13090064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1132 HUNTERSTON PL CONTRACTORS PERMIT NO:13090064
OWNER'S NAME: ZALUSKY ROBERT L AND MICHELINA DATE ISSUED:09/10/2013
OWNER'S PHONE: 4082553642 k ri Cks PHONE NO:
I ENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
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License Clas Lic.# L�
INSTALL SOLID ALUMINUM PATIO COVER ATTACHED
TO
Contractor Date G (.� REAR SFDWL
I h reby of hat I am ensed _ der the provisions of Chapter 9
(co mencin with Section 7000)of ivision 3 of the Business&Professions
Code a a(,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. Sq.Ft Floor Area: Valuation:$5700
°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 APN Number:36222027.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the abov entioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
inde ify k p harmless the City of Cupertino against liabilities,judgments, �j
costs,and a en es which may accrue against said City in consequence of the Issued b Date: `�'l-1 U
granting of is ermi. Addi'o ally,the applicant understands and will comply y'
with 11 no o' t so cc re la'ons per the Cupertino Municipal ode,Section
9.18.
RE-ROOFS:
Signa a Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
Ilk, installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
171 OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 2553 a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,sho d I us quipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as deft"y4=bb'
It ay Area Air Quality Management District i
performance of the work for which this permit is issued, will maintain complian a with th , aper mo M icipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety C de Sec io 255 ,2553 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Date: /,,
Owner or authorized ge
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall , J
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
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 I hereby affirm thatthere is�ya construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
W*PERMIT
DDRESS: 1132 HUNTERSTON PL DATE: 09/10/2013 REVIEWED BY: Mendez
PN: BP#: � *VALUATION: $5,700
PE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENMIT TYION 1 R3SFDADD
USE: p PERMIT TYPE:
WORK I INSTALL SOLID ALUMINUM PATIO COVER ATTACHED TO REAR SFDWL
SCOPE
iWJi . /'tan 0-jeck Phwnb. Plan Check Elec.Plan C;hecl�
"Wed). Ilernrit Fee, Plumb. i'eomil Fee, I:lec, Permit Fee:
Other Alech. hasp. EIFI_ Other Phonb Insp, Other Elec.Insp.
Ilech. hasp. Fee: Phnwh. h?sp. Pee: Elec.Insp.Pee:
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseor addn'l info.
-fees are based on the relimina information available and are onl an estimate. Contact the De t
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 207 s.£ Patio Cover/Sun Room
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $695.00 1PATIOMETA Metal
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
T=
PME Permit Fee: $0.00
Corzstt•uciion KIN.
fldininisivative.Fee: 0
Work Without Permit? 0 Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Travel Doci.nnentation Fees: A
Strong Motion Fee: IBSEISMICR $0.57 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.57 $695.00 TOTAL FEE: $696.57
Revised: 07/01/2013