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11020068CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10706 PINOLE CT CONTRACTOR: PERMIT NO: 11020068 OWNER'S NAME: , f 4t� 1> n( PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION I —BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. Contractor Date 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. 1 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 l 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. Date J; 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). �'fiereby 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 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 -points rce regulations per the Cupertino Municipal Code, Section 9.18. Signature-- , Date MECH F RESIDENTIAL F COMMERCIAL r— JOB DESCRIPTION: ADD 513SQFT TO EXPAND MASTER BED/BATH (2BEDROOMS), NOOK & FAMILY ROOM & REMODEL HALL BATH 106 SQ FT /STUDY 322 SQ FT, SERVICE UPGRADE, RELOCATE THE Sq. Ft Floor Area: I Valuation: $185000 APN Number: 36934022.00 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: RE -ROOFS: All roofs shall be inspected prior to any roofing material berg 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. 1 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. 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 I understand my plans shall be used as public records. Licensed Professional FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10706 pinole ct. DATE: 02/17/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: 1$185,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes 0 No OTC? © Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK addition master suite 2 beds famil rooms remodel hall bath and stud . Re lace furnaceand SCOPE Od ocate electrical panel. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE 1D R-3 (Custom) II-B,III-B,MV-B 513 $2,349.00 1R3PLNCK $1,474.00 1R3INSP TOTALS: 513 $2,349.00 $1,474.00 MECH, HOURLY Q Yes (F) No PLUMB, HOURLY Q Yes a No ELEC, HOURLY n Yes Q No ti/ech. Flan C'Jrc:rri Plumb. Plur, �, h �< I, Elec. Plan Check 0.0 hrs $0.00 ;111ech. Permil Fee: bin'lb. Pc! i70 F-e: Elec. Permit Fee: 1EPERMIT Other ,1 /ech. Insp. odwr Piurah Insp. Other Elec. Insp. 0.0 hrs $42.00 1/ech. Nip. Fare: I'lumb. b1sp. Fcc. lilctr. Imp. Nv NOTE. These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 09-05/ L'ff 711110) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,349.00 428 s.f. $443.00 Remodel, Other IREMREsom Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 3,100 s.f. $403.00 Re -roof IREROOFRES Permit Fee: $1,474.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 200 amps Electrical $42.00 IERT<200 Services PME Unit Fee: $0.00 PME Permit Fee: $42.00 Construction Tax Acoustical Fee: 0 Yes 0 No $0.00 Q 0 Work Without Permit? Q Yes 0 No $0.00 Plannin Fee: PLLONGRNGR $66.69 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: I rRAVDOC $42.00 Strong Motion Fee: 1BSEISMICR $18.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $8.00 SUBTOTALS: $4,000.191 $888.00 TOTAL FEE: 1 $4,888.19 Revised: 01 /15/2011