15030102CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7765 HUNTRIDGE LN
CONTRACTOR -TBE�-�E
PERMIT NO: 15030102
DAF, TWINED
OWNER'S NAME:
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
STRENGTHEN (E) 2X4 CEILING JOISTS W/ NEW LEVELS
�j
24"
Lic.#
License ClaAthat
Contractor Date is
I hereby am licensed under the provisions of Cha ter 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
Cpensation, as provided for by Section 3700 of the Labor Code, for the
Valuation: $4000
fp ormance of the work for which this permit is issued.
Sq. Ft Floor Area:
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: 35906024 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
WITHIN 180 DAYS O ERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS FRO CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in of the
costs, and expenses which may accrue against said consequence
Issued by: Date.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Date �IS
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
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,
do the work, and the structure is not intended or offered for sale (Sec.7044,
will
Business & Professions Code)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
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
Code, Section 25532(a) should I store or handle hazardous
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety
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
compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain
the Health & Safety Code, Seed 5 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
Ar/ Z,
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
p y p p
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
918.
Signature Date
--- CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
7765 huntridge In
DATE: 03/18/2015
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: 1$4,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1GENRE
MI
PERT TYPE:
WORK
STRENGTHEN E 2X4 CEILING JOISTS W/ NEW LEVELS 24"
SCOPE
A1ech. Ilev" C'heci,
Other MT,
llbr ib, 111wi (,'heck
off<'Y'Pitonh hZ,i'p,
P1'w'nb' 1r'T' , Fee:
Ee<:, 1'hn L'her:
:Yec' 1'...r.a, fee"
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.).Theselees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l into.
FEE ITEMS (Fee Resolution I1-053 E . 7/1/13,
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 19 No
$0.00
hours
$143.00
Plan Check, Hourly
1STPLNCx
Suppl. PC Fee: Q) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (j) No
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
°HClmindst:eti iveFee,-
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential 0
Building or Structure 0
y
r t'£iE%��E .��£}<'tt}�?i`J'�t`Cdia£3f� Fees:�
Strong Motion Fee: IBSEISMICR
$0.52
2.0 hrs
$286.00
Inspections
1sTiNsP Inspection, Hourly
Bldg Stds Commission Fee: 1BCBSC
$1.00
M ?Zy
$1.52
$429.00
TOTAL FEE:
$430.52
Revised: 02/14/2015