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12060166CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11475 CANYON VIEW CIR CONTRACTOR: SOUTHERN CALIFORNIA PERMIT NO: 12060166 ROOMS OWNER'S NAME: HO SITYH-MEI F AND FAHFU 14104 E FIRESTONE BLVD DATE ISSUED: 12/12/2012 OWNER'S PHONE: 4084464538 SANTA FE SPRINGS, CA 90670 PHONE NO: (877) 700-7666 JOB DESCRIPTION: RESIDENTIAL13 COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION INSTALLATION OF 2 PREFABRICATED SUNROOMS ON License Class Lie. # EXISTING DECKS, 328 SQFT Contractor Date REVISION #1- REVISE FOUNDATION PLAN- ISSD OTC 2/27/13 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. 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 Valuation: $22000 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 35627024.00 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 ON. 180 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 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: 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 roof is I to remove all new materials for installed without first obtaining an inspection, agree inspection. t OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1, 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 Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three California maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous declarations: 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 defined by the Bay Area Air Quality Management District I Compensation,'m provided for by Section 3700 of the Labor Code, for the air contaminants as will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. the Health & Safety Code, Sections 25505, 25533, and 25534. / I have and will maintain Worker's Compensation Insurance, as provided for by J '-1,7 , ' Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: ? j 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after'making this certificate of exemption, I Compensation of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of . . become'subject to the Worker's provisions forthwith comply such provisions or this permit shall be deemed revoked. work's for which this permit is issued (See. 3097, Civ C.) with 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 BUILDING PERMIT BUILDING ADDRESS: 11475 CANYON VIEW CIR CONTRACTOR E PERMIT NO: 12060166 DE -4 -ERMINED OWNER'S NAME: HO SITYH-MEI F AND FAHFU So k t� -e r- til DATE ISSUED: 12/12/2012 OWNER'S PHONE: 4084464538 PHONE NO: JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #_ 7 INSTALLATION OF 2 PREFABRICATED SUNROOMS ON Date/off-Y,27--1 EXISTING DECKS, 328 SQFT Contractoit! hereby affirm that I am licensed under the provisions of 9 (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: $22000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35627024.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WITIIIN 1 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAY OM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in of the costs, and expenses which may accrue against said consequence Issued b Date: y' granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section VL 9.18, RE -ROOFS: Signature Date* -/z, 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 of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550 533, 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 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 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.) Lenders 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 Y ADDRESS: 11475 Canyon View Circle DATE: 06/28/2012 REVIEWED BY: Sean ih>ch. 1'ermil Feat APN: BP#: % ,_ *VALUATION: 1$22,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: Phm�b. hasp. Teu�: PENTAMATION 1R3SFDADD I PERMIT TYPE: A WORK of 2prefabricated sunrooms on existing decks 328 sq ft). [Installation SCOPE NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the vreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resohition 11-053 E f 711111) -tc<'lt. Plrna Checlr phuvh. Plan Checlr Elect. Plan Owck ih>ch. 1'ermil Feat Phrrnh. Permit Fee. Flec. PCrnW,' FCC: Oilter Hech, hasp. Oilier Plumb Las/,, E]__L_ Olher Elec, bisp, F-1 L_ lhhx/z hz,y�, F«e: Phm�b. hasp. Teu�: Elnc. Lasp. Fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the vreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resohition 11-053 E f 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 328 s.£ $1,435.00 Patio Cover / Sun Room IPATIOENCO Other, Enclosed Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp, Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CO S11'(1Cii0il TOO. T_F_ 11 d1nilfis1ralive Fee' 0 G Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 � Tr�Cmc/ l�cx�lrlraentrrtiorl F`c��°,w�; Strong Motion Fee: IBSEISMICR $2.20 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS; $3.201$1,435.001 TOTAL FEE: 1 $1,438.20 Revised: 06/30/2012