12010167CITE' OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: t0451 N PORTAL AVE
CONTRACTOR: ANTHONY HODDER
PERAITi NO: 12010167
CONSTRUCTION
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO: (403) 257-4317
Cl LICENSED CONTRACTOR'S DECLARATION
(. I ..
License Class i Lie. #
I�R
BUILDING PERT INFO: BLBG ELECT PLUMB
Contractor LPNte
A•IECH RESIDENTIAL) COI ME, CLAL I
I Hereby affirm that I am licensed under the provisions of Chapter
JOB DESCRIPTION: 220SQFT BEDROOM AND BATH AD➢ITHON, NEW 200AMP
(co€nitiencing with Section 7000) of Division 3 of the Busl€€ess & Professions
SERVICE PANEL
Code and that my license is in full force and effect.
I hereby aft€rin tinder penalty of perjury Otte 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
Sq. Ft Floor Area:
Valuation: $80000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31630030.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expe which may accrue against said City in consequence of the
' bust.
WITHIN 180 DA17S OF PERMIT ISSUANCE OR
granting of t pe Additionally, the applicant understands and will comply
1 0 A
:
Signature ,� `
�I OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law foۥ one Of
At roofs shall be inspected prior to any roofing material being installed. If a roof is
(lie following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do Elie Nvork, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions,Code)
Signature of Applicant: Date:
I, as owner of the property, ant exclusively contracting with licensed contractors to
construct the project (Sce.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affir ill under penalty of perjury Otte of the following three
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
I have read the hazardous materials requirements under Chapter 6.95 of tl€e
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additional[ , should I use equipment or devices which emit hazardous air
I certify that in the performance of die work for which this permit is issued, I shall
riot employ any person in any manner so as to become subject to the Worker's
eottta� i s as defined by the Bay Area Air Quality Management District I will
€nfti Lain a mplianee tgitit the Cuperdn Municipal Code, Chapter 9,12 and the
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
certify that I have read this application and state that tine above information is
I hereby affirm that there is a construction lending agency for the performance of cutrk's
:orrect. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (See. 3097, Civ C.)
:o building construction, and hereby authorize representatives of this city to enter
Leader's Name
iport (tie above mentioned property for inspection purposes. (We) agree to save
ndemnity and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
;osts, and expenses which may accrue against said City in consequence of the
;ranting of this permit. Additionally, Elie applicant understands and will comply
,with all non -point source regulations peۥ the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
M 8.
I understand my plaits shall be used as public records.
signature Date
Licensed Professional
CITY OF CUPERTIN
O
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10451 n portal ave DATE: 01/30/2012 REVIEWED BY: larry s
APN: BPS:% 'VALUATION: E80,000
_
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? 0 Yes IENTAMATION IR3SFDADD
USE: OTC? 0 Yes 'ERNUT TYPE:
1
service panel. �2�20s oars foot �bedr�oom addition/bath addition. TVORK
SCOPE , P
COPEI
OCCUPANCY TYPE:
TYPE OF
FLR ARE, A
PC FEES
PC FEE ID
BP FEES
BP FEE ID
................
CONSTR.
(s.f.)
R-3 (Custom)
II-B,111-BjV,V-B
220
$994.00
IADDPLCK
$963.00
1,4DDINSP
TOTALS:
220
$994.00
$962
MECH, HOURLY 01es G No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes (j) No
Elec, Platt Check OX hrs $0.00
Elec. Permit Fee: ]EPERMIT
Other Elec. Insp. Fo 01hrs, $44.00
.. .. ....... .....
NOTE: This estinutte does not include fees due to other Departnteuts (i.e. Plawdug, Public fVorlfs, Fire, Saultaly Sewer District, School
M,0oio I Th— r— — A. —I — th, lsgiarmailn" nufulahlo andur., mjht as# oviiniah, Caahipt tho Dow
FEE ITEMS (Fee Re.3ohaion
11-053 L_, -T VI/I 1)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
F-200 amps Electrical
$44.001 IERT<200 Services
Suppl, PC Fee: (j) Reg, 0 OT
[E]
hrs
$0.00
PME Plan Check;
$0.00
Permit Fee:
$963.00
Suppt. Insp, Fee.0 Reg. C OT
0.Q
firs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
El
1
0
G
Work Without Permit? 0 Yes 0 No
$0.00
,E%dvatwc,d Plarmin-1 Fee:
PLL.OATGRNGR
$28.60
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: ITRATIDOC
$44.00
Sfi-oiig Tvlotirm Fer,-u:
IBSEISAlffCR
$8.00
Select an Administrative Item
Bidg-"!,t(Is Cowl-nissicil Fee: IBCBSC
$4.001
SUBTOTALS:
$2,06
.001
TOTALFEE: 1 $2,129.60
Revised: 1/19/2012