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10060006I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7481 ROLLINGDELL DR CONTRACTOR: CENTURY DEVELOPMENT PERMIT NO: 10060006 CONSTRUCTION OWNER'S NAME: SAN LORENZO, CA 94580 1PHONE NO: (510) 557-4176 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB n License Class �3 Lic.# 6 3 $� O 7 MECH r— RESIDENTIAL [ COMMERCIA Lr Contractor! HEE /k,/q Date I—r,29 (0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 993SQFT FAM RM, MSTRBDRM &MSTRBT &I (commencing with Section 7000) of Division 3 of the Business & Professions BDRM IN Code and that my license is in full force and effect. REAR, ADDITIONAL 349SQFT LVNGRM IN FRONT &RMDL (E)ENTIRE HSE OF 1,140SQFT(KITCHEN,BDRM,HALLWAY, 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 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 bereby 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 egul per the Cupertino Municipal Code, Section 9.18. Signature Date ►o ❑ OWNER -BUILDER DECLARATION I 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) 1, 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, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or tlis 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. Sq. Ft Floor Area: I Valuation: $250000 APN Number: 35932011,00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issulmy: Date: RE -ROOFS: All roofs shall be inspected prior to any rooting material being installed. if a too 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 th California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will aintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heal & 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. RUCTION LENDING AGENCY I hereby affirm thonstruction lending agency for the performance o work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name I Lender's ARCHITECT'S DECLARATION Signature Date understand my plans shall be used as public records. Licensed Professional REVISION CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7481 ROLLINGDELL DR CONTRACTOR: CENTURY DEVEL NO: 10060006 CONSTRUCTION OWNER'S NAME: SAN JOSE, CA 95110 PHONE NO: (510) 557-4174 ❑ LICENSED CONTRACTOR'S DECLARATION r r— BUILDING PERMIT INFO: BLDG'F_ ELECT PLUMB License Class Lic. # MECH RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 993SQFT FAMILY RM, MSTRBDRM (commencing with Section 7000) of Division 3 of the Business & Professions &MSTRBTHRM&I BDRM IN REAR, ADDITIONAL 349SQFT LVNGRM IN FRONT &RMDL Code and that my license is in full force and effect. (E)ENTIRE HSE OF 1,140SQFT(KJTCHEN,BDRM,HALLWAY, I hereby affirm under penalty of perjury one of the following two declarations: &j 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. Q f rp f --">W 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 Sq. Ft Floor Area: Valuation: $250000 permit is issued. APPLICANT CERTIFICATION APN Number: 35932011.00 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 I 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. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by,--- -' / , ����" Date: ZT' ❑l�s OWNER -BUILDER DECLARATION 1 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 1, 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 materi'l s for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three S 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 1. 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 materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & 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 1 use equipment or devices which emit hazardous air 1 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 d 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 provisions or this permit shall be deemed revoked. Date: c"'I 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 I hereby affirm that there is a construction lending agency for the performance of work's 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 Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. SignaturDate C1 10 l4 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO I,/JI FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $100 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: OVER THE COUNTER. © Yes 0 No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK 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 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No Plan Chcck Llec;. Plan Check Lfech. Permit Fee- Plumb. Permit 1,cc: Flee. Permit Fee. Ot,'s ; '.fech. Insp. Other Plumb Insp,Li Other Elec. Insp. Lj .Tech. hap. Face: Plumb. Insp. Fe". Elec. Insp, Fee. NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7111110) 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. Feed Reg. 0 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: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fees. Strong Motion Fee: IBSEISWCR $0.50 1 # $633.00 Revision IREVRESADD Addition Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $633.00 TOTAL FEE: $634.50 Revised: 8/17/2010 FM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: OVER THE COUNTER. 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: i WORK 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 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 E MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No Ifech. Plant ' Plumb I'?r'r /Ju, . Man ( h, Other Afech. Imp. Other Plumb Insp. 0/her Elec. Insp. Li l/,-eh. Insp. 1. r: Plumb. hrsp. I: /ilec. Insp. I . NOTE: These fees are based on the vreliminary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 09-051 Ljf 7/1110) 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. © OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feed Reg. 0 OT FO.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction uction 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 i Travel Documentation Fees: Strong; Motion Fee: IBSEISMICR $0.50 1 # $760.00 Revision (��q IREVSFDWL SFDWL Bldf; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $760.00 TOTAL FEE: $761.50 Revised: 9/01 /2010