13120096CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7632 RAINBOW DR
CONTRACTOR: ELI ENGELMAN
PERMIT NO: 13120096
OWNER'S NAME: ELI ENGELMAN
11652 BRIDGE PARK CT
DATE ISSUED: 04/07/2014
OWNER'S PHONE: 4088938985
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
ADD 715 S.F. & CONVERT 80 S.F. OF (E) GARAGE TO
License Class Lic. #
(N) LIVING SPACE. RAISE ELEVATION & REMODEL
REMAINING 1415 S.F.. RE -ROOF 30 SQ'S. UPGRADE
Contractor Date
1 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 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
Sq. Ft Floor Area:
Valuation: $200000
performance of the work for which this permit is issued.
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
APN Number: 36611034.00
Occupancy Type:
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. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN" 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FRO ED INSPECTION.
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
Date:
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: Dale:
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,
wil I 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(x) should I store or handle hazardous
I 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
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
the Health & SatY Code, Sections 25505, 2553 , and 25534.
Safety
Owner or authorized agent: Date:
permit is issued.
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
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
Lender's Address
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
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 source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Sig natu Date u ��
CITY OF CUPERTINO
FM__7 FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS: 7632 RAINBOW DR
TYPE OF
CONSTR.
DATE: 12/12/2013
REVIEWED BY: MELISSA
APN: 36611 034
BP#: % �� rp
'VALUATION: 1$200,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Addition
PRIMARY
SFD or Duplex
USE:
2nd Unit? Yes `; No
OTC? 0 Yes �No
PENTAMATION
1 R3SFDADD
PERMIT TYPE: 19
WORK
ADD 715 S.F. & CONVERT 80 S.F. OF
E GARAGE TON LIVING SPACE. RAISE ELEVATION &
SCOPE
REMODEL REMAINING 1415 S.F.. RE—ROOF 30 SQ'S. UPGRADE PANEL TO 200AMP
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,MV-B
795
$2,577.00
IR3PLNCK
$1,617.00
IR3INSP
PME Plan Check:
$0.00
13,000 1 s.f.
$480.00
Re -roof
IREROOFREs
Permit Fee:
$1,617.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
200 amps Electrical
$47.00 IBELEC200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
CllfR. 1ruc'd`ion da.r.'r':
TOTALS:
795
$2,577.00
$1,617.00
7-777
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). 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 11-053 E . 711113)
"'/jw/ B,"HOURLY
QTY/FEE
14er.:Ir. I'Crrrt
Phwlh. I'h,,r (.'/,c.<
Elec. Plan Check 0.0 hrs $0.00
,,.h. F'ern,�r I�>c
I'hrnrh�crrrrlP I�cc=
Elec. Permit Fee: IEPERMIT
odlev 1 ����.b. fr+.��,f
0(bcr� I>I,rr,rh I)np
Other Elec. Insp. 0.0 hrs $47.00
Vfc(il. lf1s 1 Fee:
I�IYdd11}. id/hf),. l'C'N:
PME Plan Check:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). 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 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,577.00
1,415 s.f.
$4,746.00
Remodel, Other
IREMRES2
Suppl. PC Fee: Q Reg. 0 OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
13,000 1 s.f.
$480.00
Re -roof
IREROOFREs
Permit Fee:
$1,617.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
200 amps Electrical
$47.00 IBELEC200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
CllfR. 1ruc'd`ion da.r.'r':
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee: IPLLONGR
$111.30
Select a Non -Residential
Building or Structure
G
0
i
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$20.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
:J$4,427.301$5,273.001777
Revised: 10/01/2013