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11040053CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10766 BROOKWELL DR I CONTRACTOR: PETER CONSTRUCTION I PERMIT NO: 11040053 OWNER'S NAME: 1 SAN JOSE, CA 95129 I PHONE NO: (408) 529-6412 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# 8 Contractor Da e 0 Z 1 hereby affir at 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 �% Y 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 0 Z-�/ 11 ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 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, wil I 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. BUILDING PERMIT INFO: BLDG I— ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ADD ENTRY PORCH,FOYERLIVING ROOM,BEDROOM,BATHROOM & ADDITION OF PARTIAL KITCHEN(564SQFT) SANITARY IS IN SUNNYVALES JURISDICTION. Sq. Ft Floor Area: I Valuation: $80000 APN Number: 36921037.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date.--Cz RE -ROOFS: Al I roofs shal I 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 1 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorize agent: Dater 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 Address ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional Fm_� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 10766 brookwell dr DATE: 04/08/2011 REVIEWED BY: larry s ��lADDRESS: APN: 369-21-037 BP#: "VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P god Unit? ' Yes 0No OTC? 0 Yes (E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK addition remodel add entry porch, foyer, living room bedroom bathroom addition of partial kitchen SCOPE counter, OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 564 $2,349.00 1R3PLNCK $1,474.00 1R3INSP TOTALS: 564 $2,349.00 $1,474.00 MECH, HOURLY 0 Yes E) No PLUMB, HOURLY © Yes Q No ELEC, HOURLY Q Yes Q No j771477df�. }�f N; _ ! v'.`- c,_. _ l" .. , �': i-�!', F1ri�}.LJ (,�'i ([:f' � ,1'..- l7 f.�f•' law? Fee. NOTE. These fees are based on the vreliminarv, information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,474.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CO;Istr .fmn 7er.�77 Acoustical Fee: 0 Yes (D No $0.00 Q 0 Work Without Permit? 0 Yes E) No $0.00 Planning Fee: PLLONGRNGR $73.32 Select a Non -Residential Building or Structure G /r-�fv"> Do:=arr'rvnwt Ml I Ct! . Strong; Motion Fee: IBSEISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: 1 $3,908.32 $0.00 TOTAL FEE: 1 $3,908.32 Revised: 01/15/2011