12020118 CITY.OF CUPERTIN.O:BUI_LDING PERMIT
BUILDING ADDRESS,:, 10081JUDY AVE CON"PRACTOR:GRAND=NEST PERMIT'NO: 12020.118
eg CONSTRUCTION'
O�VNER'S'N'AME-:'HONGJERRY13428 CHRISTINE;DR, DA"TE 1-SSUED,;06/21/2012
OWV'ER'S_PIIONF.: 40.83864948. SARA-TOGA;CA,25070 PHONE NO:408-89t-80,59
❑ LICENSEtIfONTRACI;OWS DECLARATION I` I
BUILDING PERMIT INFO:,. BLDG ELECT PLUMB
License Class Lic'.:#
NfECH RESIDENTIAL COMMERCIAL
Contractor� Date
Jhere_by,Alr,mrthatIaid licensedunder the provisions,,ofChapter9 SOB DESCRIPTION CONS"IRUCT`2;STORY'SkDW_L-3�771.SQ.t•'f;1'ORCfh89SQ
(commencing with Section 2000)of Division:3 of the Business&Professions 1'f&'DOCK AREA 725 SQ l'1'W/AT"LACI IED TWO CAR.;
Codcia'nd;thaf,my license is`,in full force and effect. 'GARAGE_427 SQ FlI--,SANITARY IS'SUNNY?VALE'S� ,
herebydaffirm under penalty,of perjuryone ol`Al a foll'owing�tw:o declarations:
I have and will maintain a�ceitificate.of consenvto self-iiisure�for Worker's
`Compensation,as provided for by Section 3700 of the-Labor°Code,,forthc
performance ofthe•Wbik for whi"ch this permit is:issued.
I have and will maintain Worker's°Compen-sation Insula"nce,as'provided,for byi
Section 3700 ofthed.;abor Code,for'the performance ofthe,work'forwhich,;th_is Sq.,Ft,Floor Area: VaPuation:-$51'0000
pemiit i' issued. _
APPLICANT CERTIFICATION. APN_Number:37507049.00 Occupancy'I'
I ccrtify,4115Ul have`read this application and,state Ihattlie above'ihformatioh is
correct. I agree to'com,ply with all city and county ordifia6ces and state lawsrclating.
to„building'construcfion,and'hercby authorize rcpreseritatives'rof thi's'citytto.enter
uponji-ic-above,mentioned property for:inspection purposes. (We)agreejo save, PERMIT EXPIRES-IF WORK IS NOT STARTED
indemnifyand'kecp harmless the City of,Cupertino against;liabihties,,.judgments,
costs,,andyexpense-s'which..mayaccrue-against said City of co nee of the WITHIN I80.DAYS OF PERMIT' ISSUANCE OR
:grantmg`oftliispermit. Additionally;,thc'applicant understands and wilLcornply 180 DAYS FROM LAST CALLED INSPECTION.
•with ail non-point source regulations per'the Cupertino'MuriicipalPCodc„Section p
9.i8. /
/ Issuzd Date:
Signature__==_ � l /lid Date
❑ OWNER''-BUILDER DECLARATION
RF-ROOFS:
hcrcby,affirm that Lam exempt from the,.Coritractor!ss.License Law for oneof _Ah'rools shall be inspected prior to,Eany',roofing material being instal_Ied. I f&roof,is,
the following two reasons:, installed without`lirst obtaining An inspection, (agree,to remove all new materials'for
1,as owner of,the property,or my cinpfoyeeswitli wages as their.so]e:compensation, ,inspection-.
will:do.the'work,and,thestructure isnot intended•or offered for sale:(Sec.7044,
Business,&Professions Code) Sigriature.ofAppli'cariL Date:
I,,as owner oftlie property,am eXclusively contracting with licensed contractors.to -
c'onstnrctthe;project(Sec.7044;,B,us_iness&.Professions Code). _ ALLiRo6E COVERINGS TO BE CLASS"N”OR BETTER
1 hereby affirm under penalty of?pi jury one:of the following three
declarations:
I`,have,aird will maintaih aSCertificate,of,Conseni to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as`prov.ided foriby"Section 3700 of the Labor Code, for I'Ifave read tlie:hazapdous materials requirements under Chapter 6.95 of the
performaricc`oftlic workfor'whi'ch,tli s,permit,is issued.- California Health'&Safety Code,Sections 25905„25533,and 25534. I will,maigtain
I hive and will maintain,Worker's Compensation Insurance,as provided'fcr by comCodi<ith th .Culf r i s Municipal Code,Chapter 9 12'and„the IIealth&-
com liancc with tlic.Cu crtino
S"ection 370Wo.fthe Labor Codejor'tlie,performance+ofthe.wuk for-which this Safety,_ (,). hould I store or handle hazardous rriafcrial.
