14060192 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060192
10655 CORDOVA RD CUPERTINO CA 95014(342 22 100) CRAIG A ROGERS
CONSTRUCTION INC
SAN JOSE,CA 95136
OWNER'S NAME: DATE ISSUED: 10/09/2015
OWNER'S PHONE:( PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#978553
Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11/30/2016 _BLDG _ELECT _PLUMB
MECH 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 Code and that my
license is in full force and effect. JOB DESCRIPTION:
**LOT B**HILLSIDE-CONSTRUCT 3 STORY SFDWL 2640 SQ,
I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE 440 AND PORCH 173 SQ&RETAINING
1. I ave and will maintain a certificate of consent to self-insure for Worker's WALL(S)ATTACHED&NEAR FOUNDATION(SEE PLN SHT S8.1
ompensation,as provided for by Section 3700 of the Labor Code,for the FOR LOCATIONS).
performance of the work for which this permit is issued. REV#1-NECESSARY REVISIONS DUE TO GRADING CHANGES
`°2-I have and will maintain Worker's Compensation Insurance,as provided for by (PIERS,RETAINING WALL);MINOR FLOOR PLAN CHANGES.
"a Section 3700 of the Labor Code,for the performance of the work for which this ISSUED 6-1-16.
permit is issued. REV#2 ADD BASEMENT(427 SQ FT)-ISSUED 10/19/16
APPLICANT CERTIFICATION REV#3- RELOCATE FIREPLACE IN FAMILY ROOM AND
I certify that I have read this application and state that the above STRUCTURAL CLARIFICATIONS FOR TRAY CEILINGS AND
information is correct.'I agree to comply with all city and county ordinances SKYLIGHT ON SECOND FLOOR.ISSUED 9-12-2017
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,costs,and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, :applicant understands and will comply with all non-point
source regul;ti. s per th upertino Muni ipal Code,Section 9.18.
Sign. or Date
APPLICATION EXT'D TO 9/27/15
AK r.-: 1 � !: IL
Sq.Ft Floor Area: Valuation:$500000.00
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I,as owner of the property,or my employees with wages as their sole APN Number: Occupancy Type:
compensation,will do the work,and the structure is not intended or offered for 342 22 100
salt(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). PERMIT EXPIRES IF WORK IS NOT STARTED
I hereby affirm under penalty of perjury one of the following three declarations: WITHIN 180 DAYS.OF PERMIT ISSUANCE OR
1. I have and will maintain:a:Certificate of Consent to self-insure for Worker's 180 DAYS FROM LAST CALLED INSPECTION.
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
Issued by:Legacy
2. I have and will maintain Worker's Compensation Insurance,as provided for by Date:10/09/2015
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I RE-ROOFS:
shall not employ any person in any manner so as to become subject to the All roofs shall be inspected prior to any roofing material being installed.If a roof is
Worker's Compensation laws of California. If,after making this certificate,of installed without first obtaining an inspection,I agree to remove all new materials for
exemption,I become subject to the Worker's Compensation provisions of the insp> on.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Signature ofApplic•,t
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree HAZARDOUS MATERIALS DISCLOSURE
to save indemnify and keep harmless the City of Cupertino against liabilities, I have read the hazardous materials requirements under Chapter 6.95 of the
judgments,costs,and expenses which may accrue against said City in California Health&Safety Code,Sections 25505,25533,and 25534. I will
consequenceof the granting of this permit. Additionally,the applicant understands maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
and will comply with all non-point source regulations per the Cupertino Municipal Health&Safety Code,Section 25532(a)should I store or handle hazardous
Code,Section 9.18. material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Signature Date will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 14060192
10655 CORDOVA RD CUPERTINO CA 95014 (342 22 100)
CRAIG A ROGERS
CONSTRUCTION INC
SAN JOSE, CA 95136
OWNER'S NAME:
DATE ISSUED: 10/09/2015
OWNER'S PHONE: (
PHONE NO: (
LICENSED CONT A TOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #978553
Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11/30/2016
—BLDG —ELECT _ PLUMB
MECH RESIDENTIAL C6MMERCL4,L
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.
