15060119CITY OF CUPERTINO
BUILDING PERMIT
CONTRACTOR: BLUE BAY REMODELING PERMIT NO: 15060119
BUILDING ADDRESS: 20791 DUNBAR DR
CO
1651 NOBILI AVE DATE ISSUED: 09/29/2015
SANTA CLARA, CA 95051 PHONE NO: (408)615-0135
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
OWNER'S NAME:
® LICENSED CONTRACTOR'S DECLARATION,
License Class-,Lic. # -
CONSTRUCT NEW 2 STORY SFD (4464 S.F.) WITH
ATTACHED 3 CAR GARAGE (634 S.F.)
Contractor Date
I hereby affirm that I am licensed under the provision 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:
Sq. Ft Floor Area:
Valuation: $500000
�. 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.
APN Number: 32630154.00
Occupancy Type:
2. 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
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is
correct. I agree to comply with all cityand
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued Date: •�
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18,
RE -ROOFS:
Signature -- Date_—�
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.
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1. 1, 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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
�. I have and will maintain a Certificate of Consent to self -insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
performance of the work for which this permit is issued.
Health & Safety Code, Sections 25505, 25533, and 25534.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Owner or t o izec,a
Section 3700 of the Labor Code, for the performance of the work for which this
�•�r -
permit is issued.
a. 1 certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
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
I hereby that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
his
for which this permit is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
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
I understand my plans shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter
Licensed Professional
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 expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - R1T11,D1rXV_ 7 1V1QTnN
1 ADDRESS: 20791 Dunbar Dr
A
DATE: 06/17/2016
REVIEWED BY: Paul
APN: 326 30 154
BP#: A
*VALUATION: $500,000
PERMIT TYPE: Building Permit
R-3 (Custom) A
PLAN CHECK TYPE:
New Construction
PRIMARY SFD or D
Duplex
—1
0 2nd Unit? Yes No
PENTAMATION
1
USE:
PME Plan Check:
PERMIT TYPE: 1 R3SFDW
WORK
Construct new 2 Sto!y SFD (4464 S.Q with attached 3 car Garage (634 S.f.)
SCOPE
Permit Fee:
$4,159.23
Suppl. Insp. Fee.(j) Reg. Cl OT J
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
(s.f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom) A
1l-13,ll1-B,lV,V-B
5,098
$3,358.03
IR3PLNCK
$4,159.23
IR31NSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,159.23
Suppl. Insp. Fee.(j) Reg. Cl OT J
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
5,098
$3,358.03
Construction Tax: IBCONSTAXRF1
$4,159.23
new
un ts
Afech. Plan ('heck Plumb. 111an
Ife-h-. Perm; Fee:
I OTher.A*,ch. Imp.
Akch lnsp. Fee:
I'l.wnb. Pcrnfit Fee:
01her Plumb Insp.
Phimb. fmsp. Fee:
17.fea Pernfir Fee:
Oflwr El c'.
1-jec. Imp, Fee:
IVU E: 1his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distript-oh-A Thou,, foot nro bnend nn ih, cf;f,
FEE ITEMS (Fee Resolution 11-053 E 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,358.03
Select a Misc Bldg/Structure
F or Element of a Building
Suppl. PC Fee: (j) Reg. Cl OT
0.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,159.23
Suppl. Insp. Fee.(j) Reg. Cl OT J
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXRF1
I
new
un ts
$677.77
0
Work Without Permit? Cl Yes e) No
$0.00
Advanced Planning Fee. IPLLONGR
$713.72
Select a Non -Residential
Building or Structure
G
0
TrOvel Documenialion flees:
Strom 4 Motion. Fee: jBsEismjcR
$65.00
Select an Administrative Item
Bldg_ Stds Commission Fee: IBCBSC
$20.00
WbtAIS`
V
$8,993.75
$0.00
4T_Q_T-��LF K-1
Jiz
$8,993 .75
Revised: 05/07/2015