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11080118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10228 ORANGE AVE CONTRACTOR: XCHANGE SOLUTIONS PERMIT NO: 11080118 INC OWNER'S NAME: XCHANGE SOLUTIONS INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 OWNER'S PHONE: 4082344835 SAN JOSE, CA 95125 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ' ELECT PLUMB License Class Lic.# �- MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND (commencing with Section 7000) of Division 3 of the Business & Professions PORCH Code and that m license is in full force and effect. 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 y SQFT. 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, Signature Date Ley OWNER -BUILDER DECLARATION 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 (See.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: 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 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. Additionallythe applicant understands and will comply with all non-pointiourte regulations+. er the Cupertino Municipal Code, Section 9.18. 1 y 1 �., Signature i Date r Sq. Ft Floor Area: Valuation: $600000 APN Number: 35718031.10228 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by .r Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain c. rmpliance with the Cupertino Municipal Code, Chapter 9.12 and the Health S(Tety Code,l$ections 25505, 25533, and 25534. Owner o� dii horized age` t: / Dater_ i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Niork'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 CITY OF CUPERTINO BUILDING PERMITm BUILDING ADDRESS: 10228 ORANGE AVE OWNER'S NAME: XCHANGE SOLUTIONS INC OWNER'S PHONE: 4082344835 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #{ 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 -poi)- source regulations per the Cupertino Municipa Code, Section 9.18. { Signature Date ` OWNER -BUILDER DECLARATION 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) 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: 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 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 w ich may accrue against said City in consequence of the granting of this petmif, Additionally, the'applicant understands and will comply with all non -point 06,lce reguldtlons per`#the Cupertino Municipal Yode, ection 9.18. g <, (( Si nature �` 1 y� ".�-� Date CONTRACTOR: XCHANGESOLUTIONS INC 3031 TISH WAY SUITE 901 SAN JOSE, CA 95125 PERMIT NO: 11080118 DATE ISSUED: 10/12/2011 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTIONNEW 2 STORY SFDWL,INCLUDES BASEMENT AND PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 SQFT. 7/16/12- REV#3 - REVISE GARAGE FLOOR SLAB WITH STRUCTURAL CALCS-8/28/2012 REV#3 ISS'D Sq. Ft Floor Area: Valuation: $600000 APN Number: 35718031.10228 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by.W 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 Applicant: 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 equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain cImpliance with the Cupertino Municipal Code, Chapter 9.12 and the Health, / Safety CodgSections 25505, 25533, and 25534. Owneh r Juthorized n4 Date:" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork'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 PERMIT BUILDING ADDRESS: 10228 ORANGE AVE CONTRACTOR: XCHANG , ERiNHT NO, -0118 SOLUTIONS INC D Alt 15, , OWNER'S NAME: XCHANGE SOLUTIONS INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 OWNER'S PHONE: 4082344835 SAN JOSE, CA 95125 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION J j BUILDING PERNIIT INFO: BLDG ELECT PLUNIB License Class Lia 4 (_ j_,." MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW 2 STORY SFDWLINCLUDES BASEMENTAND (commencing with Section 7000) of Division 3 of the Business & Professions 1 ORCI I 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 Code and that my license is in full force and effect. SQFT. I hereby affirm under penalty of perjury one of the following two declarations: REVISION #2- REVISE FLOOR FRAMING IN LIVING I have and will maintain a certificate of consent to self -insure for Worker's AREA- ISSD 6/8/12 Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $600000 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 permit is issued. APN Number: Occupancy'I'ype: APPLICANT CER'T'IFICATION 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED 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 /�., -- y o ' granting of this permit. Additionally, the applicant understands and