11080187 r
CITY OF CUPERTTS O BU]ILDIENG PERMIf 'Vititti ! q
..........................94=
BUILDING ADDRESS: 22637 SAN JUAN RD CONTRACTOR:ADAMS BROTHERS PERMIT NO:11080187
CONSTRUCTION
OWNER'S NAME: RIFAI STEVEN M 10100 TO RRE AVE DATE ISSUED:01/05/2012
OWNER'S PHONE. 4082305984 CUPERTINO,CA 95014 PHONE NO:(408)564-5207
171 LICENSED CONTRACTOR'S DECLARATION
71K— P 4 q BUILDING PERMIT INFO: BLDG ' ELECT PLUMB
License Class Lie. L c
MECH ' IBES COMMERCIAL '
Contractor"V's Date2-(2-
q f JOB DESCPJPTION:ADD 62SQFT TO MASTER BEDROOM,REMODEL OF
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING
Code and that my license is in full force and effect. SINGLE SFDWL I ST&2ND FLOOR
WALKOUT(3384SQFT),BATI-IROOM
--
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:$250000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34217064.00 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 applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point so cc regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. —7-7—
Signature— Date ? '2' 2- Issued by~ Date:2-
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 structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.�044,Busirie,,&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 1 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 the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must ized a- -
forthwith comply with such provisions or this permit shall be deemed revoked. Date
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of works
to building 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 fbr inspection purposes.(We)agree to save Leader's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
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
�V
CITY OF CUPERTINOI
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22637 san Juan rd. DATE: 02/29/2012 REVIENVED BY: bobs.
,. APN: '3 q,7") ! BP#: VALUATION: Iso
PERMIT TYPE: Building Permit PLAN CHECK TYKE: Alteration/Repair
P MAILYSFD or Duplex PENT TION 1GENRES
USE• PE IIT TYPE:
woRK revise stem wall with installation helical piers.
SCOPE
{ Ill
1VOTE.This estimate does not include fees due to other Depariments(Le,Planning,Public Works,:moire,Sanitary Seaver District,School
District,etc). These La are based on the erefiffina information available and are only an estimate. Contact the De t or 't info.
FEE ITEMS (f,ee.k'esohrfion 11-61-53 E f. 71/11) FEE QTY/FEE MSC ITEMS
Plan Check Fee: Hourly Only? Q Yes Q No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $260.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feer Reg. C ®T 0a0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes Q No $0.00
,-'advanced PlanninE Fee: $0.00 Select a Non-Residential
Building or Structure
S lrQDg Motion Fee: $0.00 Select an Administrative Item.
B ci4 Stdls Convmission Fee: $0.00
SUBTOTALS: $0.00 $260.00 TOTAL FEE: $260.00
Revised: 1/19/2012
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22637 san juan rd. DATE: 09/08/2011 REVIEWED BY:
ATN: BP#: VALUATION: 1$250,0000bV
-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? 0 Yes " No PENTAMATION 1 R3SFDADD
USE: OTC? 0 Yes
No PERMIT TYPE:
WORK sfd master bedroom addition 62 sq, remodel walk-out basement garage, 1 and 2nd floor , and 1 deck
SCOPE totat 4,927 sf. rid
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 62 $994.00 1ADDPLCK $963.00 IADDINSP
TOTALS: 62 $994.00 $963.00
MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0 No
El
NOTE: This estimate does not include fees due to other Depts(i.a Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7111/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $994.00 342 s.f. Swimming Pool
Suppl.PC Fee: 0 Reg. 0 OT Fo.0 hrs $0.00 $1,435.00 IPOOLGUNIT ` Gunite
PME Plan Check: $0.00 148 ; s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $963.00 $588;0a I IREMRESKIT
Suppl. Insp.Fee:O Reg. 0 OT0.0 hrs $0.00 1 205 ' s.f. Remodel,Bath(<=300 sf)
PME Unit Fee: $0.00 $588.001IREMRESBAT
PME Permit Fee: $0.00 F4,574 s.f. Remodel, Other
$6,541.00 I REMRES3
Work Without Permit? 0 Yes No $0.00 0
Advanced Planning Fee: PLLONGRNGR $8.06 Select a Non-Residential 0
Building or Structure 0
Strong Motion Fee: IBSEISMICR $25.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $10.001"
SUBTOTALS: $2,000.061$9,152.00 TOTAL FEE: $11,152.06
Revised: 09/02/2011
CITY OF CUPERTINO BUILDING PERMIT ll �n
BUILDING ADDRESS: 22637 SAN JUAN RD CONTRACTOR:ADAMS BROTHERS PERMIT NO:11080187
CONSTRUCTION
OWNER'S NAME: RIFAI STEVEN M 10100 TORRE AVE DATE ISSUED:01/05/2012
OWNER'S PHONE: 4082305984 CUPERTINO,CA 95014 PHONE NO:(408)564-5207
❑ LICENSED CONTRACTOR'S DECLARATION _
MI
BUILDING PERT INFO: BLDG' ELECT' PLUMB
License Class Lie.# i m
[ MECH` RESIDENTIAL COMMERCIAL
Contractor 1�.�°h� 3��'��� Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD 62SQFT TO MASTER BEDROOM,REMODEL of EXISTING
SINGLE SFDWL 1ST&2ND FLOOR
(commencing with Section 7000)of Division 3 of the Business&Professions WALKOUT(3384SQFT),BATHROOM 4/20/2012-REV#3-REVISE INSTALLATION OF HYDRONIC HEATING
Code and that my license is in full force and effect. IN BASEMENT LEVEL AND REMOVE AND REPLACE THE SLAB IN THE BASEMENT LEVEL-4/23/2012
REV#3 ISS'D
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:$313000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34217064.00 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 applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sou e regulations per the Cupertino Municipal Code,Section
9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date o- Issued by: Date:
❑ 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
I,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 structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
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
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
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 the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
d a¢P-t-
forthwith comply with such provisions or this permit shall be deemed revoked. Rlwnrr�r a horUe ®
Date-
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance ofWork's
to building 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,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
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. ARCHITECT'S DECLARATION
Signature Date I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22637 San Juan Rd DATE: 04/20/2012 REVIEWED BY: Sean
APN: BP#: 11080187 *VALUATION: 1$43,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRE
USE: PERMIT TYPE:
WORK Revision #3: Installation of h dronic heating in basement level and remove and replace the slab in the
SCOPE basement level.
