11110146CITE' OF CUPERTINO BUILDINGPERMIT
BUILDING ADDRESS: 10856 BROOKWELL DR
CONTRACTOR: PETER CONSTRUCTION
PERMFr NO: 11110146
OWNER'S NAME:
SAN JOSE, CA 95129
PHONE NO: (448) 529-6412
❑ LICENSED CONTRACTOR'S DECLARATION
E ..
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class._Lic. # v,
_. FRESIDENTIAL '
MECII COMMERCIAL
Contractor Date 6 i /zS j i
I hereby affirin ( at I ant licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD NEW PORCH,45SQFT & (635SQFT) FOR NEW LIVING
(commencing with Section 7000) of Division 3 of (lie Business & Professions
ROOM, BEDROOM, BATH & CLOSET & ADD (1) NEW WINDOW
Code and that any license is ht full force and effect.
SANITARY IS SUNNYVALE'S JURISDICTION.
I hereby affirm under penalty of perjury one of the following (wo 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
Sq. Ft Floor Area:
Valuation: $90000
Section 3700 of the Labor Code, for the performance of the work for which this
Permit is issued.
APN Number: 36921026.00 Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
TE
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 tris 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.Is.
- _..
Issued
Signature Date 01 1-7-5/ ( �
❑ 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
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is riot intended or offered for sale (See. 7044,
Business & Professions Code)
Signature of Applicant: Date:
1, 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:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements tinder 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 arid 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.
conta mina tits as defined by the Bay Area Ali- Quality Management Distrlet 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 €naking this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner or
forthwith comply with such provisions or this permit shall be deemed revoked.
Date: / ! s
� n!/ 2s 5 2 -
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 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 w)rk'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
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand any plans shall be used as public records.
Signature Date
Licensed Professional
_ __ CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10856 brookwell dr.
DATE: 11/28/2011
REVIEWED BY: bobs.
's
I APN:CI'
BP#: l�
VALUATION: 1$90,000
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: p
2nd Unit? 0Yes • No
OTC? 0 Yes (j)No
PENTAMATION 1 R3SFDADD
PERMIT TYPE
WORK I
sfd add new porch 45 s.f., new living, bedroom bath closet 635 s.f., add new window.
SCOPE
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
680
$2,420.00
IR3PLNCK
$1,519.00
IR3INSP
$0.00
Permit Fee:
$1,519.00
Suppl. Insp. Fee:Q Reg. Q
OT 1
0,01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i
TOTALS:
680
$2,420.00
rr
1 $1,519.00
MECH, HOURLY 0 Yes E) No _
PLUMB, HOURLY ® Yes Q; No
ELEC, HOURLY Q Yes Q No
,... r. ,�. r'i.ti1
Plan Check Fee:
$2,420.00
0 #
$783.00
Window / Sliding Glass Door
IWINwwsTR New (ShearwalUMasonry)
Suppl. PC Fee: Q Reg. Q OT
�fA)i'll�.'J' f �r.{:lir: ).E3
nus
$0.00
}�t7,ts
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 hosed an the nreliminary information available and are on/v an estimate. Contact the Dent for addtt'I into.
FEE ITEMS (Tee Resonation 11-053 E . 711111,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,420.00
0 #
$783.00
Window / Sliding Glass Door
IWINwwsTR New (ShearwalUMasonry)
Suppl. PC Fee: Q Reg. Q OT
0.0
nus
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,519.00
Suppl. Insp. Fee:Q Reg. Q
OT 1
0,01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i
rr
G
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
PLLONGRNGR
$88.40
Select a Non -Residential
Building or Structure
Strong Motion Fee:
IBSEISMICR
$9.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$4,040.40
$783.00
TOTAL FEE:
$4,823.40
Revised: 10/01/2011