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11100015CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: l 1215 MOUNT CREST PL OWNER'S NAME: CONTRACTOR: ANKIDO CONSTRUCTION PERMIT NO: 11100015 175 LEWIS RD STE 22 DATE ISSUED: 1l/02/20i t OWNER'S PHONE: I SAN JOSE, CA 95120 I PHONE NO: (408)450-2699 ❑ LICENSED CONTRACTOR'S DECLARATION License Class L3 Lic. tl 0 -T71-'" 1 Contractor O Yin G S i CZa Q'^ Date Z Z 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. 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 l 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. Signature Date z t ❑ 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) 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, l become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that l 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 BUILDING PERMIT INFO: BLDG F, ELECT r- PLUMB F MECH F RESIDENTIAL COMMERCIAL JOB DESCRIPTION: SFDWL REMODEL LIVING ROOM 432 SF & KITCHEN 225 SF. // TOTAL 657 SF- 1�3112 l�"� j-� rN4,4- &01 C-. a +a et ck u Q ,Fj�-tom �'t3'I tgy.�6-� b��-r'-i'�'a` 4-�V tl�_/Ic�ay1/•t..tX� Sq. Ft Floor Area: I Valuation: $60000 APN Number: 35626026.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM ILAST CALLED INSPECTION. Issued by: �G�%N Al %G Z Date: v",' a 9 vp- RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove al l 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. 1 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 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 25505, 25533, and 25534. Owner�gr a�horized agent- 0— 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11215 MOUNT CREST PL CONTRACTOR: TSAKHI & SARA SEGAL PERMIT NO: 11100015 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. t/ MECH r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION: SFDWL REMODEL LIVING ROOM 432 SF & KITCHEN 225 (commencing with Section 7000) of Division 3 of the Business & Professions SF. TOTAL 657 SF- ; ADD Code and that my license is in full force and effect. MASTER BATH 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 Sq. Ft Floor Area: Valuation: $60000 permit is issued. APPLICANT CERTIFICATION APN Number: 35626026.00 Occupancy Type: 1 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued b} . Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All I roofs shal I be inspected prior to any roofing material being instal led. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, 1 agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: 1 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 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 1 certify that in the performance of the work for which this permit is issued, l shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain co a Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, 1 He SafetySections 25505, 25533, and 25534. 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. Owner o horized �age.t Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and a es which may accrue against said City in consequence of the Lender's Address granting this permit. Additionally, the applicant understands and will comply with all non- ' t ource ions per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1' r/ 1 1 understand my plans shall be used as public records. Signature Date J `j J Zicensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11215 MOUNT CREST PL CONTRACTOR. > PERMIT NO: 11100015 OWNER'S NAME: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION rr ff�� / License Class — G — Li.. # ¢L 0-71( BUILDING PERMIT INFO: BLDG ELECT PLUMB r �""" " �/ � ( Contractor/}ti'kiG(d ro'y cl,,aDate /,/— Z — MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFDWL REMODEL LIVING ROOM 432 SF & KITCHEN 225 (commencing with Section 7000) of Division 3 of the Business & Professions SF. TOTAL 657 SF-NO ADDITION ON THIS PERMIT. Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: [ 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 Sq. Ft Floor Area: Valuation: $60000 permit is issued. APPLICANT CERTIFICATION APN Number: 35626026.00 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signatu Date Issued byr�'Date/ -2rL/ ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 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 I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. 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. Owner or author` ized nt: Date: _&e 0 l APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 11215 Mount Crest PI. DATE: 11/07/2011 REVIEWED BY: A. Salvador PC FEE ID APN: 356-26-026 BP#: 11100015 *VALUATION: 1$125,000 PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 7 2nd Unit? Yes No OTC? 0 Yes G No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK Add two bedrooms and two full baths 485 s.f. • Add Master Bath 173 s.f. • Remodel Kitchen and SCOPE Family Room. Raise Ceiling in Living and Dining Room. Move stair @ garage. