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14090008E CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10743 BROOKWELL DR CONTRACTOR: NEAL HEMEL PERMIT NO: 14090008 OWNER'S NAME: CUPERTINO, CA 95014-4608 PHONE NO: Cl LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] CONSTRUCT FIRST FLOOR ADDITIONS (1253 SQ FT); License Class Lic. # SECOND FLOOR LOFT (222 SQ FT); INTERIOR REMODEL (1201 SQ FT); PANEL UPGRADE (200 AMP); INSTALL NEW Contractor Date 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: 1 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. Sq. Ft Floor Area: Valuation: $400000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36921006 00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYSIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DA L ALLED INSPECTION. 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 Is b 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. RE -ROOFS: Signature Date 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. © OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505, 255J3/3, and 25534. ^1 M7 l of performance Owner or authorized agent: Date: °J permit is issued. I certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 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 Lender's Address - 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point sourcc regulations per the upertino Municipal Codc, Scction Licenscd Profcs5ional 9 18. Signature Date ! CITY OF CUPERTINO �l FEE ESTIMATOR - BUILDING DIVISION v ADDRESS: 10743 BROOKWELL DR DATE: 09/03/2014 REVIEWED BY: MELISSA PC FEE ID APN: 369 21 006 BP#:U �i��d ,VALUATION: 1$400,000 4'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes '•- No OTC? 0 Yes Q No PENTAMATION 1 R3SFDADD PERMIT TYPE: A WORK ADD 1,476 S.F. N LIVING SPACE REMODEL E 1,201 S.F. UPGRADE EL PANEL TO 200AMPS SCOPE REPLACE FURNACE & A/C,& RE -ROOF 14 SQ'S 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 1,476 $2,757.15 IR3PLNCK $2,035.55 IR3INSP $0.00 PME Plan Check: $0.00 [:200]amps $48.00 1 Electrical IBELEC200 Services Permit Fee: $2,035.55 Supp!. Insp. Fee -.Q) Reg. Q OT 0.0 hrs $0.00 =4 Mechanical $143.00 IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $96.00 0 #/ $72,00 TOTALS: 1,476 $2,757.15 ? $2,035 55 • 1VIECH, HOiJRZY, Q FYes' Qt No s,PLUMB`, HOU'RL`Y Q Yes a{f��+ No i EIy�C HOUR r' Y Q 'Yes Q Ivo' Mech. Plan Check 0.0 firs $0.00 ;.::• ° :,• .. •. Elec. Plan Check 0.0 firs $0.00 Mech. Permit Fee: IjVfPERAl1T $2,757.15 Elec. Permit Fee: IEPERVfIT Other Mech. Insp. 0.0 lu•s $48.00 Other Elec. Insp.0.0 hrs $48.00 0.0 1 hrs $0.00 PME Plan Check: $0.00 ivvtc: rots estimate noes not ittciudeJees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary intormatinn avnilnhlo nn.l nro nnh, n.. !'...,m....t,„ n.,.,, l FEE ITEMS !Fee Rcsolulion 11-053 Eft,' 7/1,,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,757.15 F1,201 s.f. $4,604.00 Remodel, Other IREMRES2 Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 [:200]amps $48.00 1 Electrical IBELEC200 Services Permit Fee: $2,035.55 Supp!. Insp. Fee -.Q) Reg. Q OT 0.0 hrs $0.00 =4 Mechanical $143.00 IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $96.00 0 #/ $72,00 Mechanical IBREMAIR A/C Units (<=10K cfnl) 1,400 1 s.f. Re -roof l REROOFRES 0 O Work Without Permit? 0 Yes 0 No $0.00$238.00 Advanced Planning Fee: 1PLLOAGR $206.64 Select a Non -Residential Building or Structure • Travel Documentation Fee: ITRA 11DOC $48.00 Strong Motion Fee: IBSF_ISMICR $52.00 Select an Administrative Item Bld,(, Stds Commission Fee: IBCBSC $16.00 ;SUBTOTALS ;' $5,211.34 $5,105.00 . TOTAL FEE $10,316.34 Revised: 08/20/2014