11030007CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1222 BUBB RD CONTRACTOR: ALOK MATHUR PERMIT NO: 11030007
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG' r ELECT F PLUMB
License Class Lic.
Contractor
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Pro essions
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 flie 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
up I on 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
J311" 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).
I hereby affirm under penalty of perjury one of the following three
declarations:
f 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 cc . rtify 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.
Signature Date 05
MECH' r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD DINING ROOKNEW NOOK AREA & OFFICE, FAMILY
BATHROOM EXTENSION(343SQ FT)& NEW SKYLIGHT;
REMODEL KITCHEN AREA COUNTER(50SQFT)PRE-APPROVAL
Sq. Ft Floor Area: I Valuation: $80000
APN Number: 36211053.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
`7 — Date�'_' _Z(�, �'- y'
Issued lby—.�
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 BETTE R
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. Iwillmaintain
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.
Owne .
!:,1 Date: CO
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of NNorms
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.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1222 BUBB RD
CONTRACTOR: ROCHA'S
PERIMITNO: 11030007
COMPANY
OWNER'S NAIME:
SAN JOSE, CA 95125
PHONE NO: (408)593-7405
LICENSED CONTRACTOR'S DECLARATION
I---
F
BUILDING PERNTITINFO: BLDG ELECT PLUNIB
License C ss 0— Lie.
F-
Contracto < Date --k—,/
NIECH RESIDENTIAL COMINIERCIAL
Iherebyaffirrn tiatl am lice edun - lie provisions of Chapter 9
JOB DESCRIPTION: ADD DINING ROOKNEW NOOK AREA & OFFICE, FAMILY
(commencing with Section 7000) of Division 3 of the Business & Professions
&
BATHROOM EXTENSION(343SQ FT)& NEW SKYLIGHT;
Code and that my license is in full force and effect.
REMODEL KITCHEN AREA COUNTER(50SQFT)PRE-APPROVAL
I hereby affirm under penalty of perjury one of the following two declarations:
S/ 11/2011 - REV# I - NEW BAY WINDOW LEVEL, NEW SKYLIGHT&
I have and will maintain a certificate of consent to self -insure for Worker's
RELOCATE EXISTING A/C TO BACKYARD -REV# I ISS'D 8/11/2011
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $80000
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.
APN Number: 36211053.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WOR14C IS NOT STARTED
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of tile
granting of this permit. Addit�vifally, the applicant ungpi%ands and will comply
Issued by: Date:
with all non -point source r glations r the , iper unicipal Code, Section
9.19.
r
Signature —X;Z�-///
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.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 (Sce.7044,
Business & Professions Code)
I, as owner of tile property, am exclusively contracting Nvith licensed contractors to
HAZARDOUS NIATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and tile
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which enlit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the CupetXo 114unicip CptVr(Cliapter 9.12 and
a ' NN" t
I have and will maintain Worker's Compensation Insurance, as provided for by
0 d C, Sections 2 25
the Health & Safety Code, Sections 25 25 —3
Section 3700 of the Labor Code, for the perforniance of tile work for which this
-agent:
permit is issued.
riz v�t a
Owner or autbo ge Date:
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (See. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and Count)' 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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand in), plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature_ Date
CITY OF CUPERTINO
WMA FEE ESTIMATOR — BUILDING DIVISION
im,ADDRESS:
FEE
I DATE_
REVIEWED BY:
APN:
I BP#:
WALUATION: Iso
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
P-0 I
PENTAMATION IGENRES
PERMIT TYPE: A
WORK
New Bay window level, New Skylight and relocate existing A/C to back yard.
SCOPE
NOTE: These fees are based on the Drelindnary information available and are on1v an estintate. Contact the Dept/or addn'l iqfo.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)..
FEE
-FT
T 7
Plan Check Fee: Hourly Only? 0 Yes G) No
$0.00
hours
$130.00
LTI-
D
Suppl. PC Fee: G Reg. 0 OT
P-0 I
hrs
NOTE: These fees are based on the Drelindnary information available and are on1v an estintate. Contact the Dept/or addn'l iqfo.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)..
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes G) No
$0.00
hours
$130.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: G Reg. 0 OT
P-0 I
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:0 Reg. 0 OTFTI
hrs
$0.00
PME Unit Fee:
$0.0-0
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes G) No
$0.00
$0.00
Select a Non -Residential E)
Building or Structure 0
Strong Motion Fee:
$0.00
#
$0.00
Revision
IREVSFDWL SFDWL
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.001
$130.00
1-1
TOTAL FEE.
$130.00
-j
Revised: 07/04/2011
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 1222 bubb rd.
I DATE: 03/01/2011
REVIEWED BY: bobs.
PC FEE ID
APN:
BP#:
*VALUATION: 1$80,000
--EPLAN
-PERMIT TYPE: Building Permit
CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes G No
I OTC? 0 Yes G No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK
dining, bath, family, nook and office, remodel kitchen and add new skylight.
[§fq_Ad
SCOPE
s.f.
$570.00
OCCUPANCY TYPE:
TYPE OF
CONSTR._
FLR AREA
(s.f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
11-B,111-BjV,V-B
343
$1,438.00
IADDPLCK
$1,169.00
IADDINSP
Insp, Pce:
$0.00
s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREM7WSKIT
Permit Fee:
$1,169.00
Suppl. Insp. Fee:E) Reg. 0 OTT-373T—hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
343
$1,438.00
1 $1,169,001
$0.00
MECH, HOURLY 0 Yes G No
PLUMB, HOURLY 0 Yes (2) No
ELEC, HOURLY 0 Yes (D No
A,fech. Plan Check I I
plwob� Plan Check
Elec, P1,111 Chcck
Afech. pei-mil Fee:
Flumb. Permit Fee�
F,,lec, Permit Fee:
01her Alech. h�i,V).
Oilier Phimb hi,V�,
Ober Eloc My,
lwcch� Imp, Fc�
fasp. Fec:
Insp, Pce:
NOTE: These fees are based on the Preflininary inforination available and are on1v an estinzate. Contart thp DPW fnr addn 11 infn
FEE ITEMS (TLee Resolittion 09-051 Eff. 7111(j)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,438.00
#
$380.00
Skylight
1SKYL<10SF I <= 10 s.f.
Suppl. PC Fee: E) Reg. 0 OT
1 0.0
1 hrs
$0.00
PNM Plan Check:
$0.00
s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREM7WSKIT
Permit Fee:
$1,169.00
Suppl. Insp. Fee:E) Reg. 0 OTT-373T—hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C on,717,11clion Tax
Acoustical Fee: 0 Yes G No
$0.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
PlanLi�� PLLONGRNGR
$44.59
Select a Non -Residential
Building or Structure
1
G
0
A
Trawl Docinnenfolion Fees:
Strong Motion Fee: IBSEISMICR
$8.00
1
Select an Administrative Item
Bldg Stds Coinmission Fee: IBCBSC
$4.00
SUBTOT,,�LS:
$2,663.59
$950.00
'TOTAL FE
3 59
Revised: 01/15/2011