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10120159CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10215 ALHAMBRA AVE LOT I I BUILDER &ODE CALIFORNIA HOME I PERMIT NO: 10120159 OWNER'S NAME: DECLARATION License Class Lic. # Contractor 4 04 01\ Date %0, __4P I hereby affirm that 1 am licensed under the provisions of hapter 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. 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 permit is issued. 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 indemnify and keep harmless the City o o against liabilities, judgments, costs, and expenses which may a again aid City in consequence of the granting of this permit. Tonally, the plicant understands and will comply with all non - ❑-06VNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. BUILDING PERMIT INFO: BLDG I— ELECT T PLUMB r MECH F RESIDENTIAL r— COMMERCIAL F JOB DESCRIPTION: LOT 1-1 STORY 1,679 SQ FT SFDWL W/ 1,288 BASEMENT, 417 SQ FT ATTACHED GARAGE Sq. Ft Floor Area: I Valuation: $400000 APN Number: 32623042.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: P z2�� RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) sEyArea tore or handle hazardous material. Additionally, should I use devices which emit hazardous air contaminants as deft y the Air Quality Management District I will maintain com ce with th up 'no Municipal Code, Chapter 9.12 and the Health & Safety Code, ScefAarl1p%25533, and 25534. performance of vork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional CITY OF CUPERTINO Fr—W FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10215 alhambra ave. lot 1 DATE: 12/21/2010 REVIEWED BY: bobs. PC FEE ID APN: BP#: 'VALUATION: 1$400,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 77)T.4L /.Caul?,1I, I. PENTAMATION PERMIT TYPE: 1R3SFDW WORK construct new sfd with basement SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 3,384 $2,787.16 IR3PLNCK $2,834.44 IR3INSP 0.0 1 hs $0.00 PME Plan Check: $0.00 0 # $21.00 Plumbing IPRSEWER Sewer, Sanitary Permit Fee: $2,834.44 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 0 # Plumbing $21.00 IBPWSVCS Water Service PME Unit Fee: $0.00 TOTALS: 3,384 $2,787.16 $2,834.44 NOTE. These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (1,ee Resolution 09-051 E . 7/1/10) Xlech. Plan Check Phinth. Ptarr 07ecA Cleo. Man (`hack Mech. !'ermil hcc Plrr»rh. Pur-rrril ret". Vec NY mil Fee, 01her aiech. Insp. Other Plurnh 011to Elec. Insp. 1lcch. Inip, Fee: F'Irrrrih. hrsp. fee: Elec. Irrt7t. J NOTE. These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (1,ee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,787.16 200 amps $42.00 Electrical IERT<200 Services Suppl. PC Fee: 0 Reg. © OT 0.0 1 hs $0.00 PME Plan Check: $0.00 0 # $21.00 Plumbing IPRSEWER Sewer, Sanitary Permit Fee: $2,834.44 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 0 # Plumbing $21.00 IBPWSVCS Water Service PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: IBCONSTAXR 1 bias $558.42 Acoustical Fee: 0 Yes (F) No $0.00 Q 0 Work Without Permit? 0 Yes (j) No $0.00 Planning Fee: PLLONGRNGR $439.92 E) 0 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $40.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $16.00 SUBTOTALS: J $6,717.94 $84,00 TOTALLEE. $6,801.94 Revised: 12/07i2010