15040149 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10374 S TANTAU AVE CONTRACTOR:NU VISION BUILDERS PERMIT NO:15040149
OWNER'S NAME:
TARZANA,CA 91356 PHONE NO:(818)924-3433
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
ADD 245 S.F.TO RECONFIGURE(E)LAUNDRY RM
License Class Lic.# z) REV#1-ADD(N)BATHROOM TO ORIGINAL ADDITION
ContractorDate �� (NO NEW SQ FT)-ISSUED 6/15/15
_��;f s �. �
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$25000
�e 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:37508032.00 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 WO STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY E 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 ED 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 com ss Date:
�/x
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspec rior 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 the Cupertino Municipal Code,Chapter 9.12 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 Owner or authorized agent:- Dater
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
WDDRESS: 10374 S TANTAU AVE DATE: 06/15/2015 REVIEWED BY: MELISSA
PN: 375 08 032 BP#: 15040149 `VALUATION: $0
YPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1GENRE i
WORK REV# 1 -ADD N BATHROOM TO ORIGINAL ADDITION NO NEW SQ FT)- ISSUED 6/15/15
SCOPE
4,.4>
htech, Plan Check Plumb. Plum Check Elec.Plan Check
;Llech. Permit Fee: Plumb. Permit Fee: lilec. Permii Fee:
Other a%ch. Insn. Other Plume Insp. F1 Other Like.Imp,
Weclr.bash. Fee: Plumb, Insp. Fee: Elec.if p.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS(Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check, Hourly
Suppl.PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 $143.00 ISTPLIVCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consiraiction Tax:
dininisirative Fee: 0
Work Without Permit? Q Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G)
Trcn el Doc ur;�c ntatir,n Fees: Building or Structure 0
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.001 $143.00 ISTINSP Inspection,Hourly
TOTAL
E FE286.00
SUBTOTALS $0.00 $286.00 $
Revised: 05/07/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10374 S TANTAU AVE CONTRACTOR:NU VISION BUILDERS PERMIT NO: 15040149
OWNER'S NAME:
TARZANA,CA 91356 PHONE NO:(818)924-3433
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
_ ADD 245 S.F.TO RECONFIGURE(E)LAUNDRY RM
License Class Lic.# C7
Contractor 40.—WS, -,O" BN,IAP6.Date 2 i / 167
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
pompensation,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:$25000
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:37508032.00 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 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 CALLED 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 comply Y Date:
/
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature
Signature - Date L 21 / All roofs shall be inspect- 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 det-ined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2553 ,and 25534.
Section 3700 of the Labor Code,for theerformance of the work for which this Gj/2/ I
p Owner or authorized
��
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
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: 10374 S TANTAU AVE I DATE: 04/21/2015 REVIEWED BY: MELISSA
APN: 375 08 032 BP#: is O/ *VALUATION: 1$25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? Yes No PENTAMATION 1 R3SFDADD
USE: SFD or Duplex OTC? 0 Yes D No PERMIT TYPE:
WORK ADD 245 S.F. TO RECONFIGURE E LAUNDRY RM
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 245 $1,091.00 JADDPLCK $1,057.00 JADDINSP
TOTALS: 245 $1,091 00 "., U $1,057.00
s k +,a c5v �' �: a r.G. i S-- uka s t 7 7•
1VIECH 'HOVRLIy Cl YesF Noy ,P�IIMB IiOURI.Y4Yes Q,No ELEC,HOi7RLY y Yes _ . Nod
�.Y:PCe<, ,- 9 .� ,� �.a ,rovll.�...t h.r.�, 'z.s ..ks.f,�d.... ® -
Nfech. flan Check E
_larr t:'6teck Elec..Plan Check
_L1ech. Perrrrii Fee: Plumb.qPeonit Glec. Permit Fee:
C)rlaer Ah,,ch. Insn: umb lrts,n. tither Elec.Insp.
Itmp.F'e�e: asp. Fee: Elec.Imp.Fee:
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 relimina information available and are onlyan estimate. Contact the Dept or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,091.00 Select a Misc Bldg/Structure
Suppl.PC Fee: Q) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,057.00
Suppl. Insp.Fee:(D Reg. Q C O,p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
.4dininistrative Fee: 0
Work Without Permit? 0 Yes Q) No $0.00 E)
Advanced Planning Fee: IPLLONGR $34.30 Select a Non-Residential E)
Building or Structure 0
Travel Documenlatactn Fees:
Strong Motion Fee: IBSEISMICR $3.25 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $1.00
^�
SUBOTALS' � $2,186.551 $0.001' EE $2,186.55
,3a. s�;�,.�.:...,5
Revised: 04/01/2015