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11080229CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10431 LANSDALE AVE CONTRACTOR: VALLEY HOME BUILDERS, PERMIT NO: 11080229 INC. OWNER'S SANTA CLARA, CA 95050 PHONE NO: (408) 248-8000 ❑ LICENSED CONTRACTOR'S DECLARATIONJ �^ - License Class Lie. #_ 2+ L4 1 Contractor Date i 1 l% I hereby affirm thiit I am licensed under the provisions of C apter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB r MECH i RESIDENTIAL F COMMERCIAL I - JOB DESCRIPTION: SINGLE FAMILY DWELLING ADDITON OF 192SQFT MASTER BATH & MASTER BEDROOM 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. Sq. Ft Floor Area: Valuation: S42000 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 reguI ti per t e pertino Municipal Code, Section 9.18. Signature Date-J 2 ❑ OWNER -BUILDS DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: /-I 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, 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, APN Number: 36911007.00 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: 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 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 I 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. i�A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of %ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARAT D Signature Date. I understand my plans shall be used as public records. Licensed Professional ��� -.2 Y `� % 1 CITY OF CUPERTINO BUILDING PERMI 7 , BUILDING ADDRESS: 10431 LANSDALE AVE CONTRACTOR: VALLEY HOME DERS, PERMIT NO: 11080229 INC. OWNER'S SANTA CLARA, CA 95050 PHONE NO: (408) 248-8000 ❑ LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic H 4?1y-5v r l` r Contractor Date MECH RESIDENTIAL COMMERCIAL I hereby 3 of the Business & Professions BEDROOM Code and that my license is in full force and effect. 10/11/201 I-REV/11-REVISE FOOTING TO ADDITION-REVNI ISS'D 10/11/2011 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 Sq. Ft Floor Area: Valuation: $42000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36911007.00 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 Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 D YS FRO ST CALLED INSPECTION. with all Issued by: Date: l0 ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I 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: 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 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, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 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 / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Hork'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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Date Licensed PrnfkWonal Fm_� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10431 Landsdale Ave DATE: 10/11/2011 REVIEWED BY: Sylvia APN: BP#: 11080229 "VALUATION: Iso 11 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Revise footing to addition SCOPE (Pf'jer A-f cb. /raj'' t?liar Pi:�r�i1. ,�a.�l;.Lj f'.e. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etG). These Pees are based on the Drelimnary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution II-053 E . 711,111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (E) No $0.00 2 hours $260.00 Plan Check, Hourly IsTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,'i:IfFfiTPl:S`ti'Jtl l'i' Pee. Q (F) Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential (D Building or Structure i Oo, -toFnc nr.!t �).i I=eeN. Strong Motion Fee: $0.00 6 # $0.00 Revision IREVSFDWL SFDWL Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $260.00 TOTAL FEE T $260.00 Revised: 10/01 /2011 Fr-M CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10431 lansdale DATE: 08/31/2011 REVIEWED BY: bobs APN: I BP#: "VALUATION: 1$42,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? % Yes 0No OTC? 0 Yes (F) No I PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK add master bath and master bedroom. �sfd SCOPE 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 192 $994.00 IADDPLCK $963.00 1ADDINSP TOTALS: 192 $994.00 $963.00 MECH, HOURLY 0 Yes E) No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No 1'( Afe"k 4, tqp. �.Li f nw. i'f',.. Y'':.. ... >r' .. . .. ... NOTE. These fees are based on the nreliminary information availableand are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E '. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $994.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $963.00 Suppl. Insp. Fee O Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �. UF.P43t7tt'tiUt: �.irt Acoustical Fee: 0 Yes (D No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee PLLONGRNGR $24.96 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISMCR $4.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $1,988.16 $0.00 TOTAL FEE: $1,988.16 Revised: 07/04/2011