will comply Issued by: 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" Olt 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) I, 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 69S of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use egr)f pment or devices which emit hazardous Compensation, as provided for b Section 3700 of the Labor Code, for the p p Y e air contaminants as defined by the 4a3, -ea Air Quality 11lanagement Distyict I performance of the work for which this permit is issued, will maintain compliance with the Oupf rtino Nluiyicipal Code, Chapter 9.11 and I I have and will maintain Worker's Compensation Insurance, as provided for by the health & Safety Code, Scctmns2�5505,25533�)nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this 1 7'� " permit is issued.� Owner m• authorized agent: Date - � � -- i I certify that in the performance of the work for which this permit is issued, I shall , t 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 ofexemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I most 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 indemnify and keep hamlf4ss the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses whikh+may accrue against said City in consequence of the I understand my plans shall be used as public records, granting of this periliit. �,ddition,�10, the applicant understands and wJll comply with all non point sAir5e regula iiin?rt per the Cupertino Municipal Code, Sec'ion Licensed Professional 9.18. s _ t `( Signature Date I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10228 ORANGE AVE CONTRACTOR: XCHANGE SOLUTIONS PERiNIIT NO: 110801 18 INC OM'NER'S NA\IE: XCHANGE SOLUTIONS INC OWNER'S PHONE: 4082344835 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# 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. Signature Date OM'NER-BUILDER DECLARATION 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) 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: 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. 1 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 t hick may accrue against said City in consequence of the granting of this perm�k. Additionally, the applicant understands and will comply V all non-�bii soGFce regulations per the Cupertino Municipal Cod , Section 3031 TISH WAY SUITE 901 SAN JOSE, CA 95125 DATE ISSUED: 10/12/2011 PHONE NO: F I ._ BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND PORCII 3,964 SQFT & ATTACI [ED GARAGE 424 SQFT. TOTAL 4,388 SQFT. 2/6/2012 - REV#1 - MINOR REVISION TO FLOOR PLAN -ISSUED 3/5/12 10/31/201 1-DEF#1- DEFERRED ROOF & FLOOR TRUSS CALCS- ISSD 1/6/2012 Sq. Ft Floor Arca: Valuation: $600000 APN Number: 35718031.10228 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: r'% Date: ` 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 Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BET"I'ER HAZARDOUS iAIATERIALS 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 Nlimicipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminant, as defined by the Bay Area Air Quality Management District I will nnaintaflli connpliancelkvith the Cupertino Municipal Code, Chapter 9.12 and the Health& Sia( ty Cod`, 25505, 25533, andI2553t4, Owner�or jrt th r nrecag nt: Date: i CONSTRUC'T'ION 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 Addre ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professio CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: 10228 ORANGE AVE CON'T'RACTOR: XCHANGE SOLUTIONS INC OWNER'S NANIE: XCHANGE SOLUTIONS INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 OWNER'S PHONE: 4082344835 SAN JOSE, CA 95125 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION � (� BUILDING PERINi1T INFO: BLDG ELECT r'Lui,Ia License Class Lic. 4 1-_. ! NISCH RESIDENTIAL COMNIERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW 2 S'T'ORY SFDWL,INCLUDES BASEMENT AND (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 SQFT. I hereby affirm under penalty of perjury one of the following two declarations: 10/31/201 1-#1-DEFERRED ROOF & FLOOR TRUSS CALCS- ISSD I have and will maintain a certificate of consent to self-insure for Worker's 1/6/2012 Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $600000 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. APN Number: 35718031.10228 OccupancyType: APPLICANT CERTIFICATION 1 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City Of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of tilt ®� Issued by: granting of this permit. Additionally, tile applicant understands and will comply Dater 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, 