11080129I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10659 MINETTE DR I CONTRACTOR: TARIQ AHMED PERMIT NO: 11080129
OWNER'S NAME:
S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT 1 PLUMB
License Class Lic.#
Contractor
Date
I hereby affirm that 1 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:
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.
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 1 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
2 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:
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 Wee
'
Compensation laws of California. If, after making this certificate of e1become subject to the Worker's Compensation provisions of the Labomust
forthwith comply with such provisions or this permit shall be deemed
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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 mentione roperty spe ion purposes. (We) agree to save
indemnify and keep ess th it
of C ertmo against liabilities, judgments,
costs, and ex I .171
m e ag inst said City in consequence of the
granting of this e . Add i nall , th applicant understands and will comply
with all Code, Section
9.18.
F_ F_ r—
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: DEMO EXISTING ONE CAR CARPORT(] 71') AND LIVING
ROOM (386). ADD FAMILY ROOM, LIVING ROOM (386),
ADDTO BEDROOM AND MASTER BEDROOM (288')AND NEW 2
Sq. Ft Floor Area: I Valuation: $75000
I APN Number: 37532035.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: (P— '" 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, 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
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 9.12 and the
Health & Safety Code, Section 25532 a) should 1 st o handle hazardous
material. Additionally, should I u quipm r de ces which emit hazardous
air contaminants as defined by t ay A r Qgality Management District 1
will maintain compliance with Cup ti o Mu icipal Code, Chapter 9.12 and
the Health & Safety Code, Seeons
CONSTRUCTION LENDING AGENCY
1 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
I understand my plans shall be used as public records.
Licensed Profession
3/J-77 / )a .
CITY OF CUPERTINO BUILDING PERNA'J"
BUILDING ADDRESS: 10659 MINETTE DR CONTRACTOR: TARIQ AHMED PERMIT NO: 11080129
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
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. :.
Signature Date
OWNER -BUILDER DECLARATION
1 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)
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,1 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 may accrue . st said City in consequence of the
granting of this p ' . Addition the a licant understands and will comply
with all non-po' t urce re a s per a Cupertino Municipal Code, Section
9'. 18.
signature Date 423- /2
JOB DESCRIPTION: DEMO EXISTING ONE CAR CARPORT(17 P) AND LIVING
ROOM (386). ADD FAMILY ROOM, LIVING ROOM (386%
ADDTO BEDROOM AND MASTER BEDROOM (288')AND NEW 2
4/23/2012 - REV# 1 - RE -ROOF EXISTING PORTION OF RESIDENCE WITH
COMPOSITION (I 189SQFT) AND RESTUCCO THE ENTIRE RESIDENCE -REV# I ISS'D
4/23/2012
Sq. Ft Floor Area: I Valuation: $83000
APN Number: 37532035.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:,'� I/✓ Date: ltln �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,,sh,ould I use equipment or devices which emit hazardous air
contamin s defi he Bay Area Air Quality Management District 1 will
mainta' plia ith a Cupertino Municipal Code, Chapter 9.12 and the
Healt Safety ode, Sgitions 25505, 25533, and 25534.
or tnor agent:
Date: 4^23-1 Z
CONSTRUCTION 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.
Licensed Professional .
FM_7
CITYOF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10659 Minette Dr
DATE: 04/23/2012
REVIEWED BY: Sean
APN:
BP#: 11080129
"VALUATION: 1$8,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWLROOF
PERMIT TYPE:
WORK
Revision #1: Reroof existing portion of residence with composition 1189 sq ft and restucco the entire
SCOPE
residence.
�,.. ,.r•c i ._:; 1c , i-�'.'?'7. 1'?CU? i'flc'x'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 based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 F.fl, 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1,189 s.f.
$168.00
Re -roof
IREROOFRES
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1 s.f.
$457.00
Restucco
1STUCOAPP
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
;1CiIli?? /irilfit'r' 1`('r:',
1
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning; Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Strong Motion Fee:
IBSEISMICR
$0.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.80
$625.00
TOTAL FEE:
$626,80
Revised: 04/01 /2012