101100850
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7592 KIRWIN LN
OWNER'S NAME: H
fj£I LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #e> ?o >tqrl
~'-'--'" Cont~or'--' .//"A ate J '"\-_ i'7 , (D
I here~;~ffirlIl ;hat I ~¥~d under the provisions ofCh/pter 9
(commencing with Section 7 00) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
"2."-
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 the work for which this
permit is issued.
APPLICANT CERTIFICATION ~ ",-,,-.
I certify that I have read this application and state that the above in ormation 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.
SignatJ.!re Date 1"--(0(7 I-~2
OWNER-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)
I, 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 ofthe 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.
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
inspection,
Signature of Applicant:
Owner or authorized agent:
der's Address
Licensed Professional
granting ofthis permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
CONTRACTOR: BESTBUILD
CONSTRUCTION INC
PERMIT NO: 10110085
1732143RDAVE DATE ISSUED: 12/17/2010
SAN LEANDRO, CA 94578 PHONE NO: (510) 388-5099
r BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD MASTER SUITE(483SQ)& REMODEL ONE
(I)BEDROOM(lOOSQ);NO RE-ROOF & NO
STRUCTURAL,1106SQ EXISTING LANDSCAPE
Valuation: $50000 Sq. Ft Floor Area:
APN Number: 35922022.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
~--Issued by: Date~l L ~ 11J\.c.l
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
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.
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.
Date: /--·'t ,U
CONSTRUCTION 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.)
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
II FEE ESTIMATOR
ADDRESS: 7392 kirwin In.
APN: I BP#:
"'PERMIT TYPE: Building Permit
PRIMARY
SFD or DuplexUSE:
WORK
SCOPE
CITY OF CUPERTINO
BUILDING DIVISION
I DATE: 11/15/2010 REVIEWED BY:
'VALUAnON: 1$50,000 1
I PLAN CHECK TYPE: Addition
I OVER THE
COUNTER? o Yes 0No
PENTAMATION
PERMIT TYPE: 1R3SFDADD
OCCUPANCY TYPE: TYPE OF
CONSTR.
FLRAREA
(s.C.) PC FEES PC FEE ID BP FEES BP FEE ID
R-3 (Custom) II-B,III-B,IV,V-B 483 $1,438.00 IADDPLCK $1,169.00 IADDINSP
TOTALS: 483 $1,438.00 $1,169.00 .'
MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0No
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 09-05I Elf 71 IO)
Plan Check Fee:
Suppl. PC Fee: o Reg. o OT I 0.0 I hrs
FEE
$1,438.00
$0.00
QTY/FEE
100 I s.f.
$380.00
MISCITEMS
Remodel, Other
lREMRESOTH I
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp. Fee0 Reg. o OT I 0.0 I hrs
$1,169.00
$0.00
I
PME Unit Fee:
PME Permit Fee:
$0.00
$0.00
I
{ !
Acoustical Fee:
I
o Yes
I
o No $0.00
I
0
Work Without Permit?
Planning Fee:
;; l/i i / }, .'1" .'
o Yes 0No
PLLONGRNGR
$0.00
$62.79
I
Select a Non-Residential
I Building or Structure
0
0
0 ....
Strong Motion Fee: IBSEISMlCR $5.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
SUBTOTALS:
$2.00
$2,676.79 $380.00
I
TOTAL FEE: I $3,056.79
Revised: 11/08/2010