15010076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11686 PALM SPRING CT
CONTRACTOR: AMERICAN HOME
PERMIT NO: 15010076
RENEWAL INC
OWNER'S NAME:
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
License Class G� Lic. # 740 S,d 7
INSTALL (2) ENTRY DOORS LOCATED IN FRONT AND
BACK
^--j �1
) l � 1 i
OF SFDWL, INSTALL HARDIE SIDING 1800 SQ
Contractor. 1�fB1 �'� _ f'r,N1 • Nr:'i,�/s-' 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: $30000
p rformance of the work for which this permit is issued.
h and will maintain Worker's Compensation Insurance, as provided for by
i n 3700 of the Labor Code, for the performance of the work for which this
it is issued.
APN Number: 36654114 00
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. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) ao save
180 DAYS FR M T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liab' ' es, judgments,
in
costs, and expenses which may accrue against said City i nsequence of the
1112 LI
granting of this permit. Additionally, the applicant erstands and will comply
Issued by: Date:
with all non-point source per the C ino Municipal Code, 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.
OWNER ER 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 deSned by the Bay Area Air Quality Manageme lstrict I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Codt,,Ghirpter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25 .
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date: % AVU
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
CONSTRUCZOb��NDING 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
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.
Signature Date
CITY OF CUPERTINO
WN FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Hire, Sanitary Sewer District, Scnooi
ef,. Thncn Foot nro hacod nn rho nrolimiaary infarmatian available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
ADDRESS: 11686 palm spring ct
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION: 1$30,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
Suppl. PC Fee: Reg. OT
PENTAMATION 1GENRES
USE:
Chiher 1 ret. IY2Sh.
PERMIT TYPE:
WORK
install 2 entry doors located in front and back of sfdwl install hardie siding 1800 s
1,800 s.f.
$1,291.00
Siding
ISIDEOTHER All Other
SCOPE
Permit Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Hire, Sanitary Sewer District, Scnooi
ef,. Thncn Foot nro hacod nn rho nrolimiaary infarmatian available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
y
f;
MISC ITEMS
Plan Check Fee:
1'ha C'1tec:.k
Plumb. 1'hin C'hee'A
Alec, 1,/ an C"'oecr;
I.i-?eeh. 1'erwif Fee:
llhanb. 1'ermit
Suppl. PC Fee: Reg. OT
("fh('r ,Ilech Inv?
0111v. Plumb IPrsn.
Chiher 1 ret. IY2Sh.
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Hire, Sanitary Sewer District, Scnooi
ef,. Thncn Foot nro hacod nn rho nrolimiaary infarmatian available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$431.00
Window / Sliding Glass Door
1 wINREP Replacement
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1,800 s.f.
$1,291.00
Siding
ISIDEOTHER All Other
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. ® OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
("Onsi uct;o1l TUX:
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning IAee:
$0.00
Select a Non -Residential
Building or Structure
0
L,rp f r
Strong Motion Fee: IBSEISMICR
$3.90
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$2.00
a
$5.90
$1,722.00
TOTjAL FEE:
$1,727.90
Revised: 01/06/2015