1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION T hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following hvo reasons: I, as owner of the property, or in), employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS NIATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California health & Safety Code, Sections 25505, 25533, and 25534, 1 will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self-insure for Worker's health & Safety Code, Section 25532(x) should 1 store or handle hazardous material. Additionally, should I use equipmer>t or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the ay Area AhQuality Management District 1 performance of the work for which this permit is issued, will maintain compliance with tb upertino �Vunacipal Code, Chapter• 9.17 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections. 5505; L5A�3, 6id-15534. Section 3700 of the Labor Code, for the performance of the work for which this _ j , permit is issued. Owner o• authorized agent: Date: 1 (�— I certify that in the performance of the work for which this permit is issued, !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 Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may acerinagainst said City in consequence of the I understand my plans shall be used as public records. granting of this pecmilt Additionally, th'c applicant understands and Will comply With all non-point sourfic Ngulations er'the Cupertino Municipal Cod , Section Licensed Professional t. Signature Date i+ _ __ __ CITY OF CUPERTINO Wl FEE ESTIMATOR - BUILDING DIVISION i9ADDRESS: 10228 orange ave. DATE: 08/15/2011 REVIEWED BY: bobs. s, APN: BP#: VALUATION: 1$600,000 ',PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: I 2nd Unit? 0 Yes ' No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK construct new 2 story with basement. SCOPE $0.00 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 4,388 $3,012.20 IR3PLNCK $3,403.20 IR3INSP 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,403.20 Suppl. Insp. Feer Reg. 0 OT Fo.0 hrs $0.00 PME Unit Fee: TOTALS: 4,389 $3,012.20 $3,403.20 )TV- Thovo foot tyro htyvod nn iho nroliminary infnrmatinn availahle and are nnly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E '. 7/1/11) FEE QTY/FFE77 MISC ITEMS Plan Check Fee: ��)r`tt:'i' _�ri�c'C'ft. �i. 11t"i: £'%' rT�i.?alr. %}Ri1El (.J(✓t{'.t' ._, ..... Ii1.Sjr, plem b. 7r• - t -:'C', �, CPL'. fi):S%), C'_'.. )TV- Thovo foot tyro htyvod nn iho nroliminary infnrmatinn availahle and are nnly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E '. 7/1/11) FEE QTY/FFE77 MISC ITEMS Plan Check Fee: $3,012.20 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,403.20 Suppl. Insp. Feer Reg. 0 OT Fo.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: IBCONSTAXR1 # new units $579.61 Acoustical Fee: 0 Yes (D No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 PlarulinFee; PLLONGRNGR $570.57 Select a Non -Residential Building or Structure Q 0 i Strong Motion Fee: IBSEISMICR $60.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $24.00 SUBTOTALS:` $7,649.58 $0.00 TOTAL FEE: 1 $7,649.58 Revised: 07/04/2011 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION Y ADDRESS: 10218 orange ave. DATE: 07/16/2012 REVIEWED BY: bobs. Alkch, A/mil Fee: APN: BP#: 11080119 *VALUATION: Iso 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Phimb, hi3O L Fcc: PENTAMATION 1GENRES PERMIT TYPE: WORK revise garage floor slab with structural calcs. SCOPE Suppl. Insp. Fee:Q Reg. Q OT0,0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are only an ecthnate_ contact the Want for mhhu ll h fo FEE ITEMS (Fee Reso/lltion 11-053 Eff.' 7/1/11 111"ch. Pleat Ch,lrk Phnub. Pluu Ch Elec. F loo Chccic Alkch, A/mil Fee: FI(nnb. : P0711il FIT, Ele Permit Fee. Olher Akch. /aNy), 0/ho. P11/111hlav),01her Dec. lisp, i14c(`h. limp, Fccc: Phimb, hi3O L Fcc: Ele, Insp. r,:(': NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are only an ecthnate_ contact the Want for mhhu ll h fo FEE ITEMS (Fee Reso/lltion 11-053 Eff.' 7/1/11 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? (j) Yes Q No $0.00 hours Plan Check, Hourly $266.00 1sTPLNCK A Suppl. PC Fee: Q Reg. Q OT FO.01hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Collso-11( ion Ten: "Idillillisir(a "?Fee: G) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 Treated Doc iacnlotioa F(:res: Strong Motion Fee: $0.00 Select an Administrative Item BldgStds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.001 TOTAL FEE: $266.00 Revised: 07/01/2012 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION WdADDRESS: 10228 Orange Ave DATE: 07/10/2012 REVIEWED BY: Sean Alech. Permil Fee: APN: BP#: 11080118 *VALUATION: $0 `PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Plant). fasp. (see: PENTAMATION 1GENRE i USE: Permit Fee: PERMIT TYPE: WORK Revision #2: Revise the floor framing in living area (Structural). SCOPE $0.00 NOTE: This estinlate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School M] fe int ata 1 Tl ea face nra haead not tba nral/ndnary lnfarnfntinn avallahla and arm nn1v an ewhnate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/11) Xh<ch, Pion Chccic Phrnrh, Plcrn Plan C'fzrrclr Alech. Permil Fee: mil rc:e: L'lec. Permit re('. 