12030080CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20916 FARGO DR
CONTRACTOR: STRAIGHT LINE
PERMIT NO: 12030080
CONSTRUCTION
OWNER'S NAME:
SAN JOSE, CA 95112
PHONE NO: (408)441-9660
❑ LICENSED CONTRACTOR'S DECLARATIONI—r
ELECT PLUMB
BUILDING PERMIT INFO: BLDG
2`^� �
License Class Lic. qy1 lU
Contractor /7Ctl rl �CeMP� �3� �2
MECHr RESIDENTIAL COMMERCIAL
I hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: NEW 2 STORY HOUSE 3,416 SQFT, PORCH 105 SQFT, AND
(commencing with Section 7000) of Division 3 of the Business & Professions
ATTACHED GARAGE 442 SQFT. TOTAL 3,963 SQ FT
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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: $350000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32630114.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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 expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,JV applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point rce regulation u ertino Municipal Code, Section
9.18.
%/
—10
Issued by: Date:
Signature
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, 1 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 the work, 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, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
1 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 the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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(x) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued, l shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Healtg&S ty Code, Sections 2 05, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, l must
C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20916 FARGO DR
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. # y
Contractory I Date �-
1 hereby affirm that 1 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.
1 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.
l 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. 1 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-pos urce regulati er the Cupertino Municipal Code, Section
9.18. {� l�
Signature EDate
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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.
1 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, l 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.
Signature Date
CONTRACTOR: STRAIGHT LINE PERMIT NO: 12030080
CONSTRUCTION
1575 INDUSTRIAL AVE STE B DATE ISSUED: 04/30/2012
SAN JOSE, CA 95112 PHONE NO: (408)441-9660
BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB r
MECH T_ RESIDENTIAL r— COMMERCIAL'S
JOB DESCRIPTION: NEW 2 STORY HOUSE 3,416 SQFT, PORCH 105 SQFT, AND
ATTACHED GARAGE 442 SQFT. TOTAL 3,963 SQ FT -
8/2/12- REVISION # 1- MINOR TRUSS CHANGE ON ROOF STRUCTURE -8/14/2012
REV# 1 ISS'D
Sq. Ft Floor Area: I Valuation: $350000
APN Number: 32630114.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date 7e' ` A-
1:1 —
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
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
ISI FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20916 fargo dr.
FLR AREA
s.f.
DATE: 03/16/2012
REVIEWED BY: bobs.
BP FEES
APN: -3D -//�/
BP#: F
"VALUATION: 1$350,000
*PERMIT TYPE: Building Permit
$2,983.85
PLAN CHECK TYPE:
New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
construct new 2 story sfd 3146 s.f. garage 442 s.f., patio s.f. 105.
SCOPE
Permit Fee:
$3,180.30
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
3,963
$2,983.85
IR3PLNCK
$3,180.30
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,180.30
Suppl. Insp. Fee -.0 Reg.
Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
3,963
$2,988.85
$3,160:30
1
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are based on the nrelininary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (F'ee Resolution 11-053 Eff 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,983.85
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. (C)OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,180.30
Suppl. Insp. Fee -.0 Reg.
Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$583.80
0
G
Work Without Permit? Q Yes (D No
$0.00
Advanced Plannine Fee:
PLLONGRNGR
$515.19
Select a Non -Residential
Building or Structure
E)
--.............,. --
Strong Motion Fee:
1BSEISMICR
$35.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$14.00
$00* 'r x
$7,312.14
$0.00
1.:; :;; t rAL 1
$7,312.14
Revised: 1/19/2012