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12050030CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 AMELIA CT CONTRACTOR: HANIWAY COMP. PERMIT NO: 12050030 OWNER'S NAME: SUNNYVALE, CA 94085 PHONE NO: (408)7333755 ❑ LICENSED CONTRACTOR'S DECLARATION r r— License Class Lic. # �Cq�� "&., BUILDING PERMIT INFO: BLDG' ELECT PLUMB . MECH RESIDENTIAL COMMERCIAL Contractor AAA—� _ _ Date 0 1( [Z hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REVISED SCOPE OF WORK:CONSTRUCT A DETACHED (commencing with Section 7000) of Division 3 of the Business & Professions 380 SQ FT STORAGE/ART STUDIO 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 Sq. Ft Floor Area: Valuation: $50000 permit is issued. APPLICANT CERTIFICATION APN Number: 32617019.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non - Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by:��/✓ ��lG,�J Date: Lf ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which -emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I ! provisions permit Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of Hork's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address 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 FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10201 Amelia Ct DATE: 05/02/2012 REVIEWED BY: Sylvia APN: BP#: 'VALUATION: $50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: L PENTAMATION 1GENRES PERMIT TYP WORK ADDI"I"ION OF 64 Q FT DETACHED GARAGE SCOPE Plcr nh, Permit Fi'e: EIaL'. Pc'r7rrfr fj'e,:.` ()' i'; r117Ii7 Insp. 0/her /isp- i ,,,,',_ ;IIs�7. 1:',•: lilac. insp. h,(,. 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS fFee Resolulion II-053 Eff 7/I/II) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $1,175.00 Garage, Detached IGARDTW<=/ Wood (1000 s.f. max) Suppl. PC Fee: Q Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. © OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 COnsiruc Lion J'ax. 4 dinillisfrative Pc(,.. Q E) Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 7r-n <4 Doc iwicawiion l• ce,,•. Strong; Motion Fee: IBSEISMICR $5.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $2.00 SUBTOTALS: 1 $7.00 $1,175.00 TOTAL FEE: 1 $1,182.00 Revised: 04/01 /2012