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11050070CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 902 BLAZINGWOOD AVE I CONTRACTOR: ROCHA'S COMPANY PERMITNO: 11050070 OWNER'S NAME: BALAKR[SHNAN SATISH 12191 MONTICELLO AVE I DATE ISSUED: 07/08/2011 1 OWNER'S PHONE: 4083092954 1 SAN JOSE, CA 95125 1 PHONE NO: (408)593-7405 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 8, Z I3 % Contractor C"%()L Arp, Date ICE / 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: 1 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. 1 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. 5.1_ APPLICANT CERTIFICATION 1 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 sour regulations per the Cupe unicipal Code, Section 9.18. Si ure 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). 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. 1 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. 1 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, [ become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL ADD 1,606 SQ FT TO LIVING, DINING, FOYER, MASTERUITE, PATIO AND GARAGE, REMODEL 1,257 SQ FT THROUGH OUT BEDROOMS, KITCHEN AND BATHS Sq. Ft Floor Area: I Valuation: $180000 APN Number: 36917016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN A PERMIT ISSUANCE OR 180 DAYS OM LAST CALLED INS�PyECTI N. Issued by: 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 Cupe no Municipal C de, apter 9.12 and the Health & Safety Code, Sections 2 5, 2553,3(pd=5 4 i Owner or authorized agwK Date: 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 1 understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMI 113 BUILDING ADDRESS: 902 BLAZWGWOOD AVE CONTRACTOR: ROCHA'S COMPANY PERMIT NO: 11050070 OWNER'S NAME: BALAKRISHNAN SATISH 2191 MONTICELLO AVE DATE ISSUED: 07/08/2011 OWNER'S PHONE: 4083092954 SAN JOSE, CA 95125 PHONE NO: (408)593-7405 ❑ LICENSED CONTRACTOR'S DECLARATION F ELECT r PLUMB r PERMIT License Class Li.. # BUILDING INFO: BLDG �"'"" �'"° MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 1,606 SQ FT TO LIVING, DINING, FOYER, (commencing with Section 7000) of Division 3 of the Business & Professions MASTERUITE, PATIO AND GARAGE, REMODEL 1,257 SQ FT Code and that my license is in full force and effect. THROUGH OUT BEDROOMS, KITCHEN AND BATHS I hereby affirm under penalty of perjury one of the following two declarations: 8/2/2011 -DEFFERED# I -DEFERRED TRUSSES-9/13/2011 REV#1 ISS'D 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: $180000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36917016.00 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. Add' nally, the applicant un [ands and will comply 180 DAYS FROM LAST CALLED INSPECTION. withal I non -point source ulatirns per the C o unicipal Code, Section 9.18. Signature Date Issued by:.'Date: 5 /Z ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beiig installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, 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 [ 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. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined b he Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance w' 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 & SafetyCo , Sectio 25505 25 3, and 25534. Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must IF o ge�2�� j Date: forthwith comply with such provisions or this permit shall be deemed revoked. 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 Hork'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 with all non -point source regulations per the Cupertino Municipal Code, Section ARCHI ECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 902 blazingwood ave. DATE: 05/11/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$180,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: p 2nd Unit? Yes •- No OTC? 0 Yes (F)No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK sfd add 1435 sq ft.= new garage, living, diningfoyer, master suite deck/porch, remodel 1257 sq ft. 3 SCOPE bedrooms, kitchen, 2 baths, pantry, garage. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 1,606 $2,476.82 1R3PLNCK $1,931.94 1R3INSP TOTALS: 1,606 $2,476.82 $1,931.94 MECH, HOURLY 0 Yes (j) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No . ,.. , r'T1.4j). U'iti'f1'71�fFF�7 �%'Cr�J. j E3 imw. NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,476.82 1,257 s.f. $4,073.00 Remodel, Other /READ ES2 Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,931.94 Suppl. Insp. Fee:a Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,r'O vrrPlcfion F7 Acoustical Fee: 0 Yes (F) No $0.00 Q 0 Work Without Permit? © Yes (E) No $0.00 Planning Fee: PLLONGRNGR $208.78 Select a Non -Residential Building or Structure Q 0 7i-irlVlDraa Strong; Motion Fee: IBSEISMCR $18.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $4,643.54 $4,073.00 TOTAL FEE: 1 $8,716.54 Revised: 04/29/2011 ��,��� CITY OF CUPERTINO Ibiii31 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 902 blazingwood ave. DATE: 08/02/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$9,000 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK deferred trusses. SCOPE NOTE: These fees are haled on the nrelindnary information availahle and are only an estimate. Contact the Dent for addn'1 info_ FEE ITEMS (Tee Resolution 11-053Lff. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 ® 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:O Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,e xtr c'tioF7 I4a Acoustical Fee: 0 Yes 0 No $0.00 Q 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Hee $0.00 Select a Non -Residential Building or Structure 0 0 r;tva% 1}rx nine n1c'rlfnr: l t : Strong Motion Fee: 1BSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.90 $520.00 TOTAL FEE: $521.90 Revised: 07/04/2011