10120016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10161 MACADAM LN
CONTRACTOR: PRESTIGE LANDSCAPING
PERMITNO: 10120016
& CONSTRUCTION
OWNER'S NAME:
r PLUMB r
BUILDING
Lie.
PERMIT INFO: BLDG ELECT
ease i(
r r r
COMMERCIAL
A-',O f ,t/G
MECH RESIDENTIAL
Contractor � - Date P_
!
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD OUTDOOR BBQ ISLAND W/BBQ/SIDEBURNER/SINK
(commencing with Section 7000) of Division 3 of the Business & Professions
67
LONG X24" DEEP X38" TALL APPROX I 1 FTSQ; NO RE -ROOF
Code and that my license is in full force and effect.
& NO STRUCTURAL;PRE-PLANNING APPROVAL BY PU.I
1 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 workgion
S . Ft Floor Area:
Valuation: $5000
permit is issued.
APPLICANT CERTIFICATION
Number: 36901054.00
Occupancy Type:
I certify that I have read this application and state that the above iAPN
correct. I agree tocomply with all city and county ordinances and
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 regulations per the Cup o Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Sip�tetttrs '� _ —.
Date:/—yl�J
❑ OWNER-BUILDE ECLARATION
I hereby affirm that I am exempt Poom 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
I, 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)
I, 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.
1 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, I 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 2 05, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner /
a
APPLICANT CERTIFICATION
STRUCTION 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 re 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.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM__I FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10161 macadam In.
DATE: 12/02/2010
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
TO7.lL
FLOOR _4fl k-1:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
construct new bbq island with bbq, sideburner, island.
SCOPE
, leJi. Mara Check
Nall ('irrcl' _FT
1
Vc'civ Pc,, nri! Fee.
Pltr;,, . i'cr,rr;1 Fe'c:
011un' Akclr.
,
Odwr Ele(, In
Akch. ln.,p. Fee:
7'Ir,=ub. hrsp. Fcc..
F.lec. Ins)),
NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$633.00
Fireplace
IFIREPLAMS Masonry Fireplace
Suppl. PC Fee: E) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee{') Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conso-aiction Tmx
Acoustical Fee: 0 Yes E) No
$0.00
Q
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Doctnnentalion Fetes:
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldy, Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$1.50
$633.00
TOTAL FEE:
$634.50
Revised: 11 /0812010