11080157 (4) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19752 BIXBY DR CONTRACTOR:JBS HOMES INC PERMIT NO: 11080157
'`A'VER'S NAME:
CUPERTINO,CA 95014 PHONE NO:(408)390-5577
LICENSED CONTRACTOR'S DECLARATION F
—�/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 9, C-Z Lic.# 2 75 •f a r f—
r-
MECH RESIDENTIAL COMMERCIAL
Contractor —5 '740A Date H—1
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD TO EXISTING MASTER BEDROOM&
(commencing with Section 7000)of Division 3 of the Business&Professions ADDMASE W 1/2 BATH
S NC &REMODELING OF NEW
ROOF
Code and that my license is in full force and effect. ADD NEW 1/2 BATH INCLUDED IN 191SQFT,NEW ROOF
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 Sq.Ft Floor Area: Valuation:$100000
permit is issued.
APPLICANT CERTIFICATION APN Number:36909017.00 Occupancy Type:
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 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
9.18. ure Date /,9_Z q r// IssuedSip-
❑ 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
I,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: HAZARDOUS MATERIALS DISCLOSURE
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 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. 1 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 Owner or author'
D 21'I /
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%ork'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
up 'le above mentioned property for inspection purposes.(We)agree to save
i, 4 and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
cosL.,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.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMITu
BUILDING ADDRESS: 19752 BIXBY DR I CONTRACTOR: JBS HOMES INC I PERMIT NO: 11080157
OWNER'S NAME:
1 CUPERTINO, CA 95014 1 PHONE NO: (408)390-5577
LICENSED CONTRACTOR'S DECLARATION
License Class A - f3 -e—?-q Liic. # (9.2 7 -�1 % 0
Contractor L �� (% •,�Iiti Date / — 22
I hereby affirm that I am licensed tinder 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, the applicant understands and will comply
with all non -point source regulations per the 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)
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.
BUILDING PERMIT INFO: BLDG ELECT J_ PLUMB F
MECH RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD TO EXISTING MASTER BEDROOM &
MASTERBATH(191 SQFT) & REMODELING OF SAME(145SQFT)&
ADD NEW 1/2 BATH INCLUDED IN 191 SQFT, NEW ROOF
11/22/2011 - REV#1-REVISE REAR FACADE EXTEND TO TWO(2)FT, RELOCATE
FURNACE TO ATTIC-11/22/2011 REVI ISS'D
Sq. Ft Floor Area: I Valuation: $100000
APN Number: 36909017.00 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,e
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.
Owner or auth edt
Date: Z
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vork'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
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
-
ADDRESS: 19752 bixby dr.
DATE: 11/22/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
-7
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
extend 2 feet relocate furnace to attic.
���cade
SCOPE
Mech. Plan Check 0.0 hrs $0.00
il"'V „ i; a.; t`hwc- t
flafi C h;
Mech. Permit Fee: IMPERMIT
?'Irr,nh i'erw< F'ce:
Other Mech, Insp. Fo.0 hrs
Li
;ife� Ce
'
'Ce.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc )_ These foes are hated nit the nrelininary information available and are only an estimate. Contact the Dent for addn'l into.
FEE'ITEMS (Fee Resolution 11-053 E . 711/11,2
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (F) No
$0.00
0 hours Plan Check, Hourly
$130.00 1STPLNCK
Suppl. PC Fee: Q Reg. OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
0 # Mechanical
$130.00 1MFR=<100 Furnace, Forced -Air
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PMEPermitFee:
$44.00
11FI.y 1.P tlt.'fi r; t ,,Pax
Administrative Fee: lADMIN
$41.00
0
E)
Work Without Permit? Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
or Structure Building
G
0
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$129.00
$260.00
TOTAL FEE:
$389.00
Revised: 10/01/2011
RMIN
CITY OF CUPERTINfl
FEE ESTIMATOR - BUILDING DIVISION
19ADDRESS:
-N
19752 bixby br.
DATE: 08/22/2011
REVIEWED BY: bob s.
APN:
mi:
"VALUATION: j$100,000 �
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: P
2nd Unit? l Yes 0 No
OTC? 0 Yes GNo
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
sfd add master suite new 1/2 bath remodel re -roof, exisiting deck.
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
191
$994.00
IADDPLCK
$963.00
1ADDINSP
TOTALS:
191
$994.00
$963.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes E) No '
ELEC, HOURLY 0 Yes Q No
tkt .t7 r'l41
F.Jrt.i7 .., `;tjJ.
('P_,
NOTE: These fees are hased on the nreliminary information available and are oniv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E '. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
F-1-457 s.f.
$588.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee: G Reg. 0 OT
F0,01hrs
$0.00
PME Plan Check:
$0.00
538 s.f. Remodel, Other
$457.00 IREMRESOTH
Permit Fee:
$963.00
Suppl. Insp. Fee:G Reg. 0 OT
0.0
1 his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
;1;' rf'77.'r7r T'ff
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes G No
$0.00
Plannin�Fee:
PLLONGRNGR
$24.83
Select a Non -Residential
Building or Structure
0
0
A
;i >1 . f><:iirtrz>r,i rJ:ttr,{
Strong Motion Fee:
1BSEISMICR
$10.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS: ;
$1,995.83
$1,045.00J
TOTAL FEE:
1 $3,040.83
Revised: 07/04/2011