12060016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10998 SYCAMORE DR
OWNER'S NAME:
License Class Lic. 0 -2V /�/t 0-
Contractor 1 ;k_ CZXAd SCc..0Y Date W A //-::)-
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
Date tCo
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License 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 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.
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.
CONTRACTOR: TRC LANDSCAPE & PERMIT NO: 12060016
MAINTENANCE, INC.
468 PERRYMONT AVE DATE ISSUED: 06/06/2012
SAN JOSE, CA 95125 PHONE NO: (408) 271-0510
BUILDING PERMIT INFO: BLDG I— ELECT F PLUMB r
MECH F RESIDENTIAL f— COMMERCIAL r—
JOB DESCRIPTION: UPGRADE GAS LINE TO EXISTING OUTDOOR BBQ (1 1/4"
LINE) AND NEW GAS FIRE PIT. NEW 20AMP CIRCUIT FOR
OUTDOOR LIGHTING, NEW 30 AMP CIRCUIT FOR HOT WATER
Sq. Ft Floor Area: I Valuation: $6700
APN Number: 34256030.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY,.S{ FROM LAST CALLED INSPECTION.
Issued by: Date: / - 6 - /1?
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
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 & SaED0,LCede,Sections 25505, 25533, and 25534.
LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional.
CITY OF CUPERTINO
FM-1 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10998 Sycamore Dr
DATE: 06/01/2012
REVIEWED BY: Sean
APN:
BP#:
'VALUATION:
1$6,700
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1RPGA
PERMIT TYPE:
WORK
Upgrade gas line to E outdoor BBQ 1 1/4" line and new gas fire pit. New 20 amp circuit for outdoor
SCOPE
lighting, new 30 amp circuit for hot water sewage injection pump for new outdoor sink and install (3) 0
Plan r "
Plumb. Plan Check 0.0 1 hrs $0.00
Elec. Plan Check 1 0.0 1 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fee: IEPERMIT
.Week I,:- -EIFL--
Other Plumb Insp. 0.0 �rs$44.00
-[Orber
Other Elec. Insp. 0.0 hrs $44.00
Phuid, igvI /: .
Insp. Fe(
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the nreliminarv, information available and are only an estimate Contact the Dent for addn'l into_
FEE ITEMS (Fee Resolution 11-053 Efl. 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$65.00
Plumbing
IPGASRES Piping, Gas <=4 Outlets
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F1 #
$9.00
Plumbing
/BPFIXTURE Fixture or Trap
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
2� Electrical
$260.00 IBREMMISC Conduits
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
Cr..+,tsrrzrc•tir,rn lir.�:
T-T
Administrative Fee: IADMIN
$41.00
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
St Building or Structure
Q
0ctu
�
Travel Documentation Fee: ITRAYDOC
$44.00
Strong; Motion Fee: IBSEISMICR
$0.67
Select an Administrative Item
Bldg Stds Commission Fee- IBCBSC
$1.00
ry SUBTOTALS:
$174.67
$334.00
TOTAL FEE:
1 $508.67
Revised: 05/01 /2012