10120104CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10135 SANTA CLARA AVE
CONTRACTOR: KEVIN HUBBARD &
PERMIT NO: 10120104
ELIZABETH KNIGHT
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
REMODEL 196 SQ FT TO KITCHEN, 45 SQ FT TO BATH
INSTAL 2 WINDOWS, REPLACE WATER HEATER
Contractor 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
Sq. Ft Floor Area:
Valuation: $25000
performance of the work for which this permit is issued.
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 which this
permit is issued.
APN Number: 326 24 021
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by: _ ' -- Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any rooting material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Appl icant: 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
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 255 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
�^
permit is issued.
Owner or authorized agent: - Date:
;
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed re d.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
J
Signature Date
CITY OF CUPERTINO
FM -7 FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
10135 santa clara ave.
DATE: 12/15/2010
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: 1$25,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
Suppl. PC Fee: E) Reg. ® OT
PENTAMATION
PERMIT TYPE: 1R3SFDRE ;
WORK
To Clear Code Enforcement Case:
SCOPE
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-05I ECJ. 7-1,10)
-
Plumb. Plan Check 0.0 1 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $42.00
MISC ITEMS
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-05I ECJ. 7-1,10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
196 1 s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: E) Reg. ® OT
1 0.0
hrs
$0.00
PME Plan Check:
$0.00
45 s.f.
$570.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee Reg.
0 OT
0.0
hrs
$0.00
0 # Window / Sliding Glass Door
$380.00 I WINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
-TT
$42.00
1 #
$25.00
Plumbing
IPRWHEATR Water -Heater
-"r1�'
Acoustical Fee:
0 Yes F) No
$0.00
G)
Work Without Permit? (F) Yes () No
$1,587.00
Planning Fee:
$0.00
Q
Travel Documentation Fee: ITRA VDOC
$42.00
Strong Motion Fee:
IBSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1,674.501$1,545.001
TOTAL FEE:
$3,219.50
Revised: 12/07/2010