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10090221 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10230 DUBON AVE CONTRACTOR:RICHARD HARO PERMIT NO:10090221 CONSTRUCTION OWNER'S NAME: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License of Chapter 9 BEDROOM,PATIO(136SQ)KITCHEN, (commencing with Section 7000)of Division 3 of the Business&Professions LAUNDRY(535.56SQ)&REMODEL Code and that my license is in full force and effect. KITCHEN(195SQ),BATHROOMS(146.5)&REPLACING WATER 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 Valuation:$200000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:34214050.00 Occupancy Type: 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 pplicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non- tD Issued hp Date Z" -_LY ❑ 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 stricture is not intended or offered for sale(Sec.7044, inspection. 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: 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. I will maintain 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 I 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 th Cupertino Municipal Code,Chapter 9.12-and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sectio s 25505,25533,and 25534. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is ct.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 ,ilding 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, 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 CITY OF CUPERTINO F-M-7, FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$200,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: OVER THE COUNTER. 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE 1D R-3 (Custom) II-B,III-B,IV,V-B 683 $2,349.00 IR3PLNCK $1,474.00 IR3INSP TOTALS: 683 $2,349.00 $1,474.00 MECH, HOURLY © Yes O No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check 0. hhrs $0.00 Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IPPERAET f:?t r Pr, r + r 1 , � . Other Mech. Insp. 0.0 hrs $42.00 Other Plumb Insp. L. hrs $42.00 oiler lac(. ,,;,,pl dle.(A JaNj?. Pc:e. Plnub 1n.y. i- t:e<.r_ NOTE: These -fees are based on the preliminary information available and are only an estimate. Contact the Dept_/or addn'l injo. FEE ITEMS (Fee Resolution 09-051 Eff. 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 146 s.f. $570.00 Remodel, Bath (<=300 sf) IREAMESBAT Suppl. PC Fee: 0 Reg. 0 OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 = s.f. $570.00 Remodel, Kitchen (<=300 sf) IREAMESKIT Permit Fee: ISUPINSFEE $1,474.00 Suppl. Insp. Fee{J Reg. 0 OT 1.0 hrs $126.00 0 $126.00 Mechanical IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $84.00 1 # $63.00 Mechanical IBREMAIR A/C Units (<=10K cfm) Construction Tax Acoustical Fee: 0 Yes 0 No $0.00 # $25.00 Plumbing IPRWHEATR Water Heater 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $88.79 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $20.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $8.00 SUBTOTALS: $4,191.79 $1,354.00 TOTAL FEE: 1 $5,545.79 Revised: 9/22/2010