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12050064 CITY OF CUPERTIN:O BUILDING PERMIT BUILDING•A_ DDRESS 10406 PALO VISTA RD CONTRACTOR,;.YD HAALAND PERMIT NO: 12050064 CONSTRUCTION;INC OWNER'S NAME: P.ALO'VISTA.LLC -575 AGUAJITO RD DATE ISSUED;107/19/2012 OWNER'STHONE: 4084645030 °CARMEL,,,CA 93923 PHONFNO:(831j726=1577 ❑ LICENSED.'CONTRACTOR'S DECLARATION l7 Vii. BUILDING PERMIT-INFO: BLDG ELECT PLUMB License.Class Lic.:# ✓'�9Z/_ _ MECH'. RESIDENTIAL' COMMERCIAL f ContractorJ'� x"77. Date I`hereby,affiern that]am,licensed underth_e provis_ibns�;of Chapter 9 JOB DESCRIPTION:-CONSTRUCTION A.3778 SQF,T TWO°,STORY RESIDENCE; (eommencing'-with,Section'7000)ofDivision;3;ofthe_Business&_Pro_fes_sions WITH Code and that my license;:is_in full force and effect. A,489';SQFT GARAGE AND".4308+SQFT COVERED.PORCH I hereby affirm under penalty of perjury one,of the folfi wing`two,declarations: I have and,will maintain;a certificate of"consent,to,self-insurerfor°\Yorker's Compensatigp,as:provided,for by Section 3700 of the Lalior Code,for the performance oftheworkforwhich this permifis.issued. I.have,and will maintain Worker's Compensation>lnsurance,asProvided for by Section_`3700 of the Labor,Cod6jo'rtheperformance ofthe,work for which this permit is issued. Sq.Ft Floor Area: Valuation:$670000 APPLICANT CERTIF[CATION licertifythatl have,read:this,application and statethatthe above inforination'is APN Number:35702048.00 occu_pa_ncy Type: correct.1 agree,to;comply witkall city and;county�ordinances'and.state,laws relating to,building?construction,and=herebyauthorize representatives bfthis city,to enter upon the above,mentioned�oiopeity'.for'.inspection`purposes (We)agree to save indemnifyand keep]iarmless theiCity,of Cupertino against liabiliiies judgments; PERMIT EXPI--RES IF WORK IS NOT'STARTED costs,,and.eth h may accrue against said City m,consequence of'the granting,ofAdditionally,the applieantunderstands_and will comply WITHIN1'80,DAYS:OF PERMIT ISSUANCE OR with all nongulation - li perfinb Municipal ode,Section180 DAYS FROM LAST CALLED:INSPECTION. •9.18. Signature Date, ►1- Issued bye ate, `. ❑_ OWNER=BU[CDER,DECLARAT[ON "I;here by,affrm that]am exemptCromsthe Contractor's License:Law,forone of RE-ROOFS: the following hvo.reasbns: All roofs shall be inspected prior.to any roofing material being installed..lf a roof.is I,as owner oft he property,or my employees with wages as:their sole compensation,, installed without first=obtaining,an inspection,.]agree to,remove all new materials for will do:the work,and,the structure is nohinte_n_d_ed or`off'ered for,sale:(Sec.7044,, inspection. Bu_siness,&Professions Code) 1,as•ownerof the property,am.exclusivelycontracting,with.licerised.coiitractors to Signature of Applicant: Date: construct the,project(Sec.7044,Business&Professions;Code). l'hereby affirin under peualty-of perjury one of.the following�th_r_ee ALL ROOF.COVERINGS TO BE CLASS"W'OR`BETTER declarations: fhave�an'd`willmaintaiwa Certificate°of.Con sentto self!insure,for Worker's HAZA"RDOUS`MATERI'ALS DISCLOSURE Com.ensation,,ds provided for'b.Section,3700,of'the:Labor Code;for the P � P Y � performancesof the work forwhich this permit is;issued. I have"read`,the hazardous'in'aterials.regairements,under Chapter,6.95 of the Fhave;andwill maintain Worker s�Qompensationlnsurance,as,.prov.ided,foi by comCalif 1 anceornihHwith the Cupertino noty dMunic oaf CodeSGhapt r 912 and ttie Health,iotain P P P Section 3700 of the Labor:Coda;.foi-the performance of.the work for which this iSafetyC.ode,Section-25532(a)should I store orhandleihaz'ardous