,�-clr. ,'Ict Flraf,yF,. Man Cl2sc; Alec.. !an Check
1 ernait .. 'Ium,7.Yermi?Fee: F"'ec. P'rm"'[Fee:
0:f/er-;i e,;:.Irs- F-1 I Jt es P?arn;;; rrsc 0olev L-lec.Insp.
tech.InSp.Fee: Phtmb. Ins t.FCe: Glec.Jmp.-Fuv:
NOTE.This estimate does not include fees due to other Departments(Le-Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelinWina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 11-053 E . 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (2) No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $130.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? O YesG No $0.00
Suppl. Insp.Fee: Reg. 0.0 OT hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (•) No $0.00
Advanced Planning Fee: $0.00 hours Inspections )
�':c e! c�cli�;al�i,atic},r :'gee $260.00 ISTINSP Inspection,Hourly 0
Strong;Motion Fee: IBSEISMICR $4.30 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
SUBTOTALS: 1 $6.30 $390.00 TOTAL FEE: $396.30
Revised: 04/01/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22637 SAN JUAN RD CONTRACTOR:ADAMS BROTHERS PERMIT NO:11080187
CONSTRUCTION
OWNER'S NAME: RIFAI STEVEN M 10100 TORRE AVE DATE ISSUED:01/05/2012
OWNER'S PHONE: 4082305984 CUPERTINO,CA 95014 PHONE NO:(408)564-5207
❑ LICENSED CONTRACTOR'S DECLARATIONMF—
/ BUILDING PERMIT INFO: BLDG ELECT PLUB
License Class d 7 Lic.# /�l
P-1 � ��q �, MECH RESIDENTIAL COMMERCIAL
r
Contractor t C A Date (i (%1
1 hereby affirm that I am licensed under the provisions of ChapterJ9 JOB DESCRIPTION:ADD 62SQFT TO MASTER BEDROOM,REMODEL OF
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING
SINGLE SFDWL 1 ST&2ND FLOOR
Code and that my license is in full force and effect. WALKOUT(3384SQFT),BATHROOM
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 j ,jn� ��/
performance of the work for which this permit is issued. � �� y �� � " U�' C
I have and will maintain Worker's Compensation Insurance,as provided for by �ff �/• �71� ,//„ /6G /1 er�,_
Section 3700 of the Labor Code,for the performance of the work for which this /
permit is issued. Sq.Ft Floor Area: Valuation:$270000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34217064.00 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 applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. �i�`n `� �-�,
tIssued
Signature i Date ate: ���/�—
❑ OWNER- UZLDER 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 structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Saf%ty Code,Sections 25505,25533,and 25534.
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. Owner or aut 6�r. Date-
APPLICANT
ate APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(See.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,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
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
FEE - UI DIVISION
tD SS: 22637 sari Juan rd. DATE: 03112/2€812 REVIEWED BY: bob s.
� j APN: EP#: 11080187YALIIATION: $20,000
�w!,
PERMIT TYPE: Building Permit PLAN CHECK E: Alteration/Repair
P ILS" PENT TION
USE: SFI or DuplexPE T TYPE:
woRK revise underpinning at front portion of sfd.
SCOPE
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,:moire,Sanitary Seaver District,School
District,etc). These Lees are based on the preffidna in or on available and are only an estimate. Contact the De t or addn'l in o,
FEE ITEMS (To e.±Resohrtion 11-053 E'I) ',1/71) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0,00 Select a Ivlisc Bldg/Structure
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Budding
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes 0 No $0.00
Suppl.Insp.Fee-0 Reg. Q®T a.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Select a Non-Residential
Work Without Permit? 0 Yes Q No $0.00 Building or Structure
Advanced arnced Pla nnnin c! Fee: $0.00 �=_� hours Inspections
$260.00ISTINSP Inspection,hourly
Stroru_L Motion lee: IBSEISMICR $2.00 Admin./Clerical Fee
BUg Stclls C-oi-nmIlss,ion Fee- IBCBSC $1.00 _J44,0aiaN
SUBTOTALS: $3.00 TOTAL,F'EE: -304-.09
Revised: 1/19/2012