11050201CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10110 FIRWOOD DR CONTRACTOR: THE BUILDING WORKS PERMIT NO: 11050201
OWNER'S NAME: 2998 S BASCOM AVE DATE ISSUED: 05/24/2011
OWNER'S PHONE: 4085598850 SAN JOSE, CA 95124 PHONE NO: (408) 559-8850
❑ I ICENSED CONTRACTORS DECLARATION
t ! ! l I BUILDING PERMIT INFO: BLDG ELECT PLUMB
License
Lic.
Contractor_j� �t4 ! ate V
I hereby affirm that I am license rider the provisions o Cha ter 9
(commencing with Section 7000) oDivision 3 of the Business & Professions
Code and that my license is in fu�l force and effect.
I hereby affirm under penalty of perjury one of the following two declaratS.
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 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 mentio ed property for inspection purposes. (We) agree to save
indemnify and cepha less the City of Cupertino against liabilities, judgments,
costs, and expo ses wh h may accrue against said City in consequence of the
granting
Date M �
❑ OWNYR-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).
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
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 die 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.
MECH' RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REMODEL KITCHEN(94SQFT),BATH(42SQFT),3 WINDOWS
&2
PATIO DOOR & 1 SKYLIGHT
Sq. Ft Floor Area: I Valuation: $75000
APN Number: 34233034.00 ( Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: / �' mr —� -- Date:._ 7
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.
Addi 'orally, s, ould I use equipment or devices which emit hazardous air
emit .in,
is defined by the Bay Area Air Quality Management District I will
mat i c mp lance with the Cupertino Municipal Code' Chapter 9.12 and the
Hea
,
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of niork'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.
Date ' Licensed
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10110 FIRWOOD DR
FEE
DATE: 05/24/2011
REVIEWED BY: MENDEZ
APN:
BP#:
VALUATION: 1$75,000
rPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
0.0
hrs
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
REMODEL KITCHN 94 SQ BATH 42 SQ
3 WINDW 2 PATIO DOOR & 1 SKYLIGHT
SCOPE
Permit Fee:
Mn'rr. 71— — oro b—ad ine ilio nrvlinninnry i"MrmliHnn nvnilnhlo and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7/U101
FEE
N Ph,-
P�_
Plan Check Fee:
Li
iP. El
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
Mn'rr. 71— — oro b—ad ine ilio nrvlinninnry i"MrmliHnn nvnilnhlo and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7/U101
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
-4-27 s.f. Remodel, Bath (<=300 sf)
$570.00 IltEA4MSBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
94 s.f. Remodel, Kitchen (<=300 sf)
$570.00 IREMIlESKIT
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0
OT
0.0
hrs
$0.00
= # Skylight
$380.00 ISKYz<IOSF71 <=10 s.f.
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
5 #
$380.00
Window / Sliding Glass Door
1 WINREP Replacement
,t r } 7` i.:
F7
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Ptaunin Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
A
s r t(ve
Strong Motion Fee:
IBSEISMICR
$7.50
Select an Administrative Item
Bldx Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$10,501$1,900.00
TOTAL FEE:
1 $1,910.50
Revised: 04/29/2011