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11050168
�w ec►IAAI � —,�— CITY OF CUPERTINO BUILDING PERMI BUILDING ADDRESS: 18780 PENDERGAST AVE CONTRACTOR: CHETAUD PRO BUILDERS PERMIT NO: 11050168 OWNER'S CAMPBELL, CA 95008 PHONE NO: (408) 313-4030 ❑ LICENSED CONTRACTOR'S DECLARATION F f— PLUMB INFO: License Class Lic. # n^, Z3 (od BUILDING PERMIT BLDG ELECT MECH � RESIDENTIAL � COMMERCIAL � Contractor v 15 ��r--`�Z..+o�Date � ZT �/ 1 hereby affirm that I am licensed under the provisions of Chapter. 9 JOB DESCRIPTION: CONSTRUCT NEW SINGLE STORY SFDW 1,88T WITH (commencing with Section 7000) of Division 3 of the Business & Professions ATTACHED GARAGE 437' (2,324' TOTAL) Code and that my license is in full force and effect. SANITARY IS SUNNYVALE 1 hereby affirm under penalty of perjury one of the following two declarations: 9/20/2011-REV4I- REVISE WINDOWS-REV#1 ISS'D 9/20/2011 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. APPLICANT CERTIFICATION APN Number: 37527028.00 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 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. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point s ce r [a' p the Cupertino Municipal Code, Section 9.18. �'' La� � Issued by: Date: Signature Date ❑ 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 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: 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: [ 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(a) should 1 store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air 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 coiSpliBiWe with 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 & ctions 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,1 must LENDING AGENCY I certify that I 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 mrk'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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18780 PENDERGAST AVE CONTRACTOR: CHETAUD PRO BUILDERS PERMIT NO: 11050168 OWNER'S NAME: CAMPBELL, CA 95008 PHONE NO: (408) 313-4030 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# CX ) Z 3 6� Contractor ?—I apt _ Date 8 r If 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. itio the appli t understands and will comply with all non -point sour at' s r t upertino Municipal Code, Section 9.18. Signature Date 114% OWNER -BUILDER DECLARATION I hereby affirm that 1 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: 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 l certify that I have read this application and state that the above information is correct. l 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. BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r— JOB DESCRIPTION: CONSTRUCT NEW SINGLE STORY SFDW 1,88T WITH ATTACHED GARAGE 437' (2,324' TOTAL) Sq. Ft Floor Area: I Valuation: $240000 APN Number: 37527028.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued bye Date: 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 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 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as define y the Bay Area Air Quality Management District 1 will maintain com n it tino Municipal Code, Chapter 9.12 and the Health & S od ti s 505, 25533, and 25534. Date: Cz�//r CONSTRUCTION LENDING AGENCY 1 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional_ CITY OF CUPERTINO IrYf l FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 18780 PENDERGAST AVE DATE: 05/23/2011 REVIEWED BY: SUEW.BS APN: 375-27-028 BP#: 11050168 *VALUATION: 1$240,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes No PENTAMATION PERMIT TYPE: 1 R3SFD WORK NEW 1 STORY HOUSE 1 88T AND ATTACHED GARAGE 437'. TOTAL SQ FOOTAGE 2,324' SCOPE 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 2,324 $2,604.64 /R3PLNCK $2,389.88 /R31NSP TOTALS: 2,324 $2,604.64 $2,389.88 Lj Ll NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/I/I0) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,604.64 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,389.88 Suppl. Insp. Fee-0 Reg. O OT TO.OThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: 1BCONSTAXR 11 new units Acoustical Fee: © Yes 0 No $0.00 O 0 Work Without Permit? O Yes 0 No $0.00 Planning Fee: PLLONGRNGR $302.12 Select a Non -Residential Building or Structure 0 Strong Motion Fee: IBSEISMICR $24.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $10.00 SUBTOTALS: $&A& ,34 $0.00 TOTAL FEE: $5,88 590 Ov Revised: 0412912011 5-bo.4-0 FM-7 CITY O CUPERTINO. FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 18780 pendergast ave. DATE: 05/20/2011 REVIEWED BY: bobs. APN: 3 ZS a-7 o "VALUATION: 1$240,W *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Constr ction PRIMARY S r Duplex USE: god Unit? •- Yes No PENTAMATIO 1 R3SFDW PERMIT TY : WORK construct ne�j story sfd. SCOPE OCCUPANCY TYPE: YPE OF C2N,STR. FLR AREA s.f. PC FEES P EE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,N, 60 $2,677.72 IR3PLNCK $2,581.48 IRRNSP TOTALS: 2,760 $2,677.72 $2,581.48 f ,.. •t-.r ()Fi.l'1" ��cii3:, r� �.�'7 Li i9ctif}, lrtc!> i r;e.' 1'+'�`•(/;/. ws;3, s;^:': Isdr<c. 1nV;. 7 eta NOTE: These fees are based on the prelindliary information available and are only an estimate. Contakthe Dept for addn7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7/1110) FEE QTY/FEE MISC EMS Plan Check Fee: $2,677.72 Select a Misc Bldg/S cture or Element a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,581.48 Suppl. Insp. Fee:0 Reg. OT 0.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: IBCONSTAXR units $ Acoustical Fee: 0 Yes � No $0. 0 Q 0 Work Without Permit? 0 Yes 0 No $0.0 Planning, Fee: PLLONGRNGR $358.80 Select a Non-Residential Building or Structure 0 i r�rt�" 11c�z-rrrn�;rrt�rtin�i.l'"t�•: Strong, Motion Fee: IBSEISMICR $24.00 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC 1 $10.00 SUBTOTALS: $6,209.701 $0.00 TOTAL FEE: I $LK9.70 Revised 04/29/2011 1Y 1 CITY OF CUPERTINO IM-7- FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 18780 pendergast ave. DATE: 09/20/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $9,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise windows. SCOPE L1•ra:r,. _ tre. NOTE: This estimate does not include fees due to other Depts (Le. Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes 0 No $0.00 F__2__j hours $260.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: O Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee 0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con it lic(io!1 T: n A'cv. 0 O Work Without Permit? 0 Yes O No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential O Building or Structure 0 Strong Motion Fee: IBSEISMCR $0.90 F 0.5 hrs $41.00 Admin./Clerical Fee IADMIN Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.90 $301.00 TOTAL FEE: $302.90 Revised: 09/02/2011 Ilv�3ol(4 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 18780 pendergast ave.is. DATE; 1 APN: BP#: 110501 *PERMIT TYPE: Building Permit PLA PRIMARY SFD or Duplex USE: wORK revise interior hallway,relocate laundry and SCOPE 1 � k �S 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 hated on the nrelimnary intartnatinn availahle and are only an estimate_ Contact the Dent for addn'1 info_ FEE ITEMS (Fee Resolution 11-053 Eff. 7/1!11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 `'ImiiFP sh'ative Fsrt': 0 0 Work Without Permit? C) Yes Q No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure E) Traa-vl 1 Jrx rtiofz 1-ee.i Strom Motion Fee: $0.00 1 # $783.00 Revision IREVSFDWt I SFDWL Bldp, Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $783.00 TOTAL FEE, $783.00 Revised: 10/01 /2011