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,III-B,IV,V-B 658 $4,511.00 1R3HPLNCK $1,731.00 1R3HINSP PME Plan Check: $0.00 1 432 1 s.£ $4 .00 Remodel, Other 1REMRESOTH Permit Fee: $1,731.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 658 $4,511.00 $1,731.00 1 "IEL ; OIJRLY ,, Yes ,':( No PT;i7M ,, HO JRLY Q Yes `Q No ELIC, HOURLY , ` Yes F) No MISC ITEMS Plan Check Fee: $4,511.00 i Remodel, Kitchen (<=300 so IREMRESKIT Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: 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 addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $4,511.00 [_2257 s.f. $5 .00 Remodel, Kitchen (<=300 so IREMRESKIT Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 432 1 s.£ $4 .00 Remodel, Other 1REMRESOTH Permit Fee: $1,731.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 const- ic"iU"" Tav Aebninislrulivc P`Ce: 0 Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: PLLONGRNGR $85.54 Select a Non -Residential Building or Structure G i i��ve/ Liocr,raau r,l<tlir�r� I°er°.. Strong Motion Fee: 1BSEISMICR $12.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 o1„ "?� T�� OT�L �% $6,345.04 $1,045.0 � re TO'T'A�F���; 7,390. Revised: 10101/2011 2011 CITY OF CUPERTINO ir' 'm FEE ESTIMATOR — BUILDING DIVISION iaADDRESS: 11215 Mount Crest PI. DATE: 11/07/2011 REVIEWED BY: A. Salvador PC FEE ID APN: 356-26-026 BP#: 11100015 *VALUATION: 1$125,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P _t 2nd Unit? Yes • No OTC? 0 Yes E)No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Add two bedrooms and two full baths 485 s.f. • Add Master Bath 173 s.f. • Remodel Kitchen and SCOPE Family Room. Raise Ceiling in Living and Dining Room. Move stair @ garage. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,III-B,IVN-B 658 $4,511.00 IR3HPLNCK $1,731.00 IR3HINSP $0.00 PME Plan Check: $0.00 432 s.f. $457.00 Remodel, Other 1REMRESOTH Permit Fee: $1,731.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 658 $4,511.00 $1,731.00 MECH, INCUR' 0' Yes' (` No PLUMB, HOURLY} Yes , 0 No ELEC, HOURLY 0 Yes Q No MISC ITEMS Plan Check Fee: Alec h. Pc wil Fe", / t..rrAi;_ f' rrrrre i -L . P, Remodel, Kitchen (<=300 so 1REMRESKIT Li p,0' hrs $0.00 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 addn'1 info. FEE ITEMS (Fee Resolution 11-053 Etf. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $4,511.00 =s.f $588.00 Remodel, Kitchen (<=300 so 1REMRESKIT Suppl. PC Fee: (F) Reg. © OT p,0' hrs $0.00 PME Plan Check: $0.00 432 s.f. $457.00 Remodel, Other 1REMRESOTH Permit Fee: $1,731.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f�C7YIlY11S1Y(�fBti'E''C': 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: PLLONGRNGR $85.54 Select a Non -Residential Building or Structure Q 0 Travel Docu mewwion FeL,s: Strong Motion Fee: IBSEISMICR $12.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $5.00 bBTOTALS $6,345.04 $1,045.00TO'TAL FEE:$7,390.04 Revised: 10/01/2011 �< !'+iTi 7 !1T !'+i T7)T T TT1�Tl1 1 '–'D 0j— OCCUPANCY TYPE: \.111 Vl' l.Vl JU1AI11111V %_11 FEE ESTIMATOR - BUILDING DIVISION I PC FEES ADDRESS: 11215 mount crest pl. DATE: 10/03/2011 REVIEWED BY: bobs. 173 APN:� BP#: "VALUATION: 1$76,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex P 2nd Unit? % Yes '; No PENTAMATION 1R D USE: OTC? 0 Yes (j) No PERMIT TYPE: WORK add master bath 173 s.f. remodel living and kitchen 657 s.f. 173 �sfd SCOPE $963.00 $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 173 $994.00 IADDPLCK $963.00 IADDINSP Li 0.0 1 hrs $0.00 PME Plan Check: $0.00 F-43271 s.f. Remodel, Other $457.00 IREAMESOTH e/7) Permit Fee: $963.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 hrs TOTALS: 173 $994.00 $963.00 MECH, HOURLY 0 Yes Q No PLUMB, HOURLY 0 Yes ` Q No ELEC, HOURLY 0 Yes Q No MISC ITEMS Plan Check Fee: $994.00 F-2257 s.f. $588.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Li 0.0 1 hrs $0.00 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 adds-" info. FEE ITEMS (lee Resolution 11-053 Gff. 7/1/11,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $994.00 F-2257 s.f. $588.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. C) OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F-43271 s.f. Remodel, Other $457.00 IREAMESOTH 0 Permit Fee: $963.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? C) Yes (E) No $0.00 Advanced Planning Fee: PLLONGRNGR $22.49 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISMICR $7.60 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $1,991.09 $1,045.00 TOTAL FEE: 1 $3,036.09 Revised: 10/01/2011 021