07her Alech, hush. Oilwr Plamb Inch. 07114,1• Ele(, bap, �11rch. limp. Fco Plant). fasp. (see: 1_slec. hr.rp, Fee: NOTE: This estinlate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School M] fe int ata 1 Tl ea face nra haead not tba nral/ndnary lnfarnfntinn avallahla and arm nn1v an ewhnate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check, Hourly $133.00 ISTPLNCx A Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 070 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cousiniclion Tax: F A(lnninisflwiive Fee: 0 E) Work Without Permit? 0 Yes 0 No $0,00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i 7_j'av :l Doctimentution Tees. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Cominission Fee: $0.00 SUBTOTALS: $0.00 $133.00 TOTAL FEE: 1 $133.00 Revised: 07/01/2012 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ikADDRESS: 10288 Orange Ave. DATE: 02/06/2012 REVIEWED BY: A. Salvador xn APN: � �'� / U� BP#: / ( f,% *VALUATION: Iso Y'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex phani), �rt��. F��': PENTAMATION 1 GENRE USE: PME Plan Check: PERMIT TYPE: WORK Minor Revision to floor plan Permit Fee: SCOPE Suppl. Insp. Fee:G Reg. Q OT NOTE: This estimate does not includefees due to other Departments (t. e. Planning, Public YVorlrs, Fire, Sanitary Sewer District, School nLQh'Ict. Ptr I. Th PSP fern are haled on the nrelimina'v information available and are oniv an estimate. Contact the Dept for addn 11 info. FEE ITEMS (Fee Resolnrtion 11-053 Etf.• 7/1/11) P/ml C l £'SIC I''ILdi77h. 111(o t. Ilti`f'1'c 0'C, Piuj7 C/'L'A 1ljc. i2, Fc't`t?illl'C'-': Plam7, Po -mil &v F/ec, f'P'imil Fec: �s,lwr ,A-, eh, /io,, ,. O!"wj, phonh Irak.Ll Other Elec' /m;/). r «. phani), �rt��. F��': Elez' h?.';n Fcc, NOTE: This estimate does not includefees due to other Departments (t. e. Planning, Public YVorlrs, Fire, Sanitary Sewer District, School nLQh'Ict. Ptr I. Th PSP fern are haled on the nrelimina'v information available and are oniv an estimate. Contact the Dept for addn 11 info. FEE ITEMS (Fee Resolnrtion 11-053 Etf.• 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 = hours Plan Check, Hourly $260.00 ISTPzwCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:G Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �1)i7,5/TCPL'G7UiZ T'n: F O 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 d "t7f%t i f)ti['iFlil t?itPiltDti i"c'E:°,; Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $260.00 TOTAL FEE: $260.00 Revised: 1/19/2012 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10218 orange ave. :�fx's':7. t'rrttl,r (;he'C1� DATE: 10/31/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: $500 rPERMIT TYPE: Building Permit },r{fE7d' z'iti7;%!; ,`t 7,i. PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK deferred roof and floor truss calcs. SCOPE NOTE: This estimate does not include fees due to outer Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminarv, information available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resohition 11-053 E ,. 7/1/11) :�fx's':7. t'rrttl,r (;he'C1� 1-'Y?u7�t, tt'iQi7 C^f78F-j( f51Cc'. F<'""1737 C'6ie'i;,i fLlnCt'P. r Plan Check Fee: Hourly Only? 0 Yes 0 No L7fld8t' ft'i'dt. f;i.tj:.E17-- },r{fE7d' z'iti7;%!; ,`t 7,i. .}f�Ifi7 r`-., ..;.17377,ET Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs NOTE: This estimate does not include fees due to outer Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminarv, information available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resohition 11-053 E ,. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 ® hours Plan Check, Hourly $520.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 't771.li'tt{'fFEi'7 '.a 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Td"i.1i%g�.%)f,`7l3r'7� i:t7i:jfl.t)iT t't.'i:�:)'; Sts Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item 1 Bldg Stds Commission Fee: 1BCBSC $1.001 SUBTOTALS: $1.50 $520.00 TOTAL FEE: ` $521.50 Revised: 10/01/2011