12090195CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1142 STEEPLECHASE LN CONTRACTOR: CENTURY PERMIT NO: 12090195
DEVELOPMENT CONSTRUCTION
OWNER'S
SAN JOSE, CA 95135 PHONE NO: (510) 5574176
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class & Lic. # 6 3 S 9 89
Contractor nk, d t=,= L-4;ju Date /0 --:)6 -- Z
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.
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. 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 Municipal Code, Section
9.18.
Signa Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two 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:
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.
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 manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, 1
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 buildingconstruction, 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.
CONSTRUCTION OF 476 SQFT ONE STORY ADDITION
INCLUDES NEW BEDROOM AND RE -LOCATE KITCHEN
TO NEW
AREA, 75 SQFT COVERED PORCH, UPGRADE
ELECTRICAL
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 35931028.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS
-a6 1�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, 1 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(s) 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2 50 , 5533 and 25534.
Owner or authorized agent:
LE ING 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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
Signature Date
IM-1
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 1142 Steeplechase Lane
DATE: 09/24/2012
REVIEWED BY: Sean
APN:
BP#: L/w
'VALUATION: 1$50,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes . No
OTC. 0 Yes � No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK
Construction of a 476 sq ft one story addition 75 sq ft covered porch, upgrage electrical panel to 220
SCOPE
amp, reroof existing portion of residence, remodel (e) kitchen to a living room (220 sq ft).
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
551
$2,468 000
1R3PLNCK
$1,549.00
1R31NSP
TOTALS:
551
$2,468.00
$1,549.00
MECH, ]HOURLY 0 Yes G No
PLUMB, HOURLY 0 Yes 47 No
ELEC, HOURLY 0 Yes Q Na
l'fech. Plan Cheek
Phu„ b. Plun Chock
Elec. Plan Check 0.0 hrs $0.00
lLtech. Perini, Fee:
Pllnwh. Permit Fee.
Elec. Permit Fee: IEPERMIT
Oilier Alech. /ns/>.
0/her Plumb Insp. Li
Other Elec. Insp. 0.0 hrs $45.00
Alech. fa%p. Fee:
Ph,mb. bmp. Fee:
Elec. Insp. Fee:
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 preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 71111.L
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,468.00
FT190 I s.f.
$180.00
Re -roof
1REROOFRES
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F200 amps
$45.00
Electrical
1 IERT<200 Services
Permit Fee:
$1,549.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
= s.f. Remodel, Other
$400.00 1REMIMESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Conso-i,ction Tax. -
,I din iri i.strati ve.Fec:
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planninp_ Fee: 1PLLONGR
$71.63
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICR
$5.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SU RTOTALS:
$4,185.63
$625.00
TOTAL, FEE-, 1 $4,810.63
Revised: 07101 /2012