11050035CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10436 N PORTAL AVE
CONTRACTOR: ROCHA'S COMPANY
PERMIT NO: 11050035
OWNER'S NAME:
SAN JOSE, CA 95125
PHONE NO: (408)593-7405
❑ LICENSED CONTRACTOR'S DECLARATION
I_
ELECT
License Class Li.. N �/
BUILDIIVG PERMIT INFO: BLDG PLUMB
F r
MECH RESIDENTIAL COMMERCIAL
under the provisions of Chapter 9
JOB DESCRIPTION: ADD 448SQFT TO BEDROOM, MASTER SUITE, REMODEL
(commencing with Section 7000) of Division 3 of the Business & Professions
246SQFT TO BATHROOMS, 114SQFT TO BEDROOMS RAISE
Code and that my license is in full force and effect.
HALL CEILING, ADD 5 SUNTUNNELS SKYLIGHTS & REPLACE
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 S 4i;7
Compensation, as provided for by Section 3700 of the Labor Code, for the 77:;'
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: $98000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31629013.00
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. dditionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point sou regulations per the Cup o Municipal Code, Section
9.18.
Issued b Date:
Signature
/
❑ 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
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:
[ 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 I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
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 ode, Sec ons 2 33, 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
or
:���
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 work'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
ARCHITECT'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: 10436 N Portal AVE
DATE: 05/05/2011
REVIEWED BY: Mendez
APN:
BP#:
"VALUATION: 1$98,000
71
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: p
2nd Unit? Yes _ No
OTC? 0 Yes (E)NO
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
add 448 sq ft to bedrm m.suite remodel 246 sq to bathrooms 114 sq ft to bedrms raise hall ceiling
SCOPE
add 5 suntunnels skylights replace 3 windows and 1 bay window
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.L
pC FEES
PC EE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
448
$1,438.00
IA DPLCK
$1,169.00
IADDINSP
TOTALS:
448
$1,438.00
$1,169.00
MECH, HOURLY Yes 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
t7,Iler Hvelt
Ll
NOTE: These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (fee Resolution 09-051 Eff 711110
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,438.00
246 s.f.
$570.00
Remodel, Bath (<=300 so
1REMRESBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
h.
$0.00
PME Plan Check:
$0.00
114 s.f.
$380.00
Remodel, Other
1REMRESOTH
Permit Fee:
$1,169.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
0 # Skylight
$380.00 1SKYL<10SF <= 10 s.f.
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
3 #
$380.00
Window / Sliding Glass Door
IWINREP Replacement
(:`<ar�s'trdc4/acttl nr�
Acoustical Fee: 0 Yes (F) No
$0.00
#
$760.00
Window / Sliding Glass Door
1WINBAYSTR Bay Window
0
G
Work Without Permit? 0 Yes (D No
$0.00
Planning Fee PLLONGRNGR
$58.24
Select a Non -Residential
Building or Structure
Q
0
Trar�yT +"�ntilerr7frrtJatic>rr T'ez':i:
Strong; Motion Fee: 1BSEISMICR
$9.80
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$4.00
SUBTOTALS:
$2,679.04
$2,470.00
TOTAL FEE:
1 $5,149.04
Revised: 04/29/2011