12040047CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10108 BRET AVE CONTRACTOR: AMJAD ALHAIT PERINIIT NO: 12040047
OWNER'S NAME:
CUPERTiNO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I PLUMB I
License Class Lic.#
Contractor
Date
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.
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 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 sours nylatigns per the Cupertino Municipal Code, Section
9.18. (./
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following hvo 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.
APPLICANTCERTIFICATION
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
a is A A. i
I__. I_.
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: DETACHED POOL ROUSE WiTH FULL BATH-198 SQ
FT -SANITARY IS SUNNYVALE'S JURISDICTION.
Sq. Ft Floor Area: I Valuation: $26000
APN Number: 37511041.00 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:
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
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 9h 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 illunicipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ownero of
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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature
Date
Licensed Professional
_____ _ CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10108 bret ave.
DATE: 04/09/2012
REVIEWED BY: bob s.im, .
APN: J �/B
#: jL
''VALUATION: 1$26,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
SFD or Duplex
2nd Unit? Yes G No
PENTAMATION
1 R3SFD
USE:
PERMIT TYPE:
WORK
sfd detached pool house with full bath.
[Igq
SCOPE
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
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
Ails, h. Plon (9ac�ci;
Phunb. Plan Check
Glec. PhIII Check
Tech' Arnrit Fee:
Phlmh. Permit Fcee:
_L_
Glec. Permit Fc�e':
Other ,1 iech, insp,
0(iter PhIMI) In.cp,L1
Other Glee. hap,
Hc� h, Imp, F"o.
Phnnb. h/sp, /,ec:
f le(. 117-sP. Fcc:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seiver District, School
Tlietrint atn 1 Th— foot nro hncod nn tho nrofr"iinary infnriantinn availahlP an/I arP. nnly an Pstimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution I-053 Eff: 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No
$0.00
® hours
$520.00
Plan Check, Hourly
ISTPLNCK
i
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes 0 No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXRF-171units
# new
$590.16
zl[: lniiiisir(ah c FHB:
0
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Tr'r,n'rrl Zio<�rnr7f�lrfutiE�11 Pecs:
Strong Motion Fee: IBSEISMICR
$2.60
8 Tl hrs
$1,040.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$594.76
$1,560.00
TOTAL FEE:
$2,154.76
Revised: 04/01 /2012