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11120062CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 SERRA ST CONTRACTOR: LOAYZA'S LANDSCAPE PERMIT NO: 11120062 POOLS & SPA OWNER'S NAME: SAN JOSE, CA. 95125 PHONE NO: (408)2"-5555 ❑ LICENSED CONTRACTOR'S DECLARATION r- r License Class • J CC-- Lic. If �ytof�/ BUILDING PERMIT INFO: BLDG ELECT PLUMB r, r, / Contractor �c�/1h%.tJ�y �/ /� Date y MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE EXISTING TRELLIS, RELOCATE ONE(1) GAS LINE — Li/"/, � 4- 1 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect., 2 , tc �� n &Cx A- ay-t & }- 6--( j ��� e �v4�n S —W �4 A - --,)+ 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 -S -H onA- 1r\ `N 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 f Sq. Ft Floor Area: Valuation: $18500 Section 3700 of the Labor Code, for the performance of the work for rch t s permit is issued. APN Number: 34259012.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupe` o against liabilities, judgments, costs, and expenses wh' mayaccrue against sai in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this perm' Ad ' zonally, the applic nderstands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point r eg lations per the C o Municipal Code, Section 9.18.� iyi �l Signature / l T Issued by: Date: �T�! v�T /t ate ❑ OWN - UILDER DECLARATION RE -ROOFS: 1 hereby affirm that I 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 1, 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: 1, 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: I 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, ection 25532(a) should I store or handle hazardous material. permit is issued. Addition" ; should I use pme or devices which emit hazardous air contami nts as defy y t e Area Air Quality Management District I will I certify that in the performance of tie work for which this permit is issued, I shall in pli with ertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's He , 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, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION LENDING AGENCY affirm I certify that I have read this application and state that the above information is I hereby that there is a construction lending agency for the performance of Mork'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 with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 10460 SERRA ST I COO TT & CPTOR: LOAYZA'S LANDSCAPE I PERMIT NO: 11120062 OWNER'S NAME: 1 SAN JOSE, CA 95125 1 PHONE NO: (408)297-5555 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class gLic. N Contractor f�y r/ 4. 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. 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 w K this permit is issued. 1_ i 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 h ss the C ertino against liabilities, judgments, costs, and expenses whi may at`crue against d City in consequence of the granting of this perm' Add' onally, the ap is t understands and will comply with all non -point rc� t. ons per t ertino Municipal Code, Section 9.18. ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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). 1 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. BUILDING PERMIT INFO: BLDG Ir ELECT r PLUMB r MECH F_ RESIDENTIAL r COMMERCIAL F_ JOB DESCRIPTION: REPLACE EXISTING TRELLIS, RELOCATE ONE(1) GAS LINE Sq. Ft Floor Area: I Valuation: $18500 APN Number: 34259012.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DA OF PERMIT ISSUANCE OR 180 DAY OM LAST CALLED INSPECTION. iz ssued b 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 Applicant: 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, s Id 1 use equipment or devices which emit hazardous air contaminan s d �4)spye Air Quality Management District I will maintain c nce witMunicipal Code, Chapter9.12 and the & ➢f�o�e,lS533, and 25534. Date �s�o1� 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FM-1 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10460 serra st. DATE: 12/08/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$18,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES I PERMIT TYPE: WORK replace existing trellis relocate 1 gas line. SCOPE Plumb. Plan Check 0.0 hrs $0.00 :'•• ilrr.. ;rrnu f rr:; Plumb. Permit Fee: IPPERMIT Other Plumb Insp. EODOhrs $44.00Li P(?.;ii;{1. �,'., � ... ... .��_ iYr v, Fee NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Distric4 School District. etc.). These fees are based on the Drelininary information avallable and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Tee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1-1 # $327.00 Awning 1 Canopy (SupporVd by Bldg) /AWNATTBLD Canopy Suppl. PC Fee: (F) Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # $65.00 Plumbing IPGASRES Piping, Gas <=4 Outlets Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 Administrative Fee: IADMIN $41.00 Q Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure d 0 Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $1.85 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $131.851 $392.00 TOTAL FEE: $523.85 Revised: 1210412011 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10460 Serra Street DATE: 04/04/2012 REVIEWED BY: Sean APN: BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #1: Revise the foundation at arbor from piers and steel columns to pad footing with SCOPE installation of hardy panels. bIV, 6. Plan ( r.h: � Phwlh. Plait Uh�,rA 1 l'lurz Cfzrck. blvch. PerlWt Fee. Piwnh. pc)rmil F,!(. l:iec. per., sir !''; : Orlwf A e,h hY5/'. olle. Pi irrlil ln.%p.L_J Oihel`Etc(.. Insp. Ll Phunh. hasp. Fee: Elcr. Insp. Pre: 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 Dreliminary information available and are only 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? Q Yes (F) No $0.00 1 hours Plan Check, Hourly $130.00 ISTPLNCK Suppl. PC Fee: Q Reg. ® OT 0.0 firs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con, iowc Lion Tax: �Ictinuri.vdrcrti�c Fee': Q E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure 0 Ti-c.tvel Docmncntutiort Fees:� Strong Motion Fee: $0.00 Select an Administrative Item Bldp- Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $130.00 TOTAL FEE: $130.00 Revised: 1 /19/2012