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15090025CITY OF CUPERTINO BUILDING PERMIT BUH.AINGADDRESS: CONTRACTOR: PERMIT NO: 15090025 10643 STEVENS CANYON RD CUPERTINO, CA 95014-3941 (342 16 134) HOMEOWNER/BUILD �ER OWNER'S NAME: DEWAN JAHANGIR HAND ISLAM FAWZIA J TRUSTEE OWNER'S PHONE: 408-391-0521 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor HOMEOWNER/BUILDER Date hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two 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. APPLICANTCERTIFICATION I certify that 1 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 9/8/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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: 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. " 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. 3, 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 certify that I have read this application and state that the above information is correct. I agree to comply with all citi 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. 1 Date 9/8/2016 ISSUED: 9/8/2016 PRONE NO: BUILDING PERMIT INFO: BLDG —ELECT -PLUMB MECH — RESIDENTLAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) ATTACHED 2ND UNIT (298 S.F.) Sq. Ft Floor Area: l Valuation: $30000,00 APN Number: Occupancy Type: 34216 134 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: ABBY AYENDE R&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: 9/8/201 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, Section 25505, 2553_3, and 25534. Owner or authorized agent: ®ate: 9/8/2016 CONSTRUCTION LENDING 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO �FF,F, ESTIMATOR — BUILDING DIVISION ADDRESS: 10646 STEVENS CANYON RD DATE: 09/03/2015 REVIEWED BY: MELISSA limAPN: 34216134 BP#: *VALUATION: 1$30,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFD2ND USE: $2,654.00 PERMIT TYPE: A WORK CONSTRUCT N ATTACHED 2ND UNIT 298 S.F. SCOPE $1,666.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 298 $2,654.00 IR3PLNCK $1,666.00 IR3INSP Permit Fee: $1,666.00 Suppl. Insp. Fee -(F) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 # ne unitws $684.98 Aciministrative P"ee. Work Without Permit? 0 Yes Q) No $0.00 TOTALS: 298 $2,654.00 - -° $1,666.00 Strong Motion Fee: IBSEISMICR A1ech. Plan Check Plarrnb. Plan Check Elee. Plan Check weck 1'errnit Fee: Plumb. Permit Fee: lllec. Pei -Wit Fee: tither,44ech. Ins. Other 11hurnb Insp. Other Flee, liasp. ilech. Irxsp. Fee: Plumb. Insp. Fee: Elee. Trap. Fee: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These feev are based on the Dreffinina information available and are onlV an estimate. Contact the Dept for addn't in o.. FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee -(F) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 # ne unitws $684.98 Aciministrative P"ee. Work Without Permit? 0 Yes Q) No $0.00 Advanced. Planning Fee- IPLLONGR $41.72 Select a Non -Residential Building or Structure 0 Travel Docurnenlulion fiees: Strong Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 $5,052.60 $0.00 = �] ,$5,052.60 Revised: 07/02/2015 CITY OF CUPERTINO ,FEE ESTIMATOR — BUILDING DIVISION 01 ADDRESS: 10646 STEVENS CANYON RD DATE: 09/03/2015 REVIEWED BY: MELISSA PC FEE ID APN: 34216134 BP#: *VALUATION: 1$30,000 `PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? • Yes 0 No I PENTAMATION 1 R3SFD2ND I USE: $0.00 PERMIT TYPE: WORK CONSTRUCT N ATTACHED 2ND UNIT 298 S.F. SCOPE Permit Fee: 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 298 $2,654.00 1R3PLNCK $1,666.00 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 298 $2,654.00 Construction Tax: IBCONSTAXR $1,666.00 # new units NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Hire, sanitary sewer District, scnoot nh n" /bo nrn/iminnry infnrmatinn availahly and aro nnly an estimate. Contact the Dept for addn'l info. 1lLJLI {LL, CLI... FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13) Alech. Plun Check Pian (..'heck /aec. Plan ( leek Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee OtherAdech. Insp. ,her Plumb In All_Ll I Other Elec. /mp. 7_ 11,>:, /, Insr). Fee: Suppl. PC Fee: Q Reg. 0 OT 0.0 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Hire, sanitary sewer District, scnoot nh n" /bo nrn/iminnry infnrmatinn availahly and aro nnly an estimate. Contact the Dept for addn'l info. 1lLJLI {LL, CLI... FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR # new units $684.98 hbninistr•ative Fec: E) Work Without Permit? C) Yes 0 No $0.00 Advanced Planning Fee. IPLLONGR $41.72 Select a Non -Residential Building or Structure E) ©'A 1 navel Documentation .Fees: Strong; Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $5,052.60 $0.00 TOTAL FEE: $5,052.60 Revised: 07/02/2015