12080245CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10327 VISTA KNOLL BLVD I CONDRA CTOR: SO NEAL J AND MA I PERMIT NO: 12080245
OWNER'S NAME:
[ CUPERTiNO, CA 95014 I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.4
Contractor Date
t hereby aAirm that I am licensed tinder the provisions of Chapter 9
(eommencing with Section 7000) of Division 3 of the Business & Professions
Code and that my lieense is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
have and will maintain a certificate of consent to self insure for Worker's
Compensation, as provided for by Seetion 3700 of the Labor Code, for [he
performance of the work for which this permit i5 issued.
1 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. 1 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
indemnity 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 pen -nit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Seetion
9.18.
Date
L'J OWNER -BUILDER DECLARATION
I hereby allirm that 1 am exempt from the Contractor's Lieense Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the stricture 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 Certifieate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of tine work for which this permit is issued.
1 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 [Wanner so as to become sub "jeet 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
l certify that I have read this application and state that the above information is
correct. l agree to Comply with all City and eounty ordinanees 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 (his permit. Additionally, the applicant understands and will comply
with all
Z ZP Z
BUILDING PERMIT INFO: BLDG r— ELECT e PLUMB I —
MECH a RESIDE'NTiAL COMMERCIAL r
JOB DESCRIPTION: ADD COVERED PAVILLION STRUCTURE, 225 SQFT, GAS
LINE, & ELECTRICAL
Sq. Ft Floor Area: I Valuation: $10000
AI'N Number: 32613121.00 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:�77'2��
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 Applicant: 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
complianee 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 Munieipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: 0/ z
CONSTRUCTION LENDING AGENCY
i hereby affirm that litre is a construction lending agency for the performance of rmrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
i understand my plans sliall be used as public records.
Licensed Professional
CITY OF CUPERTINO
F"MI FEE ESTIMATOR - BUILDING DIVISION
Kim
ADDRESS: 10327 vista knoll
DATE: 08/2312012
REVIEWED BY: larrys
APN:
BP#:
'VALUATION: j$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK covered pavillion structure 225 s . ft
SCOPE
4ech. 111an Check
Plumb. Pian Check 0.0 hrs $0.00
Elec. Plan Check 0.0 hrs $0.00
Nfec,h. per,nil Poe:
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fee: IEPERMIT
Other Hc.,eh. Insp.
Other Plumb Insp. 0.0 hrs $45.00
Other Elec. Insp. Ehr�$45_00
.11ech. Imp. hee:
Phwib. Insp. Pee:
E1ee. Insp.
NOTE This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS Tee Resolution 11-053 Lf1: 7/1/11)
FEE
QTYIFEE
7 MISC ITEMS
Plan Check Fee:
$0.00
225 s.f.
$666.00
Patio Cover 1 Sun Room
IPATIOWOOD Wood
Suppl. PC Fee: Reg. 0 0-
To
-O
hrs
$0.00
PME Plan Check:
$0.00
1=#
$67.00
Plumbing
1 IPGASRES Piping, Gas <=4 Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
1= Electrical
$45.00 IBREMRECFP Recep/Switch/Outlets
PME Unit Fee.
$0.00
PME Permit Fee:
$90.00
Con.swuction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
o
i
Travel Documentation Fee: ITR4VDOC'
$45.00
Strom Motion Fee: IBSEISMICR
$1.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$179.00
$778.00
TOTAL FEE:
$957.00
Revised: 07/01/2012