11050170CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10611 CULBERTSON DR
CONTRACTOR: CHETAUD PRO BUILDERS
PERMIT NO: 11050170
OWNER'S NAME:
CAMPBELL, CA 95008
PHONE NO: (408) 313-4030
❑ LICENSED CONTRACTOR'S DECLARATIONI
INFO:
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BUILDING PERMIT BLDG ELECT PLUMB
License Class J� Lic. #
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Contractor 2//L ate (r
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: CONSTRUCT NEW SINGLE STORY SFDW 1,956' WITH
(commencing with Section 7000) of Division 3 of the Business & Professions
ATTACHED GARAGE 424'. SANITARY 1S SUNNYVALE'S
Code and that my license is in full force and effect.
JURISDICTION
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:
Valuation: $240000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 37536025.00
Occupancy Type:
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
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. diti the plicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point sou e a e Cupertino Municipal Code, Section
9.18.
8
Issued b.. Date:F_-r �
Signature Date ��c
❑ 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, I agree to remove all new materials for
I, 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:
1, 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
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
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. I 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 I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain corn Iia i th upertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & S od e s 25505, 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, I must
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forthwith comply with such provisions or this permit shall be deemed revoked.
Date:(J
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ 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
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10611 CULBERTSON DR
CONTRACTOR: CHETAUD PRO BUILDERS
PERMIT NO: 11050170
OWNER'S NAME:
CAMPBELL, CA 95008
PHONE NO: (408) 313-4030
❑ LICENSED CONTRACTOR'S DECLARATIONr
1_6c1
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # 1
r_ F_
r
p
Contractor t E7e, 17 l �e�� Date Z `0
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: CONSTRUCT SINGLE STORY SFDW 1,956' WITH
(commencing with Section 7000) of Division 3 of the Business & Professions
ATTACHED
GARAGE 424'. SANITARY IS SUNNYVALE'S JURISDICTION
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
9/7/1 I -REVISION 111- REVISE WINDOW SIZE AT ALL LOCATIONS -ISSUED 9/29/1 1
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: $240000
Section 3700 of the Labor Code, for the performance ofthe work for which this
permit is issued.
APN Number: 37536025.00
Occupancy Type:
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
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. dit all thea cant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point Cupertino Municipal Code, Section
9.18.
Issued by: Date:
orf
Signature Date el
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that 1 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, I 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
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
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(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain co lien ith 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
Health & ec ' s 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, l must
Ow
forthwith comply with such provisions or this permit shall be deemed revoked.
Z .7
Date: /
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 certify that 1 have read this application and state that the above information is
1 hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ 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
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
Im. FEE ESTIMATOR - BUILDING DIVISION
-
ADDRESS: 10611 culbertson dr.
DATE: 09/07/2011
REVIEWED BY: bbo s.
APN:
BP#:
"VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0 1
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
revise window size at all locations.
SCOPE
$0.00
NOTE. These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E '. 711111)
FEE
QTY/FEE
MISC ITEMS
'E3 -I-f
$0.00
hours
$260.00
Plan Check, Hourly
IsTPLNCK
isLl
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
NOTE. These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E '. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No
$0.00
hours
$260.00
Plan Check, Hourly
IsTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
a„`rrrt IOtt'tl(P7 Ilii
Acoustical Fee: 0 Yes E) No
$0.00
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
i
crs G i L:c c.trrnr>r.rcu T `e'G.:
Strong Motion Fee:
$0.00
0.5 hrs
$41.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$301.00
TOTAL FEE:
$301.00
Revised: 07/04/2011