materia[. pcfmit.is issued. Additionally,shouldsl use equipment or devices which;emit,hazardous air kertifythat injhe,performdrice,of die•work for whichthis perrnit is issued,l'shall coritaniina as�defined,,by ihe.Bay�Area A'i'r:Quality ManagemenhDi§ti i'cf L-will not employ any`person`in any:mannerso as become subjecfto the.Wo'rker's maintain". mpl ance•with_.the Cupertino MuniciRai Code,.Chapter'9.12;and the Compensation laws of,Califomia.,If,after making'this certificate:of exemption;] Health, afety Code, e o 505,25533,and 255 becomesubject to;the Worker's.Compensation.provisions oftlie.Laboi Code,I must .forthwith comply with such,provisions or�thrsperhiit,shall'beideemed,revoked. Own or a" ori" Date:,L APPLICANT CERTIFICATION, CONSTRUCTION LENDING AGENCY I certify;thatl,have�read this applwatiorrand.state that the!above information is correct:1'agree'to comply withtall Pity,and county,ordmancmai d state lawsrelati I herebyaffrrru,ihatthere�isa construction lend_ing,agencyfor the performance ofwor>s 40 building construction,and hereby,authorize€representatives,.ofAiis city to;enter for,w1iich this permit is issued'(Seo.13097,Civ.C.-) upon the>ab-ove mentioned propeity for inspection.purp oses.(We);agree:to save Lender's.Name indemnify and keep har'mle`ss the City of Cupe_rtino°against•liabilities,.ju-dgments, cbsfs,and expenses'which'may accrue against,said,City:in consequence ofthe Lender's Address, tgrantiirg,of this permit:Additionally the applicant understandssand Nvill.comply with all..non-pointsource,reguIati ons per`the.Cupeitrno Municipal Code;Section ARCHITECT'S.DECLAR.4T[ON 9.18. 1,.understand,my plans shall be used'as public;records. Signature Date Licensed Professional CITY OF .CUPERTINO FEE,=ESTIMATOR•- BUI.LDINLG DIVISION ADDRESS:: 10406'Palo Vista`Dr DATE: 0`5104/2012 REVIEWED'BY. Sean AP,N: BP#i' ( �(' , VALUATION: $670,000 *PERMIT TYPE: Building Permit PLAN'C14EekTVPE:r New_C,onstruction' PRIMARY 2nd Unit? Yes, ° No PENTAMATION USE: SFD or Duplex P.ERMITTVPE: 1 R3SFD, WORK Constructs new 3778's ft two story residence with a 489•s eft, ars a and'a 308 sq ft covered -orch. SCOPE, TYPE�OF FIR AREA PC FEE ID BP'FEES BP FEE ID OCCUPANCY'TYPE: CONSTR.- s.f. PC;FEES. R-3 (Custom) II-6;111-B,IV U=B 4,575 $3,026,30' IR3PLN0K $3,514.-30 IR3INSP TOTALS: 4,575 $3,026,30. m. 2 $3;514 30 , rXg- �, .. Wk lik ). Plan("'heck FLfcc i. T>tlniI,FC(u Pi mhh. Po-nit 1"Ce' h'2 . Ptarx r Fee G)nc�r'Afech.Ins'--. Or'r'ier'F'Irerr!ir l isp. Jihtri'r'>lec. ins?. 11ech. Ln.i't�. Fire: l ItErlili:;Pits(.1'ea; Elec. NOTE: This estimate does.not include fees due-yo,other Departments(i.e.Pianning,Public Works;F{re„Sanitarysewer District,,School. District,etc.':• These-ties ees.ate based,6n th.e'p relarnina ,in_orniation'a'vailable and;are only,an'estimate: Contact tho De 1. or addh1,in o: FEE ITE'1VI9 (Fee.Resolution 11'v053_E '..7II�, FEE QTY/FEE, MISC ITEMS` ----------------- Plan Check Fee: $3,026.30 Select a Mi-sc 9tdg/Structure Suppl'. PC/;Fee: (2) Reg. 'OT 0�,0 hf§, $0.00 of Element of a.Building PME Plan Check: $0.00 Permit Fee: $3,,514.30 S00p1. Insp: Eee:Q,Reg; OT p';Q° hrs' $0:00 PME;Unit Fee $0.00' PME'Permit Fee.: $0:00 i, Construction Tax._ 1.BCONSTAR I #.tnew units $590.16 �l`l�leidd'dl;S(laf7}!Vc”�2'(.'i Wolk Without--.Permit? 0 Yes No Advanced Planning Fee. PLLONCRNGR $594:75 Select a Non�Residdhtial 9%�i�-el l�oczdirdentution 'F'�res': Buildi"ng'ovStructure ` i Strong Motion Fee: IBSEISMCR $67:00 Select an,Adininistrative It&h Bldg Stds Cohiniission Fee: - 1BCBSC $27`.00 EMar SUBTOTALS $7,,819.51 00 T©TAL FEE $7;81,9 51 Revised: 04/04/2012