Additionally,,;should I use;eguipmentor devicesrwhich c`niit hazardouslair
permit°is issued!., contaminants as defined by the Bay Area Air Quality Management Distr,ictrl will`
,I':certify that.in;the,performance,of'the workrfor'whieIvthB!,perrrnt is'issu'ed,1 shall maintain compliance with"the Cupertino Municipal'Code,Chapter,9.12 and the
not employ anypersonin anynianner"so assto.becomc-subjec't;to the Worker's Health&Safety Code,Sections 25505,r25533,and 25534.
'Compensation laws,ofCsliforn_ia. 'If.after making this,certificate'ole,�cmptioii;j
becomcsubjcet,tothc'Worker's Compensation,provisions oftheLabor'Code;.lanrffst Owncrroor/. Date
auuuihorized;agent: �J
p —v
forthwith comply with such provisions orthis, ennrtshall be dcemed.rcvoked. '4A
AP-EI;ICA'NT CER7`IFICA'1lON CONSTliUCT,ION LENDIN'G.AGENCY
(certify tliat`1 have„read this application,and,state tha(the�'above?,info rill ation is 1 here-byafflrm•that there is a.constriicti'on lcnding;agency for the performance of work's
correct:1 agree t&conrplywith all,cityand.county ordinances and state laws,rclating for which^this perrrii"t'is issued(Sec'.-309;7,Civ,C.)
to building,,construction,and`hereby authorize°representatives of this,cit'ytto•enter Lender'ssNarne
upon;thc)aboye,mcntioned property for inspection purposes.(We)tagrce;to save
indeninify and'keep harmle-'ss,'the City o'fCupertino againstliabilities;judgments, Leodcr's.Address
costs,!and"exp.enses,which-may accrue,agai-vsaid City:in consequence o'f�the
g - p y, pp s and will comply
,Withall non-point source dregulauons perlth"e CupertinoeMume'ipal Ccde;Section ARCIIITEGT'S DECLARATION
1understand my plans shall be'used,as public records;;
-Signature Date Licensed Professional
CITE'OF CUg-_E_ TIN ._
• h p
ALDDI2Ess: 10OWrjudy.ave. GATE: RiENARWED BY: bob s.
aPN: BP4; A; Oo?O/�. *v��i�,u�►�r ON, ' 0,006,
kPE1IT TYPE: Building Permit PLAiIE TYPE: New Construction
USE _,..
P12II4AFt ,nd L?nrt7 des No PENT'aM: cIciiv 1R3SFDUV
SFD or Duplex
PER T TYPE':
N116RK .�_cbfttrOtt new 2,stb `sfd._
SCOPE' - - - - - -
TYPE;Qf FLR,AREA -
OCCUPANCY TYPE: PG,FEEa PC �FE;II) 13PIF,ES' BP'�TE,[D
R=3 (Custorri) II B III-B IV V=B 5,01.2 $3;06:1.55 IR3F'ENCK $8,,.02.05 IR3IlUSP
TOTALS 5012 $3;06=1 55 r , $3 792 05
Re_.,�.
t lc:c`oa Mon
I'. ..
A J.:.., 1'is
NQTF:`.This'estimcae does not,include fees:drte,to other Diparfinents(i.e,Planning,PuNic-Xorks,Fire,,SaniiarySewer District,School
.District,etc:)., These ees lite bdkil_on4h,;,& huin4u _.Jn ornfldori,availdbke dtid,ure nn'ly esti estintafe:,.Cotitact°the>De t eir.kddtaY in o.-_
FEE ITEMS_(I'ee.11e.sohilrort 11-Oar E{f. '/14111' F'.EE, QTY/FEE-' ! IVLI 'ITEMS''
Plan Check,Fee:- $3,061;55 Select a lv iscBldgiSiructure
S'gly_:PC Fe0 Reg. OT (}:0 hr's $0.0®
or Ele - nt:of:a Building
F'M'F~PlanCheck: $0,00
Peftiift.Fee: $3,;7:92.05
Supp[Ansp.Fee Reg. 0'OT Q-`Q ;i `.firs $0.00
PIv1E iJ'n_'it Fzz $0.00
PN'1E`Pefliilt Fee: 0 00
#nett
Construction Tax,: 1BGONi'Tf A 1, unit, $583 80
Of
`York Without Permit? 'Yes `No $0.00
Advanced.P.hiiini i {ree" PLL(NGT'GR $651.56' Select;a.Norl-Residential
I,i'fd,�c .)f.3:1 a., r?''at ei.e,.=`E": :. Budding'or Structure'
Strops°Mofian'hee' 1BSEISMICR- $5:1„00 Select:an Adininistrat veItem
Bldg St&Commission Fee:,. IBGBSC $21.00
' � SLTBTCTI S $8 160.96 $0 00 TTL F1i E 8 16Q 9°6
_.. _ - . . ..6 :. �._. .., ,
Revised: 1/1,0/2012