10060080 PermitI . CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10029 0AKLEAF PL I COCONTRACTOR: NSTEVE RODERICK I PERMIT NO: 10060080
OWNER'S NAIVE:
License Class Lic. #
Contractor �C� Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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 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. Ad 'tionally, the applicant understands and will comply
with all non -point sourc a ulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 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
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REMODEL KITCHEN(360SQ),BEDROOMS&FLOOR&4
SKYLIGHTS(NON
STRUCTURALx396SQ),BATHROOMS(175SQ),REPLC ALL
Sq. Ft Floor Area: I Valuation: $200000
APN Number: 32618056.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY M LAST CALLED INSPECTION. I)
Issued by: _ �v Date:
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
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the health &
Safety Code, Section 25532(a) should 1 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 1 will
maintain complianc tth the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety de, Sections 505, 25533, and 25534.
lC7
CONSTRUCTION LENDING AGENCY
1 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.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professio
CITY OF CUPERTINO
F-M—N FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10029 Oakleaf Place
DATE: 06/14/2010
REVIEWED BY: Larry S.
PC FEE ID
APN: 32618056
BP#:
"VALUATION: 1$200,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
; i' .'i ;
APPLICATION
TYPE
MECHANICAL O Yes Q NoPLUMBING
Q Yes Q No
ELECTRICAL Yes No
W
remodel kitchen remodel 2 bathrooms raise floor in family room 6 in. add 4 skylights non structural
O O
add lighting to every room, replace all windows (11), remodel laundry room, close off one exterior door,
3 v)
add one exterior door, add and remove some nonbearing interior walls.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
2,160 s.f.
$4,823.00
Remodel, Other
IREMRES2
Suppl. PC Fee: G Reg. () OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. O OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
El
TOTALS:
0
$0.00
$0.00
$0.00
F7,
Q
(D
NOTE: These Pees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 09-051 E .. 7/1/09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
2,160 s.f.
$4,823.00
Remodel, Other
IREMRES2
Suppl. PC Fee: G Reg. () OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. O OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
c ( . L,
F-1
Acoustical Fee: Q Yes Q No
$0.00
Q
(D
Work Without Permit? Q Yes (F) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
O
StroniMotion Fee: IBSEISMICR
$20.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
1 $28.001$4,823.001
TOTAL FEE:
1 $4,851.00
Revised: 5/27/2010