15050002I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10614 JOHN WAY
CONTRACTOR: CRAIG A ROGERS
CONSTRUCTION INC
PERMIT NO: 15050002
I OWNER'S NAME:
SAN JOSE, CA 95136 PHONE NO: (408) 499-3354
A LICENSED CONTRACTOR'S DECLARATION
License Classh- I jLic. # 7
Contractor&MA•.51–ke% Date )
I hereby affirm that I am licensed under the provisions of Ch pter 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:
have and will maintain a certificate of consent to self -insure for Worker's
no5wensation, as provided for by Section 3700 of the Labor Code, for the
ormance of the work for which this permit is issued.
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. Additionally, the applicant understands and will comply
with all non -poi source regulations per Cupertino Municipal Code Section s
9.18.
Signature ✓" Date 7/ " J
❑ 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 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
JOB DESCRIPTION: RESIDENTIAL [–] COMMERCIAL
CONSTRUCT ONE STORY ADDITION (945 SQ FT) TO
CREATE
(N) MASTER BEDROOM & EXPAND KITCHEN & FAMILY
ROOM;
KITCHEN REMODEL (114 SQ FT); DEMOLISH ACCESSORY
Sq. Ft Floor Area: I Valuation: $250000
I APN Number: 35918003.00 I Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 D ERMIT ISSUANCE OR
180��rY� ALLED INSPECTION.
' 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(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the ay Area Air Quality Management District I
will maintain compliance with t pertino Muni -J
Code, Chapter 9.12 and
the Health & Safety Code,
Date 7 %
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
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.
Signature Date
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: 15050002
10614 JOHN WAY CUPERTINO CA 95014 (359 18 003) CRAIG ROGERS
CONSTRUCTION
3914 WELLINGTON SQ
SAN JOSE, CA 95136
OWNER'S NAME:
LICENSED CONTRACTOR'S DECLARATION
License Class ja Lic. #978553
Contractor CRAIG ROGERS CONSTRUCTION Date 44/30/2016
I 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.
I hereby affirm under penalty of perjury one of the following two declarations:
i. -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.
Additionally, the applicant understands and will comply with all non -point
source reguf ions er the C pertino Munici a e, Section 9.18.
Sign atu Date 111312016
hereby affirm that I am exempt from the Contractor's License Law for one of the
illowing two reasons:
i. 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)
2. 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:
1. 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.
2. 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, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLIC NT 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.
Signature Date 111312016
ISSUED: 07/27/2015
PHONE NO: 408-499-3354
PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT ONE STORY ADDITION (945 SQ FT) TO CREATE
(N) MASTER BEDROOM & EXPAND KITCHEN & FAMILY ROOM;
KITCHEN REMODEL (114 SQ FT); DEMOLISH ACCESSORY
STRUCTURE (372 SQ FT).
REV # 1 - REVISE LOCATION OF ATTIC AND UNDERFLOOR;
CHANGE CONCRETE REAR TO WOOD -ISSUED 11/3/2016
Sq. Ft Floor Area: Valuation: $250000.00
APN Number: Occupancy Type:
359 18 003
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ABBY AYENDE
Date: 07/27/2015
RF. -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:1/1 3/2016
BE CLASS "A"
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 Cod Chapter 9.12 and
the Health & Safety Code ec'ons 25505, 25533, Ind 53
Owner or authorized agent:
Date: 11/3/2016 /
NG AGENCY
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
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10614 JOHN WAY DATE: 05/01/2015 REVIEWED BY: MELISSA
APN: 359 18 003 BP#: ����� *VALUATION: 1$250,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
USE MARY SFD or Duplex 2nd Unit? Yes No PENTAMATION
OTC? 0 Yes No PERMIT TYPE: 1R3SFDADD
WORK ADD 945 S.F TO REAR OF PROPERTY TO CREATE N MASTER BEDROOM & EXPAND KITCHEN
SCOPE I& FAMILY ROOM. REMODEL (114 S.F.) OF (E) KITCHEN. REMOVE 372 S.F. ACCESSORY M
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
sX
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
945
$2,654.00
1R3PLNCK
$1,666.00
IRMNSP
l'ec' J)"an
$0.00
gBC;h, A..'1'Y%%: Fe..:
Permit Fee:
'll . �' dl'?T"zli �` .f;:
1', vb t'
Suppl. Insp. Fee -.G) Reg. C)OT
0,0
1'P7Ttt 1`u i:':
$0.00
PME Unit Fee:
I'lt m -b lY.i / •
PME Permit Fee:
$0.00
i.Jilif'!' l:i'k'c'. Ir.'s;.
TOTALS:
945
$2,654 00
$1,666 00
a ;
�[ECHs H � URLY Yves Na
PLUMB HOURLY ®'des � llo
EI.�C, HOIT�LY
MISC ITEMS
Plan Check Fee:
$2,654.00
144 s.f.
$645.00
Remodel, Kitchen (<=300 s f)
IREMRESKIT
Suppl. PC Fee: (j) Reg. 0 OTT0,0
ph vtfb. 11"'a ? ("heck ck
hrs
$0.00
l'ec' J)"an
$0.00
gBC;h, A..'1'Y%%: Fe..:
Permit Fee:
'll . �' dl'?T"zli �` .f;:
1', vb t'
Suppl. Insp. Fee -.G) Reg. C)OT
0,0
1'P7Ttt 1`u i:':
$0.00
PME Unit Fee:
I'lt m -b lY.i / •
PME Permit Fee:
$0.00
i.Jilif'!' l:i'k'c'. Ir.'s;.
Adininistralive /`E'e
'111 p.
raun u e: sues not ,nccuae fees aue to otner u, artments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etG).
FEE ITEMS (Fee .Resolution 11-053 F,ff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,654.00
144 s.f.
$645.00
Remodel, Kitchen (<=300 s f)
IREMRESKIT
Suppl. PC Fee: (j) Reg. 0 OTT0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,666.00
Suppl. Insp. Fee -.G) Reg. C)OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Adininistralive /`E'e
Work Without Permit? 0 Yes (a No
$0.00
Advanced Planning Fee: IPLLONGR
$132.30
Select a Non -Residential
Building or Structure
Q
0
i
D'ravel.l ocrrrnenealion feels,:
Strong Motion Fee: IBSEISMICR
$32.50
Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC
$10.00
$4,494.80
$645 00 TGT, F�
1.�
$5.139.801
Revised: 04/01/2015