10070122CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19973 PEAR TREE CT
CONTRACTOR
PERMIT NO: 10070122
OWNER'S NAME:
,
PHONE NO:
LICENSED CONTRACTOR'S
r r r
— �DECLARATION
License Class �Lic.# V��_/��
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
1�7
Contractor t RBJ" Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD A BAY WINDOW, REMODEL LIVING RM, FAMILY
(commencing with Section 7000) of Division 3 of the Business & Professions
RM' &
KITCHEN-670SQ
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 the work lokwlAh this
Sq. Ft Floor Area:
Valuation: $60000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31630087.00
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. tion the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signatur Date
c
Issued Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
performance of the work for which this permit is issued.
I have read the hazardous materiais requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Hei4lth & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
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
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such or this shall be deemed revoked.
,
provisions permit
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
1 hereby affirm that there is a construction lending agency for the performance of works
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 19973 PEAR TREE CT
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
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
1 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
❑ OWNER -BUILDER DECLARATION
1 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:
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 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.
CONTRACTOR: FAIRBURN INDUSTRIES I PERMIT NO: 10070122
20061 WRIGHT DR I DATE ISSUED: 08/13/2010
LOS GATOS, CA 95033 I PHONE NO: (408) 353-4285
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB 1) IO �D�OWREMODEL LIVING RM, FAMILY
RM, &
KTTCHE OSQ, 200 AMP PANEL
Sq. Ft Floor Area: I Valuation: $60000
APN Number: 31630087.00 1 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:
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.
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.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature.
Date
Licensed Professional
REVISION_
I CITY OF CUPERTINO BUILDING PERMIT DATE - ` " I
I BUILDING ADDRESS: 19973 PEAR TREE CT I CONTRACTOR: FAIRBURN INDUSTRIES I PERMIT NO: 10070122 1
OWNER'S NAME: RISHI BHARGAVA 120061 WRIGHT DR I DATE ISSUED: 08/13/2010 1
OWNER'S PHONE: 4089058344 1 LOS GATOS, CA 95033 1 PHONE NO: (408) 3534285 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 2
C tZN n
Contract Date D
I hereby affirm that 1 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.
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.
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.
APPLICANT CERTIFICATION
1 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. 'o , the applicant understands and will comply
with all non -point s a ' ns per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
1 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)
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.
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 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, 1
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. 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.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD A BAY WINDOW, REMODEL LIVING RM, FAMILY
RM, &
KITCHEN-670SQ
�-�-_`U'r �'(".,�'/
-3r7 V C c� k- C J lZY r • MS — IQ -i h a
Sq. Ft Floor Area: I Valuation: $60000
APN Number: 31630087.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM L CALLED INSPECTION.
Issued /L9 o 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
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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain complian the Cupertino Municipal Code, Chapter 9.12 and the
Health & SafetyOaWe, Sections 25505, 25533, and 25534.
Date: [ ( 0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction Iending 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.
Date
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION: 1$4,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
OTAL
/,ZOOh AhL-A:
PENTAMATION
PERMIT TYPE:
WORK
SCOPE
iWech. Plan Check
Plumb_ Plun Check
Fici . Plan Check
rb9 . Perwit F'ee.,
PhImh. Permit F'ic=:
Elec. Permit Fee
O7he-r .lkch. Insp.
Other Plumb Insp.Li I
Other Flec. Insp,
34cch. Insp. Fee:
Phimb. Insp. Fcc
Occ. Insp. Fee:
NOTE: These fees are based on the nrelindnary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PNIE 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:
$0.00
Select a Non -Residential
Building or Structure
0
0
A
Travel Docutnentution Fees:
Strong Motion Fee: IBSEISMICR
$0.50
1 #
$633.00
Revision
IREVRESADD Addition
Bldg; Stds Commission Fee: 1BCBSC
$1.00
OPW SUBTOTALS:
$1.50
$633.00
TOTAL FEE:
$634.50
Revised: 9/01 /2010
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
'VALUATION: 1$60,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex OVER THE APPLICATION 1 R3SFDADD/REM
USE: COUNTER. 0 Yes 0 No TYPE:
MECHANICAL 0 Yes 0 Na PLUMBING Yes 01 No ELECTRICAL 0 Yes, 0 No
as
cc
3U
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,v-B
20
$965.00
IR3PIXCK
$934.00
1R3!
a DD
TOTALS:
20
$965.00
$934.00
Fleck F'ennit I ,,,
Uilrtr .LfE�Ir. l up: T77(Ii.,.:r
i' rrrab. PeJmil ICc:
!'lurrrlf. l,r,,l ,
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info
FEE ITEMS (Fee Resolution 09-051 ET. 711109)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$965.00
90 s.f.
$570.00
Remodel, Kitchen (<=300 sf)
1REAIRESKIT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
670 s.f.
$506.00
Remodel, Other
1REIRES1
Permit Fee:
$934.00
Suppl. Insp. Fee:O Reg. 0
OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
( '0�78(1•.uc: ioa 7 7 XL
Acoustical Fee:
Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes Q No
$0.00
Planning Fee:
PLLONGRNGR
$2.60
Select a Non -Residential
Building or Structure
0
0
/)(;(. ut7lerftirtrrJlI Vec%':
Strong Motion Fee:
IBSEISMICR
$6.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$3.00
SUBTOTALS:
$1,910.60
$1,076.00
TOTAL FEE:
1 $2,986.60
Revised: 6/30/2010