14080080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10106 LAMPLIGHTER SQ CONTRACTOR:SEARS HOME PERMIT NO: 14080080
IMPROVEMENT
OWNER'S NAME:
LONGWOOD,FL 32750 PHONE NO:(925)245-2000
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPLACE IN(E)MASTER BATH,ONE TOILET,SHOWER
License Class'3tT Lie.# '7 2f 3 7 VALVE,PAN&TILES
Contractor f4gl. 1 W • Date
I hereby affirm that I am licensed u rder the provisions of Chapter
(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
mpensation, s provided for by Section 3700 of the Labor Code,for the
ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10900
ave and will maintain Worker's Compensation Insurance,as provided for by
S coon 3700 of the Labor Code,for the performance of the work for which this APN Number:34233001 00 Occupancy Type:
p it 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 WITHIN 180 D SUANCE 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 D OM L LED 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 ly Iss e:
with all non-point source regulations per the Cupertino Municode,Section
9 18.
RE-ROOFS:
Signature Date 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.
11OWNER- DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
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 Distric
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter . and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this � 11
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 CONST T ENDING 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
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10106 LAMPLIGHTER SQ DATE: 08/11/2014 REVIEWED BY: MELISSA
APN: 342 33 001 BP#: *VALUATION: $10,900
`PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPF]
WORK REPLACE INE MASTER BATH ONE TOILET SHOWER VALVE PAN & TILES
SCOPE
M
Plan Plumb.Plan Check 0.0 hrs $0.00 -r'Etllu,
Lloch. I'et'ntiJ Fee: Plumb.Permit Fee: IPPERMIT
!)r�r�_ =i c� Fr. 7�l�sn. Other Plumb Insp. 0.0 hrs $48.00 C t�e.1 s�f- ,r�s,ylLl
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina inormation available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E{': 7f /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 # Plumbing
Suppl.PC Fee: Re�. 0 OT0.0 hrs $0.00 $20.00 IBPFIXTURE Fixture set on One Trap
PME Plan Check: $0.00
Permit Fee: Hour y Only? ®Yes (E)No $0.00
Suppl. Insp. Fee: Regi 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Planning Feet $0.00 Select a Non-Residential G
Travel Documentation ee: ITRAVDOC $48.00 Building or Structure 0
i
Strong Motion Fee: 1BSEISMICR $1.42 1.0 hrs Inspections
Bldg,Stds Commission Fee: IBCBSC $1.00 $143.00 ISTINSP Inspection,Hourly
''B �� n $143.42 $163.00 TONAL FEE: $306.42
uw= R w ,
Revised: 07/10/2014