11100100CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10145 SCENIC BLVD
OWNER'S NAME:
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.t/
Contractor Date
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 non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ 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.
Signature__ Date L� L
CONTRACTOR: TI KNO & ERNIE
10145 SCENIC BLVD
CUPERTINO, CA 95014
NO: I1100100
DATE ISSUED:07/12/2012
PHONE NO:
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r
MECH r RESIDENTIAL r COMMERCIAL I —
JOB DESCRIPTION: RFR1111,D EXISTING STAIRS A11'n nFCK
8/21 /12-REVM 1
MUOLFY LOWER DECK(GROUND FLOOR)PIEKS I•KUM lb" DIAMETER, 4FT DEEP TO
18" DIAMETER, 2FT DEEP-REV{/l ISS'D 8/21/12
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 35709076.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS M LAST CALLED INSPECTION.
Issued Tt]aDate:
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 & Safety Code, Sections 25505, 25533, and 25534.
Date: � Z � I ---
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mrk'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.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10145 SCENIC BLVD CCOON3T0 ACTOR: TI KNO & ERNIE PERMIT NO: 11100100
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lie. tt REBUILD EXISTING STAIRS AND DECK
Contractor
Date
1 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.
1 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 non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
❑ 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)
I, 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. %
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 35709076.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPECTION.
Issued by: LC , Date: -% 1Z' 1 Z.
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 A
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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 1 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 550 25533, and 25534.
Owner or authorized agent: Date: tZ
CONSTRUCTION LENDING 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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Signature
1 ii
CITY OF CUPERTINO
RM-7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10145 Scenic blvd
DATE: 08/21/2012
REVIEWED BY: Sylvia
APN:
BP#:
'VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
NTAMATION 1GENUSE: TYPE:
�RMIT
WORK
SCOPE
Plan C'h c k
Phelnb. Plan Check
Elec. flare Chcck
r1�t�>ch. Pcrmit Fee.
Plumb. Permit Fce.
Llec. Permit Fv,
Othcr .49cch. Insp.
01hur Plumb Insp.
011ieI;lec- Insp. Li
Hoch• h p. Fee:
Plumb. high, Fey;
£let, Insp. Pee.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These Pees 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 . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
F__17 hours Plan Check, Hourly
$133.00 ISTPLNCK
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'onsvruction Tax:
l dirtirri,� ti ati tie I 'ee.
0
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
i
1, ;o<vr77tt'ftt�.tio17 Fees:
Stron.p Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$133.00 TOTAL FEE:
$133.00
Revised: 07/01 /2012
CITY OF CUPERTINO
rm-7 FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10145 scenic blvd.
DATE: 10/14/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
sfd rebuild existing stair and deck
SCOPE
�trr,f.,• ts•.dr. zrtsi�,
r7rlEes F'ierr�ria7�>>,�;ET
,, , .Li L_
NOTE. This estimate does not include fees due to other Departments Cie. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Drelininary information available and are only an estimate. Contact the Dent for addn I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7111111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 1 #
$914.00
Deck / Deck Railing
IDECKWOOD Deck & Deck Railing
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F-2-1 # Stairs
$523.00 ISTAIRS (Specify # of Flights of Stairs)
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C:',ell truvti'm To
O
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
,
1r`Clj:C>/1JrJ�'lrfY?e E'di,ffrr121•F'i.',i'
Strong Motion Fee: 1BSEISMICR
$1.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
1 $1.00
SUBTOTALS:
1 $2.50
$1,437.00
TOTAL FEE:
1 $1,439.50
Revised: 1010112011