11120113CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10211 BYRNE AVE
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.# L J l 6
Contractor - M Dat O Z
I hereby affirm that I am lic nsed under a 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.
l 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. 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-poins per the C7Date
o Municipal Code, Section
9.18.
Signature ��-0 ( Z
❑ 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 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
indemnity 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.
CONTRACTOR: JAKIN CONSTRUCTION PERMIT NO: It 120113
CORP
1601 TENAKA PL STE 223 DATE ISSUED: 02/14/2012
SUNNYVALE, CA 94087 PHONE NO: (408) 705-6650
BUILDING PERMIT INFO: BLDG ELECT' PLUMB
MECH ' RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: ADD 143 SQ FT TO FAMILY ROOM, M.SUITE, BEDROOM,
KITCHEN AND REPLACE 2l WINDOWS, REMODEL BATH 175
SQ FT, REMODEL KITCHEN 228 SQ FT, OTHER 710 SQ FT
Sq. Ft Floor Area: I Valuation: $100000
APN Number: 35711026.00 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:2�� y /f
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(x) should I 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.
Ow r au orized agent:
Date 1 `C
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.
Signature Date I Licensed Professional
REVISION #
CITY OF CUPERTINO BUILDING PERMIT DATE -/
BUILDING ADDRESS: 10211 BYRNE AVE
CONTRACTOR: JAKIN CONSTRUCTION
PERMIT NO: It 120113
CORP
OWNER'S NAME:
SUNNYVALE, CA 94087
PHONE NO: (408) 705-6650
LICENSED CONTRACTOR'S DECLARATION
F F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
F" r
MECH RESIDENTIAL COMMERCIAL
�^�, �- �y � � '' 1
Contractor AVL C O/iJ.S-TKQ ,f A)Date
I hereby affirm that l am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD 143 SQ FT TO FAMILY ROOM, M.SUITE, BEDROOM,
(commencing with Section 7000) of Division 3 of the Business & Professions
KITCHEN AND REPLACE 21 WINDOWS, REMODEL BATH 175
Code and that my license is in full force and effect.
SQ FT, REMODEL KITCHEN 228 SQ FT, OTHER 710 SQ FT
I hereby affirm under penalty of perjury one of the following two declarations:
3/14/2012 -REV# l- REVISION OF THE FOUNDATION- REV# 11SS'D 3/14/2012
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: $100000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35711026.00
Occupancy Type:
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
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 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date�
Issued by; Date:
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that l 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:
1, 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. l 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 l 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
Owner
� Dater
forthwith comply with such provisions or this permit shall be deemed revoked.
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 work'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,
Leader'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.
l understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FM --7 FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10211 BYRNE AVE
QTY/FEE
DATE: 03/14/2012
REVIEWED BY: BS
$0.00
APN:35
BP#:
"VALUATION: Iso
*PERMIT TYPE: Building Permit
$0.00
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 GENRES
PERMIT TYPE:
WORK
RE IONOF -rHE FOUIVDATION
SCOPE
1 hrs
$0.00
NOTE: This estimate does not include fees due to other Deparlmenis (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District ofc )_ These foes aro hacod nn tho nrolininary infnrmadnn auailahlo and aro nnlu an ocfimdWo_ Cmil -Y tho Dont for addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E . 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes ® No
$0.00
F__17 hours Plan Check, Hourly
$130.00 ISTPLNCK
Suppl, PC Fee: Q Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$130.00 TOTAL FEE:
F $130.00
Revised: 1/19/2012
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10211 byrne ave.
DATE: 12/21/2011
REVIEWED BY: bobs.
PC FEE ID
APN: 35_ I da (y
BP#: o20f�J
"VALUATION: j$100,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: P
god Unit? Yes No
OTC? 0 Yes (F) No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK
add family room remodel master suite bedroom kitchen replace 21 windows.
�sfd
SCOPE
228 s.f.
$588.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
S.I.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
143
$994.00
IADDPLCK
$963.00
IADDINSP
PME Plan Check:
$0.00
228 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREA MESKIT
Permit Fee:
$963.00
Suppl. Insp. Fee,0 Reg. Q OT
0,0
1 hrs
$0.00
710 I s.f. Remodel, Other
$522.00 IREAgMESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
=#
$652.
Window / Sliding Glass Door
WINREP Replacement
TOTALS:
7 143
$994.00
$963.00
MECH, HOURLY ® Yes 0 No
PLUMB, HOURLY Q Yes 0 No
ELEC, HOURLY 0 Yes Q No
MISC ITEMS
Y,'a.,
Plan Check Fee:
$994.00
175 s.f.
$588.00
Remodel, Bath (<=300 sf)
IREMRESBAT
ET?o-;,r.�„
Suppl. PC Fee: Reg. 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 tees are based on the Drelimnary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS flee Resolution 11-053 Lf 7/1,/11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
175 s.f.
$588.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
228 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREA MESKIT
Permit Fee:
$963.00
Suppl. Insp. Fee,0 Reg. Q OT
0,0
1 hrs
$0.00
710 I s.f. Remodel, Other
$522.00 IREAgMESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
=#
$652.
Window / Sliding Glass Door
WINREP Replacement
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee: PLLONGRNGR
$18.59
Select a Non -Residential
Building or Structure
0
i
Strom Motion Fee: IBSEISARCR
$10.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$1,989.59
$2,350.00.
TOTAL FEE:
F$4,339.591
Revised: 12/04/2011