JOB DESCRIPTION:
**LOT B** HILLSIDE- CONSTRUCT 3 STORY SFDWL 2640 SQ,
I hereby affirm under penalty of perjury one of the following two declarations:
ATTACHED GARAGE 440 AND PORCH 173 SQ & RETAINING
t. I have and will maintain a certificate of consent to self -insure for Worker's
WALL(S) ATTACHED & NEAR FOUNDATION (SEE PLN SHT S8.1
as provided for by Section 3700 of the Labor Code, for the
FOR LOCATIONS).
performance of the work for which this permit is issued.
REV# 1 - NECESSARY REVISIONS DUE TO GRADING CHANGES
44Compensation,
- I have and will maintain Worker's Compensation Insurance, as provided for by
(PIERS, RETAINING WALL); MINOR FLOOR PLAN CHANGES.
Section 3700 of the Labor Code, for the performance of the work for which this
ISSUED 6-1-16.
permit is issued.
(8/31/2016) REV #2 - ADD BASEMENT (427 SQ FT). ***ISSUED
APPLICANT CERTIFICATION
10/19/2016***
1 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, 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 9.15.
.
/
�"�''�ate 10/19/2016
Si �
-
Sq. Ft Floor Area:
Valuation: $500000.00
OWNER -BUILDER DF. i. R TION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
APN Number:
342 22 100
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
contractors to construct the project (See.7044, Business & Professions Code).
180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Issued by LegaCV
Compensation, as provided for by Section 3700 of the Labor Code, for the
Date: 10/09/2015
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700of the Labor Code, for the performance of the work for which this
RE -ROOFS:
permit is issued.
All roofs shall be inspected prior to any roofing material being installed. If a roof is
3. I certify that in the performance of the work for which this permit is issued, I
installed without first obtaining an inspection, I agree to remove all new materials for
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 become subject to the Worker's Compensation provisions of the , '
,Signature of Applicant:
Labor Code, I must forthwith comply with such provisions or this permit shall
Date:. 10/19/2016
be deemed revoked.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
APPLICANT CER'T'IFICATION
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
HAZARDOUS MATERIALS DISCLOSURE
relating to building construction, and hereby authorize representatives of this city
I have read the hazardous materials requirements under Chapter 6.95 of the
to enter upon the above mentioned property for inspection purposes. (We) agree
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
to save indemnify and keep harmless the City of Cupertino against liabilities,
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
judgments, costs, and expenses which may accrue against said City in
Health & Safety Code, Section 25532(a) should I store or handle hazardous
consequence of the granting of this permit. Additionally, the applicant understands
material. Additionally, should I use equipment or devices which emit hazardous
and will comply with all non -point source regulations per the Cupertino Municipal
air contaminants as defined by the Bay Area Air Quality Management District I
Code, Section 9.18.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Signature Date 10/19/2016
Owner or authorized agent:
Date: 10/19/2016
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS;
10655 CORDOVARD CUPERTINO CA 95014 (342 22 100)
OWNER'S NAME:
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor OWNER -BUILDER Date
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
'ith Section 7000) of Division 3 of the Business & Professions Code and that my
cense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
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.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. l 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, 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 6-1-16
I hereby affirm that I am exempt from the Contractor's License Law for one of the
two reasons:
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 construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
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.
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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
certify that 1 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, 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 6 1-16
CONTRACTOR: PERMIT NO: 14060192
OWNER -BUILDER
DATE ISSUED: 10/09/2015
PHONE NO:
BUILDING PERMIT INFO:
—BLDG —ELECT _ PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
**LOT B** HILLSIDE- CONSTRUCT 3 STORY SFDWL 2640 SQ,
ATTACHED GARAGE 440 AND PORCH 173 SQ & RETAINING
WALL(S) ATTACHED & NEAR FOUNDATION (SEE PLN SHT S8.1
FOR LOCATIONS).
REV# 1 - NECESSARY REVISIONS DUE TO -GRADING CHANGES
(PIERS RETAINING WALL); MINOR FLOOR PLAN CHANGES.
ISSUED 6-1=76."
APPLICATION EXT'D TO 9/27/15
Sq, Ft Floor Area; I Valuation: $500000.00
"N Number; Occupancy Type:
342 22 100
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued /0 SEAN HATCH / jJ
Date: 100/09/2013
RE -ROOFS:
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 ofApplicant:
Date: 6 1=16
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
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
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 6 1=16
C'ONS'TRUCTION LENDING AGENCY
L. CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10655 CORDOVA RD
OWNER'S NAME:
OWNER'S PHONE:
® LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 4
Contractor Date
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 nereuy affirm under penalty of perjury one of the following two declarations:
t. 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.
