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10110042CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 FARGO DR CONTRACTOR: ROBERTS PERMIT NO: 10110042 CONSTRUCTION OWNER'S NAME: LOS GATOS, CA 95032 PHONE NO: (408) 356-2185 LICENSED CQNTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ NEW SFDWL- -1249 SQ LIVING,PATIO 278 SQ & ATTACHED n f License Class Lic. # g q GARAGE 552 SQ;RE-BUILT OVER EXISTING / SLAB/FOUNDATION. Contractor) 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: Sq. Ft Floor Area: Valuation: $300000 t. 1 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 APN Number: 32630124.00 Occupancy Type: performance of the work for which this permit is issued. 2. 1 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 w h t i permit is issued. ;? _s may// PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS FROM LAST CALLED INSPECTION. 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, Issued b ate: costs, and expenses which may accrue against said City in consequence of the granting of this Code, Section 9.18. RE -ROOFS: Signature—Date % r % — 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(x) should I store or handle hazardous material. t. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the 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 performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 2. 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 Owner autl rized a ent. permit is issued. - Dater _ — a. 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 1 hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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 CITY OF CUPERTINO BUILDING PERMIT.,'.61 _ _ BUILDING ADDRESS: 20776 FARGO DR CONTRACTOR: ROBERTS CONSTRUCTION PERMIT NO: 10110042 OWNER'S NAME: LOS GATOS, CA 95032 PHONE NO: (408) 356-2185 ❑ LICENSED CONTRACTOR'SDECLARATION BUILDING INFO: © ELECT rU PLUMB rP License Class Lie. N � ( � L77 PERMIT BLDG MECH I�RESIDENTIAL © COMMERCIAL Contractor I? F S ('PLJ5Z Date 2 °-7 —7101 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW SFDWL- -1249 SQ LIVING,PATIO 278 SQ & (commencing with Section 7000) of Division 3 of the Business & Professions ATTACHED GARAGE 552 SQ RE-BUILT OVER EXISTING Code and that my license is in full force and effect. SLABNOUNDATION. hereby affirm under penalty of perjury one of the following two declarations: 2/7/2011 - REV#I - REVISED FOUNDATION PLAN- REV1$1 ISS'D 2/7/2011 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 Sq. Ft Floor Area: Valuation: $300000 permit is issued. APPLICANT CERTIFICATION APN Number: 32630124.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source r gulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date 2 _ 7 _ 2Z W Issued by: Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. .Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, l shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's 2 Date:—�� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ..5. / :.s' Tf'-3. i' �: �'�:aJ`.• ..,s . , , •..t r: -v• :.� -.lc'r=���:•• r• l i - s r � ,? s �., ' f s : r ( s;.. �r :z . ,1; ,�� r rj 3`• !� r. ..y {. � .y 7t •. a7 :,i: �; :�1 �Ir r, !s� .a 1 � 11��c S C S' �'•'P Y•E: �.� }v ;, s, {.,. +!11! i.1�:• tl�e��,. i.:,r, 1.• rte, •rT � s..� i, s r2�5 1 C.t { �. 1:3 � L r S W, �I.� ..1� ]s .. 3 . � t � - J .. .,• s �.r rr' - r r. •.. j, � y' � 1 �..� � ` .. �s�r :r 1 . �Ct� SY �.r� •. � ��is ,�_ al.l� !, s, �,....srM:.�l��..�„�, .�.5 [.� , . ..$...r ���� �f, _. ,�I��f•'J� � rr � �a : .f ,..r�, [, 3 ��� . � � y � EC � 1 • ] :r � •s���'� � 6 . LSo � .a � �r...� �.} � 4 M Ia..�a c)<�. ��r . ,�.....r �.lr .5 7 f, r . 1 : \ ff '} fi sC r ( .1� .S_..� .4 •�.•� .r' Z :<.�.. � +� ..S.i.: _z+.sr,-:_• 7, t3 �S. �. , tll.rf. ��. �\:1+ ..f • 'j. }�t'� u. xSrt $..� f -k {�� . � ... I.....![�;-v?,. 20776 Fargo Dr. Phunh. Pluo C+'.r,+.-eA DATE: 02/07/2011 REVIEWED BY: RDW JimADDRESS: APN: BP#: 'VALUATION: 1$3,000 PERMIT TYPE: Building Permit He(h. lnsp. Fee: PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION PERMIT TYPE: WORK Suppl. Insp. Feer Reg. 0 OT 0.0 SCOPE $0.00 ..5. / :.s' Tf'-3. i' �: �'�:aJ`.• ..,s . , , •..t r: -v• :.� -.lc'r=���:•• r• l i - s r � ,? s �., ' f s : r ( s;.. �r :z . ,1; ,�� r rj 3`• !� r. ..y {. � .y 7t •. a7 :,i: �; :�1 �Ir r, !s� .a 1 � 11��c S C S' �'•'P Y•E: �.� }v ;, s, {.,. +!11! i.1�:• tl�e��,. i.:,r, 1.• rte, •rT � s..� i, s r2�5 1 C.t { �. 1:3 � L r S W, �I.� ..1� ]s .. 3 . � t � - J .. .,• s �.r rr' - r r. •.. j, � y' � 1 �..� � ` .. �s�r :r 1 . �Ct� SY �.r� •. � ��is ,�_ al.l� !, s, �,....srM:.�l��..�„�, .�.5 [.� , . ..$...r ���� �f, _. ,�I��f•'J� � rr � �a : .f ,..r�, [, 3 ��� . � � y � EC � 1 • ] :r � •s���'� � 6 . LSo � .a � �r...� �.} � 4 M Ia..�a c)<�. ��r . ,�.....r �.lr .5 7 f, r . 1 : \ ff '} fi sC r ( .1� .S_..� .4 •�.•� .r' Z :<.�.. � +� ..S.i.: _z+.sr,-:_• 7, t3 �S. �. , tll.rf. ��. �\:1+ ..f • 'j. }�t'� u. xSrt $..� f -k {�� . � ... I.....![�;-v?,. Xle(b. Plan C.'heck Phunh. Pluo C+'.r,+.-eA Dec. Plan atL'Ch. Po -mil f'ce. !'ll;i+3.r'.3, F�[,4••g�ll l'o, t'tC'I'. PC•rn7rr /'C'e. olher ,lluch. lYJ.S'p. [�/hirv' l'i lJlill” Ti'(.S'�J. 0(het 1aEC lnSp. He(h. lnsp. Fee: Pl uoih. fwy. Fue is•7c(. Insp. F�ce: NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff. 7/I/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: ISUPPKFEE $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 1.0 hrs $126.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiruction Tax Acoustical Fee: 0 Yes 0 No $0.00 Q 0 Work Without Permit? O Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure Travel Documentut-ion Fees.. Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 :r4 '`?'�1 1' 'r '>>fr' �.•SS: i:..0 �a° '! t ,r = S'• :`��� � i� � ":•i' c� r.{; i � i� ;1"._ ..' �.. L•:� �'�`g, rt: 'zF::---:. A: :.rzx.: $ 127.50 $ 0.00 rl' !"R'+[ ]�r'c. S (�' Af � ��.�4f'Ir•';�r f �sC ij'S�. �•`�I':^.r-�; .--•{;�i ,•,�< <i?.1;;�u:r,; �I�,� i; ;,, i3t s : � s,; :,,s? r. wl r4j a' ,..,, s r. «.F_.., $127.50 Revised: 01/15/2011