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10120037I'iCVl�wr. CITY OF OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1104 ELMSFORD DR 0 R'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # ContractorI A 44) 04Date I hereby affirm that I am licensed under the provisions o Chapte 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 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 Cu against liabilities, judgments, costs, and expenses which may accrue ins id City in consequence of the granting of this permit. Additi y, th plicant understands and will comply with all non -point source ulations r upertino Municipal Code, Section 9.18. CONTRACTOR: CALIFORNIA HOMEI PERMIT NO: 10120037 BUILDERS & DESIGN 1775 JUNCTION AVE SAN JOSE, CA 95112 DATE ISSUED: 06/02/2011 PHONE NO: (408) 392-8200 BUILDING PERMIT INFO: BLDG F ELECT 'i PLUMB MECH F RESIDENTIAL rCOMMERCIAL JOB DESCRIPTION: ADD 1 ST & 2ND FLOOR; NEW KITCHEN( 240 SQFT ), BEDROOMS BATHS(200SQ**IST&2ND STORY)&PORCH(40SQ) ON IST STORY -NEW MASTER BEDROOMS,BATHS,BEDROOMS,FAMILY C,T 2 r, -%f I A.JE ` —lute— hk` 'ICL Imo, /�./ I ( Sq. Ft Floor Area: ' Valuation: $350000 APN Number: 36206003.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. S' re/ 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) 1, 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 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 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' 'ding construction, and hereby authorize representatives of this city to enter L, e above mentioned property for inspection purposes. (We) agree to save mu-iinify 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, 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 Appl 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(a) should I store or handle hazardous material. Additionally, should I use l t or devices which emit hazardous air contaminants as defy the Bay Area Air Quality Management District I will maintain complia a wWtbeCu rtino Municipal Code, Chapter 9.12 and the Health &Saf CodSeriiogp 505, 25533, and 25534. L.'/ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERM/IT BUILDING ADDRESS: 1104 ELMSFORD DR CONTRACTOR: f UA PERMIT NO: 10120037 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #1 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: 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 regulations per the Cupertino Municipal Code, Section 9.18. Date ❑ OWNER -BUILDER DECLARATION 1,10 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reapons: 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). 1 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, l 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 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 6 2 # L (,-- -b F.jZ I DATE ISSUED: 06/02/2011 PHONE NO: BUILDING PERMIT INFO: BLDG' ELECT r PLUMB r MECH F RESIDENTIAL F COMMERCIAL f— JOB DESCRIPTION: ADD 1 ST & 2ND FLOOR, NEW KITCHEN(240SQFT),BEDROOMS BATHS(200SQ'* I ST&2ND STORY)&PORCH(40SQ) ON 1 ST STORY -NEW MASTER BEDROOMS,BATHS,BEDROOMS,FAMILY Sq. Ft Floor Area: I Valuation: $350000 APN Number: 36206003.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b:} . _ _ Date: 4�5'—'L 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 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(a) should 1 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, Sections 25505, 25533, and 25534. �& Date:, 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 Professi FM CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School I)iclr/ri_ vtc 1. Thaca loos Oro hacnd nn tho Ora/ininnru /nfnrsnntinn nviri/ah/a and Ora only nn actimiilo_ Cnn1ar11he /)Ont fnr addn 11 into_ FEE ITEMS (Fee Resolution 11-053 a. 7,1/11) ADDRESS: 1104 elmsford dr. DATE: 10/06/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$4,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: hrs NTAMATION 1GENRES TPERMIT TYPE: WORK revise beam ceiling beam to bended steel roof beam shear wall at entry door. