11060055CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22366 HARTMAN DR
CONTRACTOR: LE DAN AND HOANG KIM
PERMIT NO: 11060055
ANN
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
F F r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r— RESIDENTIAL F COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD 79 SF TO EXISTING HOME, REMODEL LIVING AREA
(commencing with Section 7000) of Division 3 of the Business & Professions
(800 SF), REMODEL KITCHEN AND BATHS, NEW FURNACE,
Code and that my license is in full force and effect.
WATER HEATER, SERVICE PANEL UPGRADE
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.
D
1 have and will maintain Worker's Compensation Insurance, as provided for by
��C•
Sq. Ft Floor Area:
Valugt;gr $600000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
4
APN Number: 32613136.00
pancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued by: Date:
Signature Date
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. if a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three /
declarations:
[ have and will maintain a Certificate of Consent to self -insure for Worker'ss /
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Ow
441
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature. Date t<
Licensed Professional
CITY OF CUPERTINO
Fm---7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 22366 Hartman Dr.
DATE: 08/04/2011
REVIEWED BY: A. Salvador
APN:
BP#:
"VALUATION: 1$200,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes !) No
OTC? 0 Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
'A
WORK
Add 79 s.f. to existing dwelling. Remodel Kitchen 169 s.f.),Remodel Bathrooms 304 s.f. Remodel
SCOPE
Dwelling (1,705 s.f.). New Water Heater, New Furnace, Upgrade Panel.
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
79
$965.00
1ADDPLCK
$934.00
IADDINSP
TOTALS:
79
$965.00
$934.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
Mech. Plan Check 0.0 1 hrs $0.00
Plan Check 0.0 hrs $0.00
Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT
-Pllumb.
v Plumb. Permit Fee: IPPERMIT
V Elec. Permit Fee: IEPERMIT
0.0 hrs
Lt,her Mech. Insp. $42.00
0.0 hrs $42.00 Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $42.00
;,.
Plumb, Inv) rat
Lr<.
NOTE. These fees are based on the vreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 EfYi' 7,11/l0)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$965.00
1,705 s.f.
$4,573.00
Remodel, Other
IREMRESZ
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 #
$25.00
Plumbing
IPRWHEATR Water Heater
Permit Fee:
$934.00
Suppl. Insp. Fee0 Reg.
0 OT
0.0
Trs
$0.00
0 # Mechanical
$126.00 IMFR=<looFurnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$126.00
200 amps
$42.00
Electrical
IERT<200 Services
�.`r,.arrucr.?nri T,'';,
Acoustical Fee:
0 Yes E) No
$0.00
0
E)
Work Without Permit? p 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$10.27
✓
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation FAA'ITRAvDOC
$42.00
Strong Motion Fee:
IBSEISMICR
$20.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
$2,105.27
$4,766.00
TOTAL FEE:
$6,871.27
Revised: 04/29/2011