13040081 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11109 SUTHERLAND AVE CONTRACTOR:TALENT DECIDE INC PERMIT NO: 13040081
OWNER'S NAME: JONATHAN SHEN 218 HARDING AVE DATE ISSUED:09/16/2013
OWNER'S PHONE: 4089738176 LOS GATOS,CA 95030 PHONE NO:(408)306-3968
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REMODEL KITCHEN/LAUNDRY(234 SQ FT); REMODEL 3
License Class Lic.# _1P"00p-y 1 BATHROOMS(206 SQ FT); REMODEL OTHER(938 SQ FT);
REMOVEIREPLACE/ADD (14)WINDOWS AND DOORS;
Contractor 7i��j��eioS 1,--C Date �C/d��/Sc REMOVE
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions REVISION#1-REVISE FLOOR PLAN TO INCLUDE CHANGES IN
Code and that my license is in full force and effect. REMODEL OF KITCHEN AND BATHROOM-ISSD OTC 4/8/2014
1 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 �10
performance of the work for which this permit is issued. RV Sq.Ft Floor Valuation:$100000
1 have and will maintain Worker's Compensation Insurance,as provideby
Section 3700 of the Labor Code,for the performance of the work f tis APNumber:35617061.00 Occupancy Type:
permit is issued.
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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 189DAYS 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 VROlV AST CALLED INSPE�`T�bN.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, r/ / / O
costs,and expenses which may accrue against said City in consequence of the ..
granting of this permit. Additionally,the applicant understands and will comply Issued by: Dater
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature �.ti �d Date ; All roofs shall be inspected prior to any rooting 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
Signature of Applicant: Date:
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,
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 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. l 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
1 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 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.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 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 1 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.
Signature Date
CITY OF CUPERTINO
ILIFEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 11109 sutherland ave DATE: 04/08/2014 REVIEWED BY: Mendez
APN: BP#: 13040081 *VALUATION: Iso
'PERMIT TYPE: Building PermitPLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: I PERMIT TYPE: A
WORK REVISION #1- REVISE FLOOR PLAN TO INCLUDE CHANGES IN REMODEL OF KITCHEN AND
SCOPE BATHROOM- ISSD OTC 4/8/2014
Li
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resolution 11-053 E .' 7%1%13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: 0 Reg. C) OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. C) OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure
Stron#; Motion Fee: $0.00 1.0 hrs Revisions
Bldg Stds Commission Fee: $0.00 $139.00ISUPPKFEE Over the Counter
SUBTOTALS: $0.00 $139.00 TOTAL FEE: $139.00
Revised: 04/01/2014
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX (408) 777-3333 • buildingcDcupertino.or4
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/ FERRED ORIGINAL PERMIT#
PROJECT ADDRESS 1AL*�%Zow 1Po
OWNER NAME ,I I,•,� PHONE s E-MAIL
STREET ADDRESS CITY, STATE,ZIP s TFAX
CONTACT NAME PHONE E- AIL
STREET ADDRES,Sf � CITY,ST TE ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT X CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE Nl j�EE LICENSE TYPE BUS.LIC# d0
COMPANY NAME E-MAILL FAX
STREET ADDRESS CITY,STATE, IP PHONE
�� r73�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS �y �CITY,STATE,ZIP PHONE
DESC PTION OF WORK � ! x I' low
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA car AREA ` AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? [3 NO ADDITION? []NO
f
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES .RECEIVED BY T VALU T N:.
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
�-
By my signature below,I certify to each of the following: I am the property owner or authorized agentr.ac n the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify i accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-iiddenti/fled
dpproperty for inspection purposes.
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATI N REQUIRED rLnn CHECKTYPE. . ROUTINGS I
New SFD or Multifamily dwellings: Apply for demolition permit for OVER THE COUNTER BUILDING PLA REVIEW
existing building(s). Demolition permit is required prior to issuance of building ;
permit for new building. ❑ EAPREss ❑ PLANNINCPLANREVIEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDaRD ❑°'PuBLICw0Rxs
form if any Hazardous Materials are being used as part of this project. LARGE FIRE DEPT'.
_Copy of Planning Approval Letter or Meeting with Planning prior to
Q MAJOR: SANITARYSEWERDISTRiCT
submittal of Building Permit application.
