120200479 U
CITY OF CUPERTINO BUILDING PERMIT d
BUILDING ADDRESS: 18760 TUGGLE AVE
CONTRACTOR: BAY AREA CUSTOM _p
PERMIT NO: 12020047
BUILDERS INC
OWNER'S NAME: LAHAV RONEN
1002 S DE ANZA BLVD STE Al
DATE ISSUED: 05/16/2012
OWNER'S PHONE: 4084274546
SAN JOSE, CA 95129
PHONE NO: (408) 446-1200
❑ LICENSED CONTRACTOR'S DECLARATION
r I— r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class ) Lic. # f,
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: CONSTRUCTION NEW SINGLE FAMILY ONE(1) STORY
(commencing with Section 7000) of Division 3 of the Business & Professions
DWELLING(2678SQFT)-SANITARY IS SUNNYVALE'S
JURISDICTION. 10/23/12-REV#1 - REVISE THE LAYOUT OF MASTER BTHROOM;
Code and that my license is in full force and effect.
MOVING LOCATION OF (2)SKYLIGHTS AND (I)SUN TUNNEL -10/23/12 REV#1 ISS'D
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
Sq. Ft Floor Area:
Valuation: $410000
permit is issued.
APPLICANT CERTIFICATION
APNNumber: 37527022.00
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said said City in consequence of the
withtalgnothis tlly, the alfe Cupa ono Muni opal Codes and
point source regulations Section
WITHIN 1 fbAYS OF PERMIT ISSUANCE OR
per ,
180 DAYS;' OM LAST CALLED INSPECTION.
9.Is.
p
Signature Date ¢
Issued by:i ,"� Date:
Y
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (See.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the -flay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with -the prtino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code; Sectiofis 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
i
-J`7
forthwith comply with such provisions or this permit shall be deemed revoked.
,,.
Owner or a forjz 1 age t:'
d Date: C�
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of,wrMs
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
Iil FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Wwrict. otc ). These fees are based on the nrelinzinary information available and are only an estimate. Contact the Dent for addit'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12)
ADDRESS: 18760 Tuggle Ave
DATE: 10/23/2012
REVIEWED BY: Sean
Jkfeclr, Petnrll Fee:
APN:
BP#:
*VALUATION: Iso
,PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Phnub. hr.sp, 7:ee:
PENTAMATION 1GENRE
PERMIT TYPE:
WORK
Revision #1: Revise the layout of master bathroom; movinq location of 2 skylights and 1 suntunnel.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Wwrict. otc ). These fees are based on the nrelinzinary information available and are only an estimate. Contact the Dent for addit'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12)
�Afecdr. Plan Check
Plumb, Pkrrr Check
Elec, Plan Chec%
Jkfeclr, Petnrll Fee:
Plrrnrb, Permit Fee:
Elec. Permit fee:
Olher AIech. Insp.
Other Plurrth hasp.Ll
011ier Elec. InsP.
AJech. Msp. Fee:
Phnub. hr.sp, 7:ee:
Elee. Imp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Wwrict. otc ). These fees are based on the nrelinzinary information available and are only an estimate. Contact the Dent for addit'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? ® Yes Q No
$0.00
hours Plan Check, Hourly
$266.00 1STPLNCK
i
Suppl. PC Fee: 0 Reg. Q OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
f 0,0
hrs
$0.00
PME Unit Fee:
$0.00
.PME Permit Fee:.
$0.00
Conso-ilclion Tax: _FT
Administrative Fee:
1
0
G)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
i
Trmwl Doclnnenlotion Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
'Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$266.00
TOTAL FEET-
$266.00
Revised: 10/01/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18760 TUGGLE AVE
CONTRACTOR: BAY AREA CUSTOM
PERMIT NO: 12020047
BUILDERS INC
OWNER'S NAME: LAHAV RONEN
1002 S DE ANZA BLVD STE Al
DATE ISSUED: 05/16/2012
OWNER'S PHONE: 4084274546
SAN JOSE, CA 95129
PHONE NO: (408) 446-1200
JOB DESCRIPTION: RESIDENTIAL 11COMMERCIALE]
F1 LICENSED CONTRACTOR'S DECLARATION
License Class %S� Lie. # r'� ?_ o 6- 4 �A
CONSTRUCTION NEW SINGLE FAMILY ONE(1) STORY
"�r�,
DWELLING(2678SQFT)-SANITARY IS SUNNYVALE'S
Contractor _/fern� Date 0 �_ t,
JURISDICTION.
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 fill 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
Sq. Ft Floor Area:
Valuation: $410000
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
APN Number: 37527022.00
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 FROM 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: �/Y /�� U Date:
granting of this permit. Additionally, the applicant understands and will comply
7
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date, 2
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)
1, 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:
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
OCCUPANCY TYPE:
TYPE OF
FL R ARE, A
PC FEES
PC FEE TD
BP FEES BP FEE ID
Select a Misc Bldg/Structure
or Element of a Building
T I
CONSTR.
(S-0
$0.00
PME Plan Check:
$0.00
R-3 (Custom)
11-B,111-B,IV,V-B
2,678
$2,739.58
IR3PLNCK
$2,615.84 JR31NSP
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Comtructioi-i Ta-: IBCONST,4XR
# new
units
$583
11,86
G)
Work Without Permit? OYes ONo
$0.00
Advanc.ed 1F-'1annin-, Fee: PLLONGRNGR
$348.14
Select a Non -Residential G
Building or Structure 0
Str(,"II,LL/tgfi(-'g Fee: IBSEISAKCR
$41.00
Select an Administrative Item
RLdg, Stds Coamnissioti Fee: IBCBSC
TOTALS:
2,678
$2,735.58
$2,615.84
711
NOTE. This estinuite does not include fees due to other Deparinwids (I. e, Planning, Public f Vorks, Fire, Sanitary Sewer District, School
Wwript Pie- ). Thovp fpov /fro hacod Im th" filf'-priliadnop, amullahb, and aro nilhalp pollpf"to 4-Alffapi Mo BVIly fAl. ajdsill Illf"
FEE ITEMS (FceResoh�fion 11-053 Eff, 1:/IMQTY/FEE
I
FEE
I MISC I I MS
Plan Clieck Fee:
$2,739.58
Select a Misc Bldg/Structure
or Element of a Building
T I
Supp), PC Fee: (D Reg. 0 OT
0.0 hrs
1
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,615.84_
Supp). Insp. Fee -0 Reg. 0 OT
.0 his
0.0
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Comtructioi-i Ta-: IBCONST,4XR
# new
units
$583
11,86
G)
Work Without Permit? OYes ONo
$0.00
Advanc.ed 1F-'1annin-, Fee: PLLONGRNGR
$348.14
Select a Non -Residential G
Building or Structure 0
Str(,"II,LL/tgfi(-'g Fee: IBSEISAKCR
$41.00
Select an Administrative Item
RLdg, Stds Coamnissioti Fee: IBCBSC
$17.00
SUBTOTALS:
$6,345.36L54
TOTAL F E E:117$767,3 47573 61
Revised: 1/19/2012