12030101CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1137 SCOTLAND DR I CONTRACTOR: AVAKIAN EDIK TRUSTEE I PERMIT NO: 12030101 I
OWNER'S NAME: AVAKIAN EDIK TRUSTEE 11137 SCOTLAND DR I DATE ISSUED: 07/19/2012
OWNER'S PHONE: 4082306414 I CUPERTINO, CA 95014-5060 1 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.#
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 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.
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
611) OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following 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).
I hereby affirm under penalty of perjury one of the following three
declarations:
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
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
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. ,p �7
Signature/ T V�—"�`— Date / Z
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH F RESIDENTIAL r COMMERCIAL F
JOB DESCRIPTION: SFD ADDITIONSF, BEDROOM, BATHROOM, WALK IN
CLOSET, LIVING ROOM, 200 AMP SERVICE PANEL
UPGRADE
Sq. Ft Floor Area: I Valuation: $35000
k1'N Number: 36226057.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Dater /,l7_ /-L—
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(x) 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.
Owne or authorized agent: f 4 �2
Date: 1
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
,5po 120 3o I 1c) I
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1137 scotland drive
DATE: 03/19/2012
REVIEWED BY: larrys
APN:
BP#:
'VALUATION: 1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Duplex 2nd Unit'? 0 Yes -0 No
USE: � OTC? 0 Yes E) No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK
addition, 498 sq ft. bedroom, bathroom walkin closet, living room. 200 amp service panel upgrade
SCOPE
PME Plan Check:
........................................... - ..........
0C0fPANC1'TYPF:
TYPE OF
CONSTR.
FLR AREA
�sf
(..)
PC FEES
PC FEE ID
BP FEES BP FEE ID
R-3 (Custom.)
11-B,111-B,1V,V-B
498
$1,482.00
IADDPLCK
$1,205.00 ]ADDINSP
hrs
$0.00
PME Plan Check:
$0.00
200 amps Electrical
$44.001 IERT<200 Services
Permit Fee:
$1,205.00
Suppl. Insp. Fee -0 Reg.
0 OT 0.0
lirs
......................... ........ . .
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
498
$1,482.00
$1,205.00
EC I, HOURI.,Y 0 Yes 0 No
PLUMB, HOURLY 0 Yes (3) No
EIEC, HOURLY 0 Yes G) No
MISC ITEMS
7
Elec, Plwi Check 1 0.0 1 hrs $0.00
$1,482.00
IElec. Permit Fee: IEPERAffT
Suppl. PC Fee: 0 Rea,
Other Elec. Insp. 10.0 1 hrs $44.00
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prefininarp information available and are only an estimate. Contact the Dept -for addh 7 in/b.
FEE ITEMS (Fee Resolution I I- OL; Eff. 711/11
FEE
QTY/FEE
MISC ITEMS
7
Plan Check Fee:
$1,482.00
Select a Misc Bldg/Structure
or Element of a Buildim-,
Suppl. PC Fee: 0 Rea,
hrs
$0.00
PME Plan Check:
$0.00
200 amps Electrical
$44.001 IERT<200 Services
Permit Fee:
$1,205.00
Suppl. Insp. Fee -0 Reg.
0 OT 0.0
lirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
F—]
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fec:
PLLONGRNGR
$64.74
Select a Non -Residential
Building or Structure
0
A
0
Travel Documentation Fee: I TRA VDOC
$44.00
IBSEISAffCR
$3.50
Select an Administrative Item
Bld,,= Stds Commission Fee` IBCBSC
$2.001
SUBTO,rALS.
$2,845.24=$44.001
TOTAI, FEE: $2,889.24
Revised: 1/19/2012
A