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14080054 469. 253.s17'� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18920 NEWSON AVE CONTRACT0..�i�BP--T4)2E PERMIT NO: 14080054 D OWNER'S NAME: GLEN&BARBARA SHARPE DATE ISSUED:08/07/2014 OWNER'S PHONE: 4082538214 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL F] PROPERTY LINE CLEAN OUT License Class Lic.# //43�� Contractor n ate �� l I hereby affirm that in 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9800 ha and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number:37535009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITE WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 AYS OF RMIT 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 FR ALLED INSP TON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, cAnon- ii expich may accrue against said City in consequence of the g . Additionally,the applicant understands and will comply Issued by: Date: wce regulations e u ipal Code,Section 9RE-ROOFS: S Date 011V 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. ❑ 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 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 theQVpertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this '�QJ 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 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 rGENERAL PERMIT APPLICATION itA M E P COMMUNITY DEVELOPMENT DEPARTIiEN 1 • BUILDING DIVISION c/ 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 clJ'kAttHO �UO (408) 77-7-322B•FP.X(40B)777-3333•building a(�cuoe tino.ora m I s IPLUIJ�3TG ❑1` C`rLzI�IC.4L ❑ELE=CA-L nI'asCELT—AN,ous ?� ^'Cr .DDBSS ADDRESS SS � CTi Y, ST,STa,Z?,. I FAX COT�_ACT Nft,T f PHONE S??=HADD? S CITY,ST.Sic, ZIP FA-X M oa'1-at ❑ O-A,--T BUaMDL ❑ ov,,N�,ADZ' ❑ CON-T IXTOR ❑COTiASCTORAG-!TT ❑ A?=.LzCr ❑ZNC3,r—F, ❑ D=1 oP=e ❑ E:,tNS COTT?ICIORTIAI= C 30S.LIC: }1 / C AIQYTAj,^- I =-I�aII I rFs A� b S1—F_3f P' e �� I CITY iAT�,Z A- IV PB -t,, / fi�Ciui /tNGrTT-YNAIJ I LiCn�TSEI.'L7ER. I BUS.LIC COIJrPf?�YN.41� 1}IJAII I FAX STREET ADDRESS I CITY,STAT n,ZIP I ?"HONE USB OF ❑SFD of DUPLEX L7 MaTI-FAMLY I PROJECT LN WIIAL NM ❑ YES I PROJBCr�i�T ❑YES I is BLDG.Qq ❑Y---s BUII.DII.G: ❑Co1zvmr-LkL IMAN D\t�R_FAQ AREA NO FLOOD ZAI�M ❑NO Llc=HOl r.-.•7 ❑To DRSCRIPTION OF WOP.K V,&pe C '1AJ a eU' S�J'�� c-z M6Z AJ T0T..<1VArUA-17O>: By my sic;ar-re below,Ice;iry to a o he fo11O ing: I e.-n t~re pr opt;ty ov er or au;hori�d z_eni to act on' e prop---L)' rop- L o is bthalf. I have r d thds applimtion and he in o a a5oa I ha ar led is c :d_3 k�+e��s IiOn of Fork and -'M it is zec�-att. I air t to co gal - �pplioahle local Or cinances and state laws relating t a 'ion. I authorize reprtsentauves ofCupt;inO to enter the abOv identi rt prop- y for i�sptc:ion pu pe>ts. SiCmatureofA.pplicaat,'A2=t: Date: -A-SNr'A.L NkOR�LkTION 2E U LD IM "- ' h P.k�'sc�f?�_�011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18920 newsome ave DATE: 08/07/2014 REVIEWED BY: Mendez APN: BP#: EVALUATION: $9,800 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK prop rty line clean out SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $25 TOTALS: $25.00 Plumb.Plan Check 0.0 hrs $0.00 M'f'mit Fee: Plumb.Permit Fee: 1PPERMIT � Other Plumb Insp. 0.0 hrs $48.00 I' Phut/). lir,;�. T�:ee f:iec !,ss Z NOTE.This estimate does not include fees due to other Departments(he.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . 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 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 i Strom Motion Fee: IBSEISMICR $1.27 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $1.00 "IrU� =` �� $168.27 $0.00 TOTAL FEE: $168.27 ao-- m m ,x n,. . Revised: 07/10/2014