13020003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18701 HANNA DR CONTRACTOR:DIETER STATEZNI PERMIT NO: 13020003
OWNER'S NAME: DIETER STATEZNI 18701 HANNA DR DATE ISSUED:03/14/2013
OWNER'S PHONE: 4082309332 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALO _
License Class Lic.# CONSTRUCT A 530 SQ FT ADDITION WITH A 432 SQ FT
GARAGE AND A 31 SQ FT COVERED PORCH. DEMOLISH
Contractor Date (E)GARAGE(365 SQ FT).
I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1-ADD(N)COMP ROOF TO(E)STRUCTURE(14
(commencing with Section 7000)of Division 3 of the Business&Professions SQ'S)-ISSUED 5/9/2013
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. Sq.Ft Floor Area: Valuation:$150000
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:37529008.00 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 above mentioned property for inspection purposes. (We)agree to save 180 DAYS F ST CALLED INSPECTION.
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 _d,9 b-3
and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
Cyd' OWNER-BUILDER DECLARATION
Signature of Applicant: � Date: 5- 9X3
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 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent• Date•S '7
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a 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
ADDRESS: 18701 HANNA DR DATE: 05/09/2013 REVIEWED BY: MELISSA
APN: 375 29 008 BP#: 13020003 *VALUATION: Iso
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: p PERMIT TYPE:
WORK RE-ROOF E SFD TO MATCH ADDITION FOR PERMIT# 13020003
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,400
Xtech. Plan Check Phonb.Plan Check Elec.Plan L'c:ck
1.1c>ch. Permit Fe-, Plumb, Permit Fee: Elec.Permit
Other 11lech_Insp. Other Plumb Insp. Li L Other Elee,Insp.
llech. Insp. Faze: hrsp. Fc-., r 10c.Imp.Fce:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Dept
or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1!13) FEE QTY/FEE MISC ITEMS
Permit Fee: $210.00
Suppl. Insp Fee
Plumb.11fech.lElec
Plumb./Allech./Elec Permit UOC.
Constrztction Tar:
4dninistrative Fee:
Work Without Permit? 0 Yes Q No $0.00
Strong Motion Fee: 1BSEISMICR $0.00 Select an Administrative Item
BldgStds Commission Fee: $0.00
SUBTOTALS: $210.00 $0.001 TOTAL FEE: 1 $210.00
Revised: 04/29/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18701 HANNA DR CONTRACTOR:DIETER STATEZNI PERMIT NO: 13020003
OWNER'S NAME: DIETER STATEZNI 18701 HANNA DR DATE ISSUED:03/14/2013
OWNER'S PHONE: 4082309332 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONT'RACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lic.# CONSTRUCT A 530 SQ FT ADDITION WITH A 432 SQ FT
GARAGE AND A 31 SQ FT COVERED PORCH. DEMOLISH
Contractor Date (E)
I hereby affirm that I am licensed under the provisions of Chapter 9 GARAGE(365 SQ FT).
(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. Sq.Ft Floor Area: Valuation:$150000
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:37529008.00 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 above mentioned property for inspection purposes. (We)agree to save 180 D=M OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, �
costs,and expenses which may accrue against said City in consequence of the Issued by: Date-- 1 �13'
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.
RE-ROOFS:
Signature Date 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.
❑ 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(Scc.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 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2255533,and 25534. j
Section 3700 of the Labor Code,for the performance of the work for which this /� -/ V-L
Owner or authorized agent: Date: I/,,/
L
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a 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 f /y
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18701 Hanna Dr. DATE: 02/04/2013 REVIEWED BY: jsg
APN: BP#: d - "VALUATION: $150,000
rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? 0 Yes 0 No PENTAMATION 1 R3SFDADD
USE: OTC? Q Yes No PERMIT TYPE:
WORK Addition of dining, living room 1/2 bath and garage. Removal of existing detached garaqe.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 993 $2,468.00 IR3PLNCK $1,549.00 IR3INSP
TOTALS: 993 $2,468.00 $1,549.00
MECH,HOURLY 0 Yes (F) No PLUMB,HOURLY Q Yes (j) No ELEC,HOURLY Q Yes E)No
i'Ltech. Plan Check Plwnb. Plan C'heeT-T Elec.Plan Check
ltecb. Permit Fee: Plumb.Permit Fee: Elee.Permit F::
Other illech. hasp. Other Plumb Insp. Other flee.Insp. ET
�Wcch.Ins�;r Phmh. Insp. Fl".- Elec.Insp. Fee
NOTE:This estimate.does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etG). Thesefees are based on the prelhiniina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,468.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,549.00
Suppl. Insp. Fee.0 Reg. Q OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C'onsit7tction Tavl
din111lStrativv Fee:
Work Without Permit? Yes i@ No $0.00 G
Advanced Planning Fee. 1PLLONGR $129.09 Select a Non-Residential G
Building or Structure
i
Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $6.00
SUBTOTALS: $4,167.09 $0.00J TOTAL FEE: $4,167.09
Revised: 01/01/2013