l'��:c': Ek, IPlsp> 1" . NOTE. These_/ees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,787.16 1 amps $42.00 Electrical IERT<200 Services Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 0 # $21.00 Plumbing 1PRSEWER Sewer, Sanitary Permit Fee: $2,834.44 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1 # $21.00 Plumbing 1BPWSVCS Water Service Constr. Tax: 1BCONSTVa? 1 bld S $558.42 Acoustical Fee: © Yes E) No $0.00 Q 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $433.81 0 Travel Documentation Fee: ITPA VDOC $42.00 Strong Motion Fee: 1BSEISMICR $33.37 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $14.00 SUBTOTALS: $6,703.20 $84.00 TOTAL FEE: $6,787.20 Revised: 12/07/2010