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12080322-F CITY OF C>I P ERTI NO ]BUILDING PERMIT BUILDING ADDRESS: 10225 GLENCOE DR CONTRACTOR:PETER LOC PERMIT NO: 12080322 OWNER'S NAME: PETER LOC 10225 GLENCOE DATE ISSUED: 11/02/2012 OWNER'S PHONE: 4089830541 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PEIlaIrtiIl'Il'INFO: BLDG IElL1EC'I'r IPILUJIa'iIJB r License Class Lic.ti M ECH r— RESIDENTIAL L F COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT A DETACHED GARAGE 504 SQFT AND (commencing with Section 7000)of Division 3 of the Business&c Professions OFFICE Code and that my license is in full force and effect. SPACE 493 SQFT.TOTAL 997 SQ FT 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 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. Sq.Ft Floor Area: Valuation:$80000 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:32630019.00 Occupancy Type: 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, PERMIT lEX?fIR ES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF IP'IEI[BM1<T ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 D YS gj'R®ly[JL.AS;CAIL.IL.IEIID INSPECTION. 9.18. J Signature Date Issued by: Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&c Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the CupertinoMunicipalshould 0t Code,Chapter 9.12 and the Health&c Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&c Safety Code,Sections 25505,25533,and 25534. 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. Own or orizec�apg��ent:� 11��- Date: (, ��— APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. i 0 (� 1 understand my plans shall be used as public records. Signature Date ILicensed Professional 1 CONSTRUCTION PERMIT APPUCATM ED COMMUNITY DEVELOPMENT DEPARTMENT^BUILDING D 1SJRPR 10300 TORRE AVENUE>CUPERTINO, CA 95014-3255 —(408) 777-3228^ FAX(408)777-3333 buildin cu ertino.Or [��R��QJJ J ONEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESSa LEW OF- I* APN# OWNER NAME ��I �� PHONE r_j� p3 E-MAIL l 0 . STREET ADDRESS CITY, STATE,/�ZI(PJ�1 u �b i tk)/ci�4��J rI L FAX CONTACT NAMEC LA R I AJ� PHONE�/,®�D�p'�'^`� E- STREET ADDRESS O' 63,9 CITY,STATE,Z� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 9 ENGINEER ❑ DEVELOPER ❑ TENANT [CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGIN -XM LICENSE NUMBER BUS.LIC# COMPANYNME E-MAI e FAX STREET ADD SS '�� CITY,STATE,ZIP 9 PHO DESCRIPTION OF WORK X41 � 3 EXI ING USEPROPOSED USE CONSTR.TYPE #ST RIES .� 1 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA G GL PORCH AREADECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UMTS: IS A SECOND UNITS SECOND STORY F1BEING ADDED? O ADDITION? l O PRE-APPLICATION ❑ IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED'BY TOTAL VALUATION: PLANNING APPL# PLANNING APPROVAL LETTER EICHLER HOME? ARG By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I h ve read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu ng constr ction. I authorize representatives of Cupertino to enter the above-id ritifil property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT INFORMATION REQUIRED ��'PLAN CfECK'TYPE ,,w RoUnNG'SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ,p❑ OVER-THE-COUNTER „ BUILDIING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. E)XXESS � PLkrNl G PLAN'REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure y STANDARD. PUBLICWORKS, form if any Hazardous Materials are being used as part of this project. ;,E] 'LARGE IREDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. a0 nlAroRSANITARY,SEWER DISTRICT' ENVIRONMENTALHEALTH B1dgApp_2011.doc revised 06/21/11 MY OF CUPEIaTING '�� 19e' �0 FEE ESTIMATOR—BUILDING I➢IVISI®lei ADDRESS: 10225 Glencoe Br DATE: 08/31/2012 REVIEWED BY: Sean AIN: O ()ICJ EP#: *VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY 2nd Unit? , Yes No PENTAMATIION USE: SFD or Duplex PERMIT TYPE: 1U1 WORK [Construct a detached garage/office 997 sq ft). SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FLEE IID BP FEES B?FEE IID CONSTR. s.f. U (Private Gar/Ag Bldg) II-B,111-B,IV,V-B 997 $0.00 /U/PLNCK $1,199.00 IUIINSP TOTALS: 997 $0.00 $1,199.00 :Lfec:h. Plan Check phunb.Plan ChecA Eh e.flan Check rlkkch. Pernril Flee: Plumb.Permit Fee: F1ec. Permit Fee: Other Afeeh.Insp. El Other Plumb Insp, EJ Other Eler Insp. Wch.Insp.I,ee: Plumb, lisp.Fee: Elec.Insp,Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the grelimina information available and are on!y an estimate. Contact the De t or addh 7 in o. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MffSC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: (D Reg. OT Q,Q hrs $0.00 or Element of a Building PME.Plan Check: $0.00 Permit Fee: $1,199.00 Suppl. Insp. Fee:Q Reg. ® OTQ Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1 Construction Tax: IBCONSTAxR #new $595.41 units Adlnirdstrative.Fee: 0 Work Without Permit? Yes (j) No $0.00 E) Advanced Planning Fee: IPLLO1vGR $129.61 Select a Non-Residential E) Travel Documentotion Fees: Building or Structure01 a Stronp, Motion Fee: IBSEISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $1,936.02 $0.00 TOTAL FEE: $1,936.02 Revised: 07/01/2012