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.
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 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, judgme
costs, and expenses which may accrue against said City in consequence of e
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
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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
¢ I�s e (Sec.7044, Business & Professions Code)
y s owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
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 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,
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.
v/r //S-
CONTRACTOR: 001 LI LYNN AND WU PERMIT NO: 14060192
JACK R
1457 KOCH LN DATE ISSUED: 10/09/2015
SAN JOSE, CA 95125 PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
**LOT B** HILLSIDE- CONSTRUCT 3 STORY SFDWL 2640
SQ, ATTACHED GARAGE 440 AND PORCH 173 SQ &
RETAINING WALL(S) ATTACHED & NEAR FOUNDATION (SEE
Sq. Ft Floor Area: I Valuation: $500000
APN Number: 34222100.00 1Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF
180 DAYS LAS1
T ISSUANCE OR
ED INSPECTION°
Date: /r)
RE -ROOFS:
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:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous 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 the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow or horizee e�ntt
Date• �b j
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my.plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060192
10655 CORDOVA RD CUPERTINO CA 95014 (342 22 100) CRAIG A ROGERS
CONSTRUCTION INC
SAN JOSE, CA 95136
OWNER'S NAME: DATE ISSUED: 10/09/2015
OWNER'S PHONE: ( PHONE NO: (408) 978-5484
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #978553
Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11/30/2016 — BLDG — ELECT — PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH — RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
**LOT B** HILLSIDE- CONSTRUCT 3 STORY SFDWL 2640 SQ ,
I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE 440 AND PORCH 173 SQ & RETAINING
1. I have and will maintain a certificate of consent to self-insure for Worker's WALL(S) ATTACHED & NEAR FOUNDATION (SEE PLN SHT S8. 1
Compensation, as provided for by Section 3700 of the Labor Code, for the FOR LOCATIONS).
performance of the work for which this permit is issued. REV #4 - SITE WORK TO INCLUDE NEW DECKS AND STAIRS (920
2. I have and will maintain Worker's Compensation Insurance, as provided for by SF), RETAINING WALLS (230 LF TOTAL), TRELLIS (162 SF), AND
Section 3700 of the Labor Code, for the performance of the work for which this SPA WITH SAFETY COVER - ISSUED 01/15/2019
permit is issued.
APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $500000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 342 22 100
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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 01/15/2019
Issued by: Legacy
Date: 10/09/2015
OVVNER- D %RECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner-of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 01/15/2019
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Co
correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 01/15/2019 Licensed
Professional
CITY OF CUPERTINO
FEE ESTIMATOR — RITILDING OIVIgION
ADDRESS: 10655 Cordova rd
TYPE OF
CONSTR.
DATE: 06/30/2014
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: $500,000
*PERMIT TYPE: Building Permit
II-B,III-B,IV,V-B
PLAN CHECK TYPE:
New Construction
PRIMARY SFD or Duplex
USE:
$3,566.36
2nd Unit? r'
Yes " No
PENTAMATION 1R3HILL
PERMIT TYPE:
WORK
construct 2 story sfdwl 3214 sq,
attached garage 440 and porch 173 s'
SCOPE
Permit Fee.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Hillside, Custom)
II-B,III-B,IV,V-B
3,827
$$,514.28
IR3HPLNCK
$3,566.36
IR3HINSP
$0.00
PME Plan Check:
$0.00
Permit Fee.
$3,566.36
Suppl. Insp. Feer Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
3,827
$5,514.28
Construction Tax: IBCONSTAXR
$3,566.36
11
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
%)Z.Qtrirt_ Ptlt ) Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711,113)
FEE
1 _an �, zc.=.
f
.t It .. r.. tit, f •"_c..
?. r,�r: _?,. tE t`...:.
!'.... t2'S-1, s t...c.
.$5,514.28
')= F)' _
t
h3"'jp
0.0
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
%)Z.Qtrirt_ Ptlt ) Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711,113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
.$5,514.28
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee.
$3,566.36
Suppl. Insp. Feer Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$659.99
0
E)
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee. IPLLONGR
$535.78
Select a Non -Residential
Building or Structure
0
0
Strong Motion Fee: IBSEISMICR
$50.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$20.00
SUBTOTALS:
$10,346.41
$0.00
TOTAL FEE:
$10, 46.41
Revised: 04/01 /101 4