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11060087CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 11197 LINDA VISTA DR OWNER'S NAME: JACOBS STEPHEN M AND ARLENE L OWNER'S PHONE: 4082556041 LICENSED CONTRACTOR'S DECLARATION License Class J Lic.# S Oo,� 2 C� Contractor S ON ZI'5� UN—1 I k Date ZG ll 1 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. CONTRACTOR: SUNRISE CONSTRUCTION PERMIT NO: 11060087 20725 SUNRISE DR DATE ISSUED: 08/29/2011 CUPERTINO, CA 95014 PHONE NO: (408)257-9020 BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r— MECH r— RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION: ADD (141SQFT) TO MASTER BEDROOM & KITCHEN REMODEL(250SQFT),REMODEL BATH(150SQFT) 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: 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. q Signature Date o-' 2A —D ❑ 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). 1 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 1 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. APN Number: 35626023.00 Valuation: $150000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by.—'ate:�ZyG� 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 1 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. Ownereep authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Nwrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Signature Date I Licensed Professional_ i(�� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CURERTIND (408) 777-3228 • FAX (408) 777-3333 • building(@-cupertino.org 2- Co U ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS I VIS - APN N OWNER NAME PHONE J S '9 _ C STREET ADDRESS FAX La hA S T7' ddTZd C'6- q5l71+ CONTACT NAME . II PHOrr� E- / G 14AP-D Q f Sa N (05-0 --32,--,7,, roc ar�Ai'ic/7�cv� er rw.� STREET ADDRESS�% D 1lm d tf( SVr Z, CITY. STATE ZIP a-dwo d q4o G 3 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT KARcHrrm ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �� LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME r ItX (o COS) 1) E-MAIL FAX c� Z� - y 17 ^ 59 %1 STREET ADDRESS T 0 13 0-)( Z r0O 00 CITY, STATE, ZIP J1 �1 �q PHONE ARCHITECT/ENGINEER NAME ' ! LICENSE NUMBER 1 BUS. LIC # (App0t1'AjVT'. C6 OTAZ G iS COMPANY NAME U O Q�so� ^ (� t I� E-MAIL FAX STREET ADDRESS 1� r, CITY, STATE, ZIP PHONE DES A /JI of wpLt I S �@ A�1 57 }32 #Lt BldgApp_1011.doc revised 03/16/11 CITY OF CUPERTINO ffim FEE ESTIMATOR - BUILDING DIVISION - ADDRESS: 11197 linda vista In DATE: 06/13/2011 REVIEWED BY: larry s PC FEE ID APN: BP#: "VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes No OTC. Q Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK I addition -141 sq feet kitchen remodel- 250 sq. feet 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 141 $965.00 IADDPLCK $934.00 IADDINSP $0.00 PME Plan Check: $0.00 150 s.f. $570.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: $934.00 Suppl. Insp. FeeAD Reg. 0 OT 0.0 1 hrs $0.00 = s.f. Remodel, Other $380.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1 141 $965.00 $934.00 No I PLUMB, HOURLY Q Yes Q No I ELEC, HOURLY Q Yes Q No NOTE: These fees are hased on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l Info. FEE ITEMS (Fee Resolution 09-051 Eff. 7%1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $965.00 250 s.f. $570.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 150 s.f. $570.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: $934.00 Suppl. Insp. FeeAD Reg. 0 OT 0.0 1 hrs $0.00 = s.f. Remodel, Other $380.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 Q E) Work Without Permit? Q Yes 0 No $0.00 Planning Fee: PLLONGRNGR $18.33 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item Ll Bldg Stds Commission Fee: IBCBSC $6.001 SUBTOTALS: $1,938.331$1,520.001 TOTAL FEE: 1 $3,458.33 Revised: 04/29/2011 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 1119 L; .d.x, vis t Oa-ivt PERMIT # D OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: •/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # NM�Cabinets & Millwork Cement Finishing Electrical Say.wvq%C e,31— ltd, % Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing U"- t w. 7� L Heating jz MT M��i1o�.ic�` 336( i Insulation �4*n- 1NL Landscaping Lathing Masonry Painting / Wallpaper Jwn N jw&t f�A�n71`I j � > Paving Plastering lxa 1- ,pk�4,0-� 3 S 1 S Plumbing PLV" 3 3 21$� Roofing &,G -r 2 (p VI Septic Tank - Sheet Metal Sheet Rock ll Tile GahrTA*cA 4 % - S-OKM\R uv,, O vner / Contractor Signature —/o—/-?- Date /o1/2Date CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: / r PHONE # - i GENERAL CONTRACTOR: �.,, . ,� - BUSINESS LICENSE # ADDRESS.r_ � 1 6 �` ',�,��: w _ s �" r CITY/ZIPCODE:=fi *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS NAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date