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11020114CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19730 MERRITT DR CONTRACTOR: PARRA BUILDERS INC PERMIT NO: 11020114 OWNER'S CASTRO VALLEY, CA 94552 PHONE NO: (510) 889-0102 ❑ LICENSED CON OR'S DECLARATION F { BUILDING PERMIT 1NF0: BLDG ELECT PLUMB UO&M Class I, A�LSA ' MECH RESIDENTIAL COMMERCIAL Cop ; � .� — ) JOB DESCRIPTION: ADD 3 BEDROOMS, 1/2 BATH (574 SQFT)& REMODEL I hereby arm that -,Ace ged under the provisions of Chapter 9 (comm cing wit c n 7000) of Division 3 of the Business & Professions HALLWAY(IOOSFT) &BATH (60SQFT); NO RE -ROOF &DOES Code and that cense is in full force and effect. HAVE STRUCTURAL 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 Sq. Ft Floor Area: Valuation: $80000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31629045.00 Occupancy Type: 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 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. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -points ce regulations the Cupertino Municipal Code, Section 9.18. Issued by: Date:��I L, Signature Dates a ❑ NER-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 I, 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: [, 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 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 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 complia with the rtino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safe de, Sectio s 2 05, 25533, 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 Owuer : forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION i CONSTRUCTION LENDING AGENCY rhereby I certify that I have read this application and state that the above information is a 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 relatingh this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter '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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO Fm-F FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 19730 merritt dr. DATE: 02/28/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? ' Yes `, No OTC? 0 Yes No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK sfd add 3 bedrooms 1/2 bath remodel hallway and bath. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 574 $2,349.00 IR3PLNCK $1,474.00 1R3INSP TOTALS: 574 $2,349.00 $1,474.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No Mech. Plan Check Plumb. Plan C hack Elec. flan Check Mech. Permil Fee. I' oml;. 1 cc mi/ FCC: i"I"(. P(,rmi/ FCC Other ,Wech. Ins1). Ocher Phem() In.v).Li Usher 1,1c" . Insp, Lj ,ldeeh. Imp. Fee: 1117inth. hasp, Fve: Elc°c. Insp. FCC: NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7100) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 60 s.f. $570.00 Remodel, Bath (<=300 sfl 1REMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 100 s.f. $380.00 Remodel, Other IREMRESOTH Permit Fee: $1,474.00 Suppl. Insp. Fee-0 Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $74.62 Select a Non -Residential Building or Structure 0 0 i Trovel Documentation Fees: Strong Motion Fee: 1BSEISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $3,909.62 $950.00 TOTAL FEE: $4,859.62 Revised: 01/15/2011