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15100190CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100190 20846 CHERRYLAND DR CUPERTINO CA 95014 (359 20 03 1) OWNER/BUILDER OWNER'S NAME: CHERRYLAND LLC OWNER'S PHONE: 408-568-0616 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor OWNER/BUILDER 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 hereby 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. 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 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, 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 03/25/2016 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 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). 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. a. 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 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. Signature �� I Date 03/25/2016 erry" L' -G DATE ISSUED: 03/25/2016 PHONE NO: TBD BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) 2 STORY SFD (3,266 SF) WITH ATTACHED GARAGE (464 SF) AND COVERED PORCH (277 SF) Sq. Ft Floor Area: I Valuation: $540000.00 "N Number: Occupancy Type: 35920 031 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF UANCE OR 180 D I I I 4PF( T1nN_ Issued by: 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 ofAppl Date: 03/25/2016 ROOF COVERINGS TO BE CLASS "A" 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: 03/25/2016L L i I hereby affirm that there is a construction lending agency r 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 FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 20846 Cherryland Dr DATE: 10/23/2015 REVIEWED BY: Phuong O�P APN: 359-20-043 BP#: *VALUATION: $540,000 ERMIT TY PE:PE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes No PENTAMATION PERMIT TYPE: 1 R3SFD i WORK CONSTRUCT N 2 STORY SFD (3,266 SF WITH ATTACHED GARAGE 464 SF AND PORCH 277 SCOPE SF) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 4,007 $3,280.73 IR3PLNCK $3,549.93 1R31NSP Permit Fee: $3,549.93 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $687.10 tl(lininistr•cativc P'c c: E) Work Without Permit? © Yes Q No $0.00 TOTALS: 4,007 $3,280.73 Tru��crl Dncurnentutiora Fees: $3,549.93 Strom=, Motion Fee: IBSEISMICR 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 preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 a.' 7/U13U 11ech. Plan Check Plumb. Plan Check aec. New Cheek dlech. Permit Fee: Plumb. Permit Fee Elec. Permit Fee Other Mech..lnsp. Other Plumb Insp. )cher Alec. hasp. $0.00 Plumb. Insp. Fee: �. 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 preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 a.' 7/U13U FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,280.73 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: O Reg. () OT 0.0 T hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,549.93 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $687.10 tl(lininistr•cativc P'c c: E) Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $560.98 Select a Non -Residential 0 Building or Structure � Tru��crl Dncurnentutiora Fees: Strom=, Motion Fee: IBSEISMICR $70.20 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $22.001 SUBTOTALS: $8,170.94 $0.00 TOTAL FEE: 1 $8,170.94 Revised: 10/01/2015