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11030048CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 795 ALDERBROOK LN CONTRACTOR:. D PERMIT NO: 11030048 OWNER'S NAME: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class /S Lic. sy �q� / MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 2ND FLOOR, 20"SQFT CONVERTED GARAGE TO (commencing with Section 7000) of Division 3 of the Business & Professions HABITABLE AREA,MASTERSUITE,BATH,GAMEROOM & HALLWAY Code and that my license is in full force and effect. 38SQFT FIRST FLOOR TO THE REAR SIDE, STAIR 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: $167000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36916013.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 ma accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Addi onall the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source r ulati per the Cupertino Municipal Code, Section 9.18. Issued bar Dater Signature Date /��—���� ❑ 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 [, 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. 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 1 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 C de, 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 forthwith this be deemed Ow LENDING AGENCY I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of mrk'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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 795 ALDERBROOK LN OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION Q License Class 4 1 SClS% Lic. # 131(S— Contractor =;'rl Date ,Z3 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 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, th plicant understands and will comply with all non -point source regul ions a Cupertino Municipal Code, Section 9.18. Signature Date_ ❑ 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 mamrer 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, l 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. CONTRACTOR: EMPIRE FLOORING DESIGN CENTER 495 E BROKAW RD SAN JOSE, CA 95112 DATE ISSUED:09/01/2011 PHONE NO: (408) 213-0996 BUILDING PERMIT INFO: BLDG I— ELECT ' PLUMB F MECH r- RESIDENTIAL I COMMERCIAL r- JOB DESCRIPTION: ADD 2ND FLOOR, 20"SQFT CONVERTED GARAGE TO HABITABLE AREA,MASTERSUITE,BATH,GAMEROOM & HALLWAY 38SQFT FIRST FLOOR TO THE REAR SIDE, STAIR 1/3/12 REVISION #I -REVISE CONVENTIONAL ROOF FRAME TO ENGINEERED TRUSSES WITH STRUCTURAL CALCS.- 1/23/2012 REV#1 ISS'D Sq. Ft Floor Area: I Valuation: $167000 APN Number: 36916013.00 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: 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 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. : % $� Dater 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 Address ARCHITECT'S DECLARATION Signature Date. I understand my plans shall be used as public records. Licensed Professions CITY OF CUPERTINO FM_7 FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 795 alderbrook In. DATE: 01/03/2012 REVIEWED BY: bobs. APN: BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: wORK revise conventional roof framing to engineered trusses. SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nrelininary information available and are only an estimate. Contact the Dent for addn I/ into. FEE ITEMS (Fee Resolution 11-053 E . 7/11Il) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 F-47 hours Plan Check, Hourly $520.00 1STPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 IminLYli fiti vc 1 , 0 0 Work Without Permit? 0 Yes 0 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: $0.001 $520.00 TOTAL FEE: 1 $520.00 Revised: 12/04/2011 CITY OF CUPERTINO Fm-7- FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 795 alderbrook dr. DATE: 03/10/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$167,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? Yes •• No OTC? 0 Yes ONo PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK I sfd addition master suitegame room stairs bath. Remodel kitchen laundry hall bedroom re -roof. 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 1,043 $2,367.26 IR3PLNCK $1,539.42 IR3INSP TOTALS: 1,043 $2,367.26 $1,539.42 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No Li NOTE: These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (I ee Resolution 09-051 F., . 71111Q) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,367.26 98 s.f. $570.00 Remodel, Bath (<=300 so IREMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 160 s.f. $570.00 Remodel, Kitchen (<=300 so IREWESKIT Permit Fee: $1,539.42 Suppl, Insp. Fee:O Reg. 0 OT 0.0 1 hrs $0.00 = s.f. Remodel, Other $443.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 640 s.f. $91.00 Re -roof IREROOFRES Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $135.59 Select a Non -Residential Building or Structure 0 0 '�1,.0 1'E.'! l;•�r�<.r++.c�::, ..,, <?tt fcE:. Strong Motion Fee: IBSEISMICR $16.70 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $7.00 SUBTOTALS: $4,065.97 $1,674.00 TOTAL FEE: 1 $5,739.97 Revised: 01 /15/2011