11100076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10365 CALVERT DR CONTRACTOR: FAI DANIEL JOHN ET AL PERMIT NO: It 100076
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATIONr–-
BUILDING PERMIT INFO: BLDG ELECT ' PLUMB
License Class Lic.
Contractor Date
I 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 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.
Date
6CJ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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
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 lit. Additionally, the licant understands and will comply
with all non tit sour*regulatiais the Cupertino Municipal Code, Section
9.18. ??
Signature Date
MECH F RESIDENTIAL i— COMMERCIAL f—
JOB DESCRIPTION: CONSTRUCT SFDWL(1822SQFT LIVING AREA)&
ATTACHED
GARAGE(429SQFF}SANITARY IS SUNNYVALE'S
JURISDICTION
Sq. Ft Floor Area: I Valuation: $280000
APN Number: 37517025.00 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 berg 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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) 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 25 , 25533, and 25534.
own eor rtholpZed agen _ Z) 1
} Date•
/ CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of modes
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org
CUPERTINO
EK NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT AD RES
AFN l
I r
2
NAME —
PHONE
(410 OCA O �1G5
�/��a i a/W V, 6c7VLi
STREET Lrj v,�/1'� Yl ✓iii
�2.r-G�1't�t}
F
p��{g�
C ACT N CST IW Vl L I
l�D 4S?j 6
Q C LGA! avi,
STREET ADD 3
.STA ZIP C 2220F40
Gt Ya
❑ OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT X ARCHITECT ❑ ENGWEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. tic #
COMPANY NAME
E-MAIL
FAX .
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINE M NAME
LICENSE NUMBER
BUS. LIC #
cU P 2 is
c�'� cwt. c�r►'L
ao $6 33
STAEETADD
Cl� A ZIP D
P ONE A 93 /
��—
v
DES ON OF WO co `
r vw � -3 LatL
EXISTING1 USE
r I
S rl
PROPOSED USE CONSTR.
TYPE
v
0 STORIES
USE
TYPE
OCC.
SQFT.
VALUATIONS)
EXLSTG
NEW FLOOR
DEMO
TOTAL
AREA [ D 7%
AREA (O
^REe` t o 3
NET AREA
C�
BATHROOM f
KITCHEN
THER
REMODELAREA
REMODEL AREA
ODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: UDErACH
'RATracH
4 Z
# DWELLING UNITS:
IS A SECOND UNITEl YES
SECOND DRY ❑ YES
BEING ADDED? 0
ADDITIO . 0
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
T TAL VALUATION:
PLANNING APPL / r1NO PLANNING APPROVAL LETTER
EICE"M 11014Z? Tlf0
By my signature below, I certify to each of the following:
I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ntatives of Cupertino to enter the above -identified property for inspection purposes.
ordmarces and state laws relating building c ction. IZ=7
Signature ofApplicant(Ageat
Date: Oct 291 I
SUPPLEMENTAL INFO
REQUHUD
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-.THZ-COMM l,R
❑ BU .DnvG PLAN REVJXW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required
prior to issuance of building
permit for new building.
❑ MWRESS
❑ PLANNIIYG PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
11PUBI IC WORKS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
11 MAJOR
ElSANITARY SEWER DtSTRICT
submittal of Building Permit application.
❑ MWMONMENTAL HEALTH .
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
r� FEE ESTIMATOR - BUILDING DIVISION
I&
ADDRESS: 10365 calvert
DATE: 10/11/2011
REVIEWED BY: larrys
PC FEE ID
APN:
BP#:
"VALUATION: 1$280,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes `' No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
new sfdwl 1822 sq ft living area 429 s ft garage
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,111-B,IV,V-B
2,251
$2,664.53
IR3PLNCK
$2,394.94
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,394.94
Suppl. Insp. Feel@ Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
2,251
$2,664.53
Constr. Tax: IBCONS_A
$2,394.94
new
units
NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
District,eta). These fees are based on the oreliminary information available and are only an estimate Contact the Dept for addn7 info.
FEE ITEMS (lee Resolution 11-053 Lf. 7,11111)
t fn"• E 8f: .1?: ,.
.�:P7 s i (i �f`(��
if'f.. ,1 � t'/ i � .. t.
C:
------ -I-
..
$2,664.53
El
El
Suppl. PC Fee: e) Reg. Q OT
0.0
NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
District,eta). These fees are based on the oreliminary information available and are only an estimate Contact the Dept for addn7 info.
FEE ITEMS (lee Resolution 11-053 Lf. 7,11111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,664.53
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: e) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,394.94
Suppl. Insp. Feel@ Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCONS_A
1#
new
units
$582.00
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning PLLONGRNGR
$292.63
Select a Non -Residential
Building or Structure
t c(d Etracrr r��"rrr fir_k
Strong Motion Fee: IBSEISMICR
$28.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$12.00
SUBTOTALS:
$5,974.10
$0.00
TOTAL FEE:
1 $5,974.10
Revised: 10/01/2011