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13060102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:.10303 S BLANEY AVE CONTRACTOR:ANTHONY HODDER PERMIT NO:130601.02 CONSTRUCTION OWNER'S NAME: HAGGARD SABINA ET AL 7504 BOLLINGER RD DATE ISSUED:06/12/2013 OWNER'S PHONE: CUPERTINO,CA 95014 PHONE NO:(408)257-4317 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALU License Class(_[ ,Lic.# LN �� REPAIR KITCHEN BACK SPLASH Contractor Date I hereby affirm tat I am licensed under the provisio of C pter 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. Sq.Ft Floor Area: Valuation:$450 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 APN Number:36932014.00 Occupancy Type: permit is issued. 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.I agree to comply with all city and county ordinances and state laws relating WITHIN0 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 DA OM LAST CALLED INSPECTION. indemnify and kee harmless the City of Cupertino against liabilities,judgments, costs,and i. pe es hich may accrue against said Ci consequence of the 6. granting of pe it. Additionally,the appli t u rstands d will comply Issued by: Date: with all no oint urce re seer the pertin M cip Code,Section 9.18. �j RE-ROOFS: Signa e t ( 4inspection. roofs shall be inspected prior to any roofing material being installed.If a roof is stalled without first obtaining an inspection,I agree to remove all new materials for ❑ OWNER-BUILDER ECLARATION 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 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 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 Cu ertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, n 255 5,2 533,and 25534. nt: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ageDat 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 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 revoked. 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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. Signature Date CONSTRUCTION PERMIT APPLICATION b COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIINO (408)777-3228• FAX(408)777-3333•build ing(cDcupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTEJRATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#/// PROJECT ADDRESS Zo 22 OWNER NAME(, PHONE E-MAIL O J STREET ADDRESS D 3C) CITY,STATE, '` FAX CONTACT N 1 1 PHONE E-MAIL STREET ADDRESS 5y-6 �J`/ / y� I/ CITY ATE,ZIP D FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT P- NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT LICENS r�2 LICEN E BUS.LIC# CO ANY NA Ivf� 1�� / s MAIL > FAX STREET �(� C�6C�� ?] t/�(C�"`� �Lf�J I/� ARCHITECT/ENGINEER NAME (' �J LICENSE NUMBER BUS.LIC# / lJ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK (Ls' EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ODETACH ❑ATTACH #DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY OYES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES r" EIn' DSEY ; TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING AL LETTER EICHLER HOME? ❑NO M1 ; A By my signature below,I certify to ch of a following: am the prope own or au oriz d agen o act on the property owner's behalf. I have read this application and the information I ve p ide ave read the esc tion of or and v fy it is accur te. I agree to comply with all applicable local ordinances and state laws relatin to bu ng ons i authorize rep se tives o Cu ino to enter the abo -identified property for in coon purposes. Signature of Applicant/Agent: Date: SUPPLE INFORMATION REQU cwt tl rP�t1N Cis.tXP"E �.SL ,� IG _ IIV New SFD or Multifamily dwellings: Apply for demolition permit forpz existing building(s). Demolition permit is required prior to issuance of building permit for new building. '� � G�7P• 32E _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure o RTzs {ii form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval.Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION q+ ADDRESS: 10303 S BLANEY DATE: 06/12/2013 REVIEWED BY: 450 APN: BP#: "'VALUATION: $450 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: p PERMIT TYPE: i woRK REPAIR KITCHEN BACK SPLASH SCOPE r E ..�.., ass.,_ _ _ ,, Mech. Plan Check Plumb.Plan Check Elec.Plon Check L1ech. Perrrrit Fee: Plumb. Permit Fee: Elec, Permit Tee: Other.11ech.Insp. Other Plumb Imp, Other Elc(. Insp. EI-L-- -.Hech.Insp.Iire: Plumb. hrsp.Fee: Elec.Insp—Tee: 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 based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: 0 Reg. Q OT 0-.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (D No $0.00 Suppl. Insp.Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tir_x: dininistt-crtive Fee: Work Without Permit? 0 Yes No $0.00 E) Advanced Plannin Fee.- $0.00 hours Inspections E) Travel Documentation Fees: $133.00 1STINSP Inspection,Hourly 0 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 _� $1.50 $133.00 xW $134,501 { i k .. ,lily _ _ - g*C°_ Revised: 04/29/2013