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12080215CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 1138 KENTWOOD AVE OWNER'S NAME: 13 LICENSED CONTRACTOR'S DECLARATION License Class- Lic. 4 - tractor t4l L�ro ;� Con (P Dat 4- I hereby affirm that I 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. CONTRACTOR: CENTURY DEVELOPMENT PERMIT NO: 12080215 CONSTRUCTION 5487 CRIBARI GRN DATE ISSUED: 08/28/2012 SAN JOSE, CA 95135 PHONE NO: (510) 557-4176 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r— MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SFDWL ADDITION OF 250 SQ FT TO REAR OF FAMILY ROOM 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 Sq. Ft Floor Area: Section 3700 of the Labor Code, for the performance of the work for which this I 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 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 witb-DIjiRn-pzin11spyrce.reg tions tb1C:Quper4mCi MUtijripaJ Code, Srction t Signatur . . . . .......... Nita SQ. r--, - Aw -P.— OWNER-B LDER DECLARATION t 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 afTirm 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. Signature Date APN Number: 35931054.00 Valuation: $30000 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: RE -ROOFS: All roofs shall be inspected prior to any roofing material beirig installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of 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. Iwillmaintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505,25533, and 25534. CONSTRUCTION LENDING AGENCY I hereby affirm that re is a construction lending agency for the performance of Wrk's for which this permit i rissued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona CITY OF CUPERTINO FM_7 FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: DDRESS: 1138 Kentwood Ave DATE: 08/20/2012 REVIEWED BY: jsg PC FEE ID A p N BP4: *VALUATION: F$30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes E) No � OTC? 0 Yes E)No PENTAMATION 1R3SFDADD PERMIT TYPE: 19 woRK ft addition in rear, single story SCOPE ��q OCCUPANCY TYPE: TYPE OF CONSTR FLR AREA J.) PC FEES PC FEE ID ' BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,1V,V-B 250 $1,014.00 JADDPLCK $983.00 JADDINSP Permit Fee: $983.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("'on vrl lotion Y'erv.. P-ec.. 0 E) Work Without Permit? 0 Yes No $0.00 TOTALS: 250 $1,014.00 o*,) n. 1.1;�'.�. $983.00 Strong Motion Fee: IBSEISAffCR ""V0� . ........... 's .......... .............. W, MISC ITEMS Plan Check Fee: Plan Cr .11, b Pei Fcc. M:orl;" El ET PME Plan Check: $0.00 Permit Fee: NOTE: This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitaq Sewer District, School District,etc.). These fees are based on thepreliminary information available and are onlv an estimate. Contact the DeDt for addnl info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,014.00 Select a Misc Bldg/Structure or Element of a Building 'A Suppl. PC Fe e: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $983.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("'on vrl lotion Y'erv.. P-ec.. 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Planniqg Fee. IPLLONGR $32.50 Select a Non -Residential 0 Building or Structure 0 o*,) n. 1.1;�'.�. Strong Motion Fee: IBSEISAffCR $3.00 Select an Administrative Item Bldjz Stds Commission Fee: IBCBSC $2.001 ... ...... .... ...... 5' $2,034. 0 1 0. 0 0 R T 2,034.501 s. Revised: 07/0112012