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12120011CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10381 S DE ANZA BLVD CONTRACTOR: PERMIT NO: 12120011 OWNER'S NAME: US BANK NA ASSC DATE ISSUED: 12/04/2012 OWNER'S PHONE: 6505620190(us PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr F ELECT License Class Lie.# (2Sz( BUILDING PERMIT INFO: BLDG PLUMB MECH RESIDENTIAL COMMERCIAL Contractor E*A Date t 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: EXTERIOR OF BLDG - REPAIR THE DRY ROT AT BOTTOM (commencing with Section 7000) of Division 3 of the Business & Professions OF EIGIIT(8) EXTERIOR COLUMNS 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 Sq. Ft Floor Area: Valuation: $5000 permit is issued. APPLICANT CERTIFICATION APN Number: 35917005.00 Occupancy Type: I certify that 1 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 City in consequence of the granting of this permit. dditionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point u r lations per the Cupertino Municipal Code, Section 180 DAYS F LAST CALLED INSPECTION. 9.18. Signature Date —1 Is b C Date: e ❑ 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: A]I 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 (Sec.7044, inspection. Business & Professions Code) 1, 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. 1 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(x) should 1 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, l shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain co ce with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health S fety de, Sections 25505, 255339 and 25534. become subject to the Worker's Compensation provisions of the Labor Code, l mustOw forthwith comply with such or this shall be deemed revoked. a au)h agent: provisions permit Date: l 1/ 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 work's 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 FEE ESTIMATOR — BUILDING DIVISION it ] Uti� /. .t.S .•5, 7. ..7. ,5.; �. .':J"' - 1. .- - s�-•3'.'•i t' -•) ., .,j:� -�% ',•[ "\�'v"•j - J .F �f %'�� , ��y 4��•�rr[�• , �, �£ , �� (.�s� )rr;�:[[yys 4° [44 ,. .�SS �;..,�, piSt .i.7,�,� �, tj3 F fr.� � ��r �S�a��;t�'s ='.•ry:�s i s ?�'� ?a I: ]�)r!•r° tr�:'''� '! � `[ }�'� ill. •••3� � 3 C{ q ll y I ,a ) �' °rlCslf?� ll� �.� � y � 1 �A��11:53� f �i�]�i�� ] I ri�CC [}�yf �^ 4��` S1�`�3 � , i.�.i� 1.S ?jLy •�,�tf � �=S is,•C ��Sc•:��;l�i� sF,{��•�� S ��,1� it�l�' � !f � t �i��i.t1 ��5 f �1�•, �1��1 � � �3 �� 3 �� 1� [ �S' �'? � 7 �� , �3�� f?I�� r,—s� ;C� �1 �;" � ��. �5��) �� G,> �i�� '� ��. �- ADDRESS: 10381 DE ANZA BLVD DATE: 12/04/2012 REVIEWED BY: SEAN Phlmb. Plan Check Elec. Plan Check APN: BP#: �a Twao l 'VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PME Plan Check: PENTAMATION 1GENCOM PERMIT TYPE: WORK REPAIR THE DRY ROT AT BOTTOM OF 8 EXTERIOR COLUMNS. SCOPE Suppl. Insp. Fee Reg. Q OT it ] Uti� /. .t.S .•5, 7. ..7. ,5.; �. .':J"' - 1. .- - s�-•3'.'•i t' -•) ., .,j:� -�% ',•[ "\�'v"•j - J .F �f %'�� , ��y 4��•�rr[�• , �, �£ , �� (.�s� )rr;�:[[yys 4° [44 ,. .�SS �;..,�, piSt .i.7,�,� �, tj3 F fr.� � ��r �S�a��;t�'s ='.•ry:�s i s ?�'� ?a I: ]�)r!•r° tr�:'''� '! � `[ }�'� ill. •••3� � 3 C{ q ll y I ,a ) �' °rlCslf?� ll� �.� � y � 1 �A��11:53� f �i�]�i�� ] I ri�CC [}�yf �^ 4��` S1�`�3 � , i.�.i� 1.S ?jLy •�,�tf � �=S is,•C ��Sc•:��;l�i� sF,{��•�� S ��,1� it�l�' � !f � t �i��i.t1 ��5 f �1�•, �1��1 � � �3 �� 3 �� 1� [ �S' �'? � 7 �� , �3�� f?I�� r,—s� ;C� �1 �;" � ��. �5��) �� G,> �i�� '� ��. �- FEE z 3°f� r „� •t�,S,�r �� 1JC'£ •, hY s51�� 5��A�'�� ..�`? s?..�;�� •YI ,�j << -:n .:, s z•. s 3 ss 5 s s s Xfech. Plan Chu,4 Phlmb. Plan Check Elec. Plan Check L1ec1,. Permit f ar: P111rnh. Powlir Five: Elec. Perrair Fc F: 0,i'wr ;lfech. Insp. 07/70'P,Dn i. Insp.Li OrhCr Eler. Insp. ;Vech. Inch. lee: Phallb. b1sl), Fce. Elec. Insp. Free: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These tees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $133.00 1STPLNCK Suppl. PC Fee: Q Reg. Q OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes Q No $0.00 Suppl. Insp. Fee Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswitclion Tax: Administrative Fee: Q 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 27 hours Inspections 0 $266.00 1STINSPInspection, Hourly Travel Docinnenlation lees: Strong; Motion Fee: 1BSEISMICO $1.05 Select an Administrative Item 131da Stds Commission Fee: 1BCBSC $1.00 Y ' l'1 � � i{ � �! r •,' S t� • Sc. • y+ r d.. �... Y� r:.lk5i \ S ] �' �.� .�a� ,�3r ��, ,��?�'£��r ��{ '�i��£��i!�` �; . �5: �� e £r �s[ 4..r� •.S]Yi✓� � � �.i-x.:.. 1. s F :.�a. (�,,�] '.��. G.�.S.��1;r.t.:•1+FS�rl:�r�r:.-:.t-. X51.. ] Y �S .:..� _� $ 2.05 I Iti y7?rS�1.1?,:\�'s•'�is s%f�s • �E [.:s z�.ss5 \' ,.;?.�i ( � 399.00 '�'�;.. ',:��,Z�� :.�;�• �� Y " � ��`` �� $ � i5 ��li. 5[.'• k ) x.:.r�: xJ ,r =[:.:.... r..,1:,?S; �S\ �?��! ��S�.s.::t �-=`-U.�...1.•1. 401.05 Revised: 10/01/2012