15120019p -
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10351 S BLANEY AVE
CONTRACTOR: ANTHONY HODDER
PERMIT NO: 15120019
CONSTRUCTION
OWNER'S NAME: HAGGARD PAUL ET AL
7504 BOLLINGER RD
DATE ISSUED: 12/02/2015
OWNER'S PHONE: 4154975881
CUPERTINO, CA 95014
PHONE NO: (408) 257-4317
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Ti"'s,lass,. O y � —37L
REPLACE (E) TILE ON FLOOR & SHOWER IN (E) HALL
BATH, INCLUDING (N) VALVE
-o 1 Z_ 2- r t S
1—/
Contractor,,, ,4 Dat,
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: $10000
performance of the work for which this permit is issued.
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: 36932044.00
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 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 SPECTION.
indemnify and ]seep harmless the City of Cupertino against liabilities, judgments,
costs, and expense which may accrue against said City in consequence of the
Date:
granting of this r it. Additionally, the applicant understands and will comply
with all non -p nt ource r rations per the C perti o Municipal Code, Section
RE -ROOFS:
9.18.
Signaturfe Z
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 B y Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with th C pertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sec 'ons 5 3, and 25534.
`�
Section 3700 of the Labor Code, for the performance of the work for which this
1/ Z
Owner or authorized agent: Date
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
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
CUPERTIN0
GONSTRUC T ION PERMIT APPLICATION
COMMiiUNITY DEVELOPMiENT DEPARTMiiENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - bu0dino(.cuDer'Hno.org � S 1 % OOC
❑ NEW CONSTRUCTION u ADDITION . ❑ AL T ERkTi0N / TI ❑ REVISION / DEFERRED ORIGIN 4I PERMIT
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ARCPIT ECT/ENGINEER NAME
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DESCRY T -QF
L Ft4 WORK
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EXISTING USE PROPOSED USz CONSTR T r E ',STORIES
USE TYPE I OCC. I
SQ.FT.
VALUATION (5)
=)c TO
NEW FLOOR
DEMO
TOTAL
AREA
AREA
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OTr�R
REMODELAR
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REMODEL. AaBA
PORCH AREA
DECK AREA
TOTAL DBCiJPORC'H AjPZA
GARAGE AR' -_A: DETACH
[] ATTACH
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'DWELLII.GUNTrS:I
ISASECONDUNIT ❑YES
SECOND STORY ❑YS
BEING ADDED? 0 N
ADDITION? ❑NO
PPr ,LDPLICAT10N ❑ YES IF 71 rS, PROVIDE COPY OF
IS THE BLDG AN ❑
l .
TOTAL VALUATION:
PLANWrNGAPPLR ❑NO PLANN�GAPPROV'kLLTER
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By my signature below, I certiry to ch f the following: I am the property ;nor or authonze ages to act on the prope, ov,•ner's behalf. I have read this
application and the information I ve rovided i ect. I have read ,e D scrip''o, of Work and verily it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to building co Is cion, I authorize e enta ve O'or Cu�pe.rtlno to enter thea ve ioentined property�or inspection purposes.
Signature of Applicant/Agent- r Y
Date: 2-0ls
SLPPLEIMENTAL INFORMATION RE IRED
ec~E, _MMU_
_otiTG_sL�:3t
_ New SFD or Mulhifarnily du-ellings: Apply for demolition permit for
s
.OS�R T1 COIj 1'E
E
BIIIIDL'�GPL3N12n17t1y'
� -__
i_einQexisting building(s). °�s). Demolition permit s required prior to icuance of bL
permit for new building.
pe
--
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
r4�ain _
L� pLEIaG�oR�ts
form if any Hazardous Materials are being used as part of this project.
-
_ Copy of Planning Approval Letter or Meeting with Planning prior to
—
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-
submittal of Building Permit application.
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SA��T}shySEliEn�ISTRICT y
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`�_:En��on•ir,E3rds�.4I_,zx
Bla'g.4pp_2011,doc revised 06/21/11
CITE' OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10351 S BLANEY AVE
DATE: 12/02/2015
7
REVIEWED BY: MELISSA
APN: 369 32 044
BP#:
'EVALUATION: j$10,000
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Plumb. Plan Check
PENTAMATION 1 RPFI
PERMIT TYPE: A
WORK
REPLACE E TILE ON FLOOR & SHOWER IN E HALL BATH
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
MWrirt_ etr_ )_ These fepc Ore ha.ced on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resohition 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.001=
#
$10.00
Plumbing
IBPFIXTURE Fixture set on One Trap
Plumb. Plan Check
0.0
hrs
$0.00
;r;:'c c:. P/o,?
PME Plan Check:
$0.00
Permit Fee: Hourly Only? C) Yes 0 No
Plumb. Permit Fee:
1PPERMIT
Eil
hrs
r. ,her � _ 1e s ' .. hl i.�.
PME Unit Fee:
Other Plumb lnsp.0.0
PME Permit Fee:
hrs
$48.00
(A'wsiruclh-m Yin".
Administrative Fee: ]ADMIN
$45.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
MWrirt_ etr_ )_ These fepc Ore ha.ced on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resohition 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.001=
#
$10.00
Plumbing
IBPFIXTURE Fixture set on One Trap
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? C) Yes 0 No
$0.00
Suppl. Insp. Fee:O Reg. 0 OT
Eil
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
(A'wsiruclh-m Yin".
Administrative Fee: ]ADMIN
$45.00
0
`"
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISILIICR
$1.30
1.0 hrs
$143.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
SiTBTOTALS:
$143.30
$153.00
TOTAI,'FIEE: '
$296.30
Revised: 10/01/2015