B-2016-1252CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1252
948 FERNGROVE DR CUPERTINO, CA 95014-4665 (375 38 024)
(TEE SANDMAN
TERMITE COMPANY)
SAN JOSE, CA 95125
OWNER'S NAME: GUINN LISAA AND STEPHEN H
DATE ISSUED: 01/25/2016
OWNER'S PHONE:
PHONE NO: 408-265-7500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. 9425229
Contractor (THE SANDMAN TERMITE COMPANY ) Dale 01/25/2016
X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_ COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Cade and that my
license is in full force and effect.
JOB DESCRIPTION:
IN GARAGE, REMOVE UN -PERMITTED ROOM, ADD (N) 100 AMP
I hereby affirm under penalty of perjury one of the following two declarations:
SUB PANEL, ADD/REPLACE 9 LIGHTS & 7 OUTLETS. ADD (N) CAR
1. I have and will maintain a certificate of consent to self -insure for Worker's
CHARGER & ENCLOSE TANICLESS WATER HEATER & BOILER.
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
z. 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
Sq. Ft Floor Area:
Valuation: $15000.00
f this permit is issued,
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
37538 024
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, costs, and
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
-
Issued by i�
Signature Dale 01/25/2016
Date: 01/25/2016
OWNER-BUILDERDECLARATION
RF ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prier to any roofing material being installed If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the properly, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sce.7044, Business & Professions Code)
Signature of Applicant:
1. 1, as owner of the property, am exclusively contracting with licensed
Date: 01/25/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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
HAZARDOUS MATERIALS DISCLOSURE
performance ofthe work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance, as provided for
California IIealth & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with tine Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safely Code, Section 25532(a) should I store or handle hazardous
s. 1 certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shell not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Section .2 50 , �533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:
be deemed revoked.
_
Date: 0112512016
APPLICANT CERTIFICATION
ONSTRUCT Q LENDING AGENCY
I certify that I have read this application and state that the above Information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit Is Issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save Indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 01LZ&2016
1,2971
CUPERTINO
mm COTiS UC770N
CONSTRUCTION PERMIT APPLICATION
COMOUNIT f DEVELOPIViENT DEPARTIdiENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 85014-3255
(408) 777.3228 • FAX (�408) 777-33"s3 - buildina(a�cuuzdino.ora
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By ny signature below, I ceniy to each of the fell owing: I an the proper-), ov;mer or authorized agent to act c yrapery owner's behalf have reed this
aaDLcation and the information I have provldy� is erect. I heve read the Description of -Work and verify cv. Ete. I a�ee to comply with all applicable local
c dinaneu and state laars relE`•.in,.o buiidi;,�t/O 'fop. I aniho; ize. represen _:Ives of CDpe.rtino to enter the abev� iQTi red pmpe� :or inspection purposes.
Slcature of =molicant/A-ent s�-ffr ata: 1 %�l -.
SL"FPLFhi—FNTAL! "TOR \ .A 1.iO'N E QU1�.D
New SFD or Miiltifa-mily dv:ellin_s: Apply for demolition pe=it :'or
exists, buildine(s). Den-:olition pemit is reeuired prier to issbLU;,g
pe.-it for ne„ building.
_ Commercial Bld,s: Provide a co-,pleted Hurrdous Materials Disclosure
er::! if--gy Hazardous h2Ei_risls €e belp, used as Da: i of h s project,
Copy of Plsn,-rine Approval Letter or>\ eetine iLh P'-�•,�ing prior to
=ub2i Lal of Building Pe I;t apDlicetion, .
Bldgrgo_2011. dbc revised 061211)1
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 948 FERNGROVE DR DATE: 01/25/2016
APN: 375 38 024 BP#:
REVIEWED BY: MELISSA
"VALUATION: $15,000
*PERMIT TYPE: Building Permit
PLAN CHECI{ TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
IN GARAGE REMOVE UN -PERMITTED ROOM ADD N 100 AMP SUB PANEL ADD/REPLACE 9
SCOPE
LIGHTS & 7 OUTLETS. ADD (N) CAR CHARGER & ENCLOSE TANKLESS WATER HEATER & p
,lfeelr. l'Inn Cht;ck
111vTO, l'tct,+ t'h,,,,k
Elec. Plan Cheek OA hrs $0.00
A1'kch. Permit F"ee:
Pinnik Yerrur 1 ie'r
Elec. Permit Fee: lEPERMIT
01her_tkeh. hi-T
Other .Yl7mrbLrsp.
Other Elec.Insp. 0.0 hrs $48.00
tlfach. In.p. {•'ems'
F'li mb. hi'p. Fret
(:'.rc. trap. /gee:
NOTE., This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary Information available and are only an estimate. Contact the Dept for addn'1 into.
FEE ITEMS (Yce Resolution 1.1-053 E{f7// 3,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$109.00
Alternative Energy System
iCHRGSTfi EV Charging Station
Suppl. PC Fee: (E) Reg. 0 OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
=
$48.00
Electrical
1 1BREMIU'CF.P Recep/Switch/Outlets
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl, Insp. Fee:Q) Reg. 0 OT
0.0
hrs
$0.00
=
$72.00
Electrical
IBREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
F 100 lamps
$48.00
Electrical
1BELEC20o Services
Construction Mx
Administrative Fee:
1A1)MIN
$45.00
0
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee:
IBSEISMICR
$1.95
F 1.0 hrs
$143.00
Inspections
1STINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
1 $1.00
SUBTOTALS:
$143.95
$420.00
TOTAL FEE:;
$563.95
Revised: 01 /01 /2016
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