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15060098CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22421 CARNOUSTIE CT CONTRACTOR: INTEGRITY PERMIT NO: 15060098 CONSTRUCTION OWNER'S NAME: LIVERMORE, CA 94550 PHONE NO: (408) 781-0006 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E) HALL BATH (77 S.F.), NO STRUCTURAL �, License Class Lie. # O© 7 CHANGES " Date Mon* Contractor V ri -j ,Q (j�y Ile( 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 Ie ormance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $12000 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: 35603025.00 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 DAYS F D 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 I ate: S 11r granting of this permit. Additionally, the applicant understands and will comply with all non -point sourc atio r the Cupertino Municipal Code, Sectio 918. Signature Date tl / . % All roofs shall be inspected p ' 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, 3,%33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this�� Owner or an agent: D e: 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 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 918. Signature Date CITY OF CUPERTINO -4 FEE ESTIMATOR — EUILDING DIVISION imADDRESS: , 22421 CARNOUSTIE CT DATE: 06/1512015 REVIEWED BY: MELISSA APN: 356 03 025 BP#: "VALUATION: 1$12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex p PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: i WORK I REMODEL E HALL BATH 77 S.F.),NO STRUCTURAL CHANGES SCOPE ,,Wch. Plan Check 1'tuwL I'Iaa Cheek Elec. flan Check blech. Perntid Fee: I Plumb Permit Fee --I_ f Elec. emlir Fee: C)rher Alech. Insp,E3__L_ other Plurrth Insp.Ll Other Lslec. Imp. LJ i2erds. Insp. Fee: Plumb. bash. Fee: Elec. Insp. Lace: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School llicfrint et- 1 Ttaoco foot nro hncod nn the nrvliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction )n Tax: A(bninistr(,five Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Plaiming Fee: $0.00 Select a Non -Residential Building or Structure I i Travel Docuinentation Fees: Strom Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS--, $2.56 $645.00 TOTAL FEE:.- $647.56 Revised: 05/07/2015