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09050036CTTY OF CUPS LlYO BUILDING DIVISION PERTMT r», x w^; > p :r » r l S . BUILDING ADDRESS: PERMIT NO. 10151 HILLC E T RD TBD — T OWNER'S NAME: PERMIT ISSUE DATE PHONE: A CONTROL NO. ARCH17ECr/ENGINEER: BUILDING PnmrriNFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing p with section 7000) of Dnvfsi n 3 of the alminm and Professions Code, and my license is Inn CO-1 a e fxt S I S (� RMODEL BTHRM AREA (10 0 SQ ) 0 Me �n trwtor ARCHREGTS DECLARATION 1 understand my plans shall be used u pubnc records Licomsed Pmfessional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Conuacoles License Law for the following reason. (Section 7031.5. Business and Pmfcsaiona Code: Any city or calmlywhich requires a permit to construct, Biter, improvedemolish, or repair any suocmm prior to its issuance, also requires the applicant for such permit to rile a signed sutenncmt that he is licensed pursuant to the provisions of the contractors License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or Out he is exempt therefrom and the basis for the alleged exemption. Any v+oldon of 2 0 0 0 0 APN Number P Y `J l*,� Occupancy 1� Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SM 32616047 .00 ❑ L u owner of the property, or my employees with wages u their sale compemdon, Required Inspections will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuaclors L.kense LAw does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for skim If. however, the building or improvement is sold within one year of completion. the owner- buiWer will have the bodeof proving that he did not build or improve for purpose of sale.). ❑ L as owner of the property, am exclusively contracting with licensed contractors to consbuct the project (Sec. 70", Business sod Professions Code:) The Coubkeroes Li- . ormac LAM does not apply to an owner of property who builds or improves thereon. and . who contracts for such projects with a contractor(s) licensed pursuant to the Conusetors . Lice= Law. ❑ 1 am exempt under Sec B At P C for this lesson Owner Dan WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and win maintain a Certificate of Consem to self -insure for Workers Compem- sadon, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain Worbes Compensation Insurance, u required by Section 370D of the Labs Codr:6 for the performance of the work for which this permit is iris d My Worlds Compensation Insurance carrier jhd Poliry mum are: Cartier S ` rC ,�� liry No.: CERTIFICATE OF EKEMP 710N FROM WORKERS' COMPENSATION INSURANCE (This sectlon need not be completed If the permit is for am hundred dollars ($ 100) Or lets.) 1 testify 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 becomo subject to the Workers' Compensation Laws of California Date Applicam NOTICE TO APPLICANT: If. alter making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this peunil shall be deemed revoked CONSTRUCTION LENDING AGENCY 1 hereby affirm that dire is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) L cadds Nave Lzndees Address 1 certify Thu 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county on ina n es and stale laws relating to building construction, and hereby authorize teprexntativu of this city to enter upon the above -mentioned property for Inspection purposes (Wc) agree to save, indemnify and keep harmless the City of Cupertino against Ifabilitia, judgments, cam and expenses which may in try way acme against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND NU COMPLY WITH ALL NON -POINT Issued by: Date J- % �1 SOURCE REGULATIONS. S / Re -roofs Type of Roof Signs = of Applkant/Contreco�r r HAZARDOUS MATERIALS DISCLOSURE Win the applicant or future building occupant sore or handle hazardous material f l/ as defined by the Cupertino Municipal Code Chapter 9.I7. and the Health and Safety cede.s«uanzss3z(■>7 []No All roofs shall be inspected nor to an roofing material being installed. P P� Y g S ❑arcs If a loos is installed without first obtaining an inspection, I agree t0 remove Will the applicant or future Indicting C.;U nl sae equipment err devices which emit hazardousair conuminants u aclincd by de Bay _ y Area Air Quality Management all new materials for inspection. District? /\ . ❑ Yes ❑ No^i.rr- 1 have mad the hazardous materials rcgniimments ondcrQaprer 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534. I urndcratand that If the building does not currently have a taunt, that It is my responsibility to notify the occupant of the requirements which must be arcrynor m Lssumna of a Certificate of Octvpanry. Signature of Applicant Date All roof coverings to be Class 'YJ' or better Date Owner or authorized agent CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type ADDITIONS 1R3SFDADD PLLONGRNGR Long Range Planning/Residential PL 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B IR3REPINSP Dwellings Repeat Inspection B 1R3REPPLNC Dwellings Repeat Plan Check B 1R3HINSP Dwellings Hillside inspection B 1R3HPLNCK Dwellings Hillside plan check B 1R3HREINSP Dwellings Hillside Repeat Ins ection B 1R3HREPLNC Dwellings Hillside Repeat Plan Check B 1 R3ALTINSP Dwellings Alternate Materials Inspection B 1 R3ALTPI NC Dwellings Alternate Materials Plan Check B 1PCESS Cesspool P 1PPRSEWG Ea, Private Sewage Disposal System P 1 PRSEWER Sewers P 1 BPSPRINK Lawn S prinkl er/Back flow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE SeismicResidential B 1REROOFRES Residential Re -roof Each 100 SF B CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Sq Ft Group DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood) -Each B (Each) 1 DECKRAIL Deck Railing -Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 B SF PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1 PATIOENCLW Enclosed Wood up to B 300. SF 1 PATIOENCLM Enclosed Metal up to B 300 SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered -Each B (Each) REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check) ZO-d 1 REMRESBAT Bath Remodel up to 300 SF B 66 1 REMREOTH Other Remodel up to 300 B 66 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 REMRES2 Remodel Residential Greater than 1000 sq ft B 1 REMRES3 Remodel Residential Greater than 2500 sq ft. B 1REROOFRES Residential Re -roof Each 100 SF B REMODEL PLNCK 1 STPLNCK (1-3 for remodel) Standard Plan Check B NOT FOR OVER THE COUNTERMAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows (ea 8 windows) B 1 WINNEWNSTR New Window (non- structural) B 1 WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'l B 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 4: CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Grou Permit Type 1 MECPLNCK Stand Alone Mechanical Pln Ck (hourly M 1 PLMPLNCK Stand Alone Plumbing Pln Ck (hourly) P / f 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B