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School I)iclr/ri_ vtc 1. Thaca loos Oro hacnd nn tho Ora/ininnru /nfnrsnntinn nviri/ah/a and Ora only nn actimiilo_ Cnn1ar11he /)Ont fnr addn 11 into_ FEE ITEMS (Fee Resolution 11-053 a. 7,1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F__17 hours $130.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Plannint; Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 Strong Motion Fee: 1BSEISMICR $0.50 0.5 hrs $41.00 Admin./Clerical Fee IADMIN Bldp, Stds Commission Fee: IBCBSC $1.00 :1:[T'X'x ::: ................ 1.50 171. 00 :::: .....::``Q $172.50 Revised: 10/01/2011 � CITY OF CUPERTINO EI FEE ESTIMATOR — BUILDING DIVISION [L DRESS: 1104 ELMSFORD DRIVE FAP DATE: 12/07/2010 REVIEWED BY: LARRY S PC FEE ID BP FEES N: BP#: VALUATION: $350,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: OVER THE COUNTER. 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK REMODEL ADDITION NEW WINDOWS NEW ROOF COMPLETE NEW EXTERIOR STUCCO NEW SCOPE SKYLIGHT. EXISTING ELECTRICAL PANEL AND GAS METER TO REMAIN. FIRE SPRINKLERS 0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 3,974 $2,896.60 1R3PLNCK $3,087.40 1R3INSP Pl s.. Ih. Permit Fee: El¢c. Permit $3,087.40 0/her alec•h. Insp. 0.0 Other Ph•nrFl; Li Orher 1`h•r Insp. 00 0,04PA PME Unit Fee: J tech. Insp. Fee. PME Permit Fee: Plumb. lay. Fee: Dec. Insp. Fee: ConstructionTax TOTALS: 3,974 $2,896.60 ,��,�y�r�l�';�fr, Er $3,087:44 Y �ifr.• .;;�ts�=1=r":..':l�;�; r, -i-:•� •�+,5'.,.Ssf'r1. tI S �Sa �'I r7'�• •cx3 �W"— ra �....-.. • x... �y;u•�r'�-ay;�lH' fI;$S i����1 . S :!�' q 1 1 ..1. :.-.cG �::.4ii.:'v .� :fi sF i i i+.T s":3� ;>i3'� e '!ti \ -t0."•crc ` ���.•�. � �a4'r -!,. . �s Y '1 .+ { S - �.... 1`Z e„ (��{� r � • i h$-�1j}}s) � f E. � �S Tie :y14(Jis� ::5� .y • :1 ,�. - S. Y.::•e:.rG Si`.•SSII�:. 3 } •'� F P S:"'{'✓,>. e i c b S ?, er>� t St t�'.+., tt ��`>� f �' Ai 1��- �.. �Ff{: } .. .. l7 d5 +-� "r 1 t :•. ;7 i": T :1iS:.-+>•..^S l,fech. Plan Check $2,896.60 Phimb. Plan Check ........................................ .E'lee. Plan f?hco 0.0 his I�fech. Perri! Fee: Pl s.. Ih. Permit Fee: El¢c. Permit $3,087.40 0/her alec•h. Insp. 0.0 Other Ph•nrFl; Li Orher 1`h•r Insp. 00 0,04PA PME Unit Fee: J tech. Insp. Fee. PME Permit Fee: Plumb. lay. Fee: Dec. Insp. Fee: ConstructionTax NOTE: These Pees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 EK. 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,896.60 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. © OT 0.0 his $0.00 PME Plan Check: $0.00 nd Permit Fee: $3,087.40 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 00 0,04PA PME Unit Fee: $0.00 PME Permit Fee: $0.00 ConstructionTax Acoustical Fee: 0 Yes 0 No $0.00 a 0 / �V 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $516.66 Select a Non-Residen'ttal 0 Building or Structure 0 i Travel Docrrincntution Fees: Strong Motion Fee: IBSEISMICR $35.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $14.00 i• 7 :�5 i'%l;; i7;;Frs .�ar' ,I.a r`�}f,crh's,'-i:i:•f:[s„{<�HF'Uf tz;...:1sf %rrJ�:,': -jrs! )lw x�•l.•i,r. ',�,:'.!l,:s f',;,�•3r1r•i:'t; "ii�::: � =T,.a:+;.:.?.r) t'rr3 r `'::1S ..� i�;' :arSi: ' t...31 0.00o?�)lit:ilr ;'l_7`:.l'S..:�i:�'•+in; $:•lt5c $6,549.66 Revised: 11/08/2010