�].ENVIRON114ENTA6HEALTH
B1dgApp_2011.doc revised 06/21/11
J Building Department
City Of Cupertino
r 10300 Tone Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: /-45/ w PERMIT# �C�<kev `
OWNER'S NAME: a v 'V z7 / PHONE P,6�'
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets& Millwork ?>
Cement Finishing
Electrical C i`� 1 &1e 5-�-
Excavation
Fencing
Flooring/Carpeting c Gj
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper 7ATC7 29e.-Or,
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11109 SUTHERLAND AVE CONTRACTOR:TALENT DECIDE INC PERMIT NO: 13040081
OWNER'S NAME: JONATHAN SHEN 218 HARDING AVE DATE ISSUED:09/16/2013
OWNER'S PHONE: 4089738176 LOS GATOS,CA 95030 PHONE NO:(408)306-3968
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class 2 Lic.# 0�'426PY.3/ REMODEL KITCHEN/LAUNDRY(234 SQ FT); REMODEL 3
A BATHROOMS(206 SQ FT); REMODEL OTHER(938 SQ FT);
Contractor '�J' `��4 Date ����//� REMOVE/REPLACE/ADD(14)WINDOWS AND DOORS;
I hereby affirm that I am licensed under the provisions of Chapter 9 REMOVE
(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. Sq.Ft Floor Area: Valuation:$100000
4� ave 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:35617061.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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 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 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
granting of this permit. Additionally,the applicant understands and will comply Issued by. l(r' Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date l �� 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"OR 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)
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. 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
1 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ? ��
permit is issued. Owner or authorized agent: z/G' Date
1 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,l 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 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 accrue against said City in consequence of the l 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.
Signature Date
CONSTRUCTION PERMIT APPLICATION C�
12COMIAUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION l ^O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O `
(408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org \�]
CUPERTINO I
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
C ,o dl
OWNER ME /y PHO -� � E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
,.d W-? ti¢ S014e
CONTACT NAME PHONE _ E-MAIL
AV
OF
STREET DRESS CITY,STATE,ZIP FAX
"413
❑ OWNER ❑ OWNER-BUDDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICE E ER 7LICENS TYPE BUS.LIC#
.fav S 3 v
COMPA NAME E-MAIL FAX
STRE DRESS�s� CITY,STATE,ZIP
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMP)SNY NAME E-MAIL FAX
STREET ADDRESS CITY TATE ZIP P O
7W 4LZ J'�A:=- :- E CA
DESCRIPTION OF WORK
Ale) Al
J
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
I`//fj USE TYPE OCC. SQ.F-I'. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA;>67,(:r AREA Ae AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREAj REMODEL AREA REMODEL AREA
1co s 1/00
PORCH AREA DECK AREA TOTAL DECKTORCH AREA I GARAGE AREA: DETACH
Q U RATTACH
_#D-WELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? El NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
r
By my signature below,I certify to each of the following: I am the property owner or authorized agent to a on the property owner's behalf. I have read this
application and the information I have provided is correct 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFO ION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ExPREss ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ EN'VTRONhIENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 11109 Sutherland Ave DATE: 04/18/2013 REVIEWED BY: Sean
APN: BP#: �01 Ll01_!K 'VALUATION: $100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION •I R3SFDREM
USE: PERMIT TYPE:
woRK REMODEL KITCHEN/LAUNDRY 234 SQ FT); REMODEL 3 BATHROOMS 206 SQ FT); REMODEL
SCOPE OTHER (938 SQ FT); REMOVE/REPLACE/ADD (14)WINDOWS AND DOORS; REMOVE AND
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: IPPERMIT
Other Mech.Insp. Ehrs $45.00 Other Plumb Insp. 0.0 ��s �$45.00� Li
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS(Fee Resolution 11-053 Ef 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 DKI s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: (F) Reg. OT 0.0 hrs $0.00 $600.00 IREMRESBAT
PME Plan Check: $0.00 234 1 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 1REMRESKIT
Suppl. Insp. Fee-0 Reg. OT 0.0 1 hrs $0.00 F-938-1 s.f Remodel,Other
PME Unit Fee: $0.00 $601.00 IREMRESOTH
PME Permit Fee: $90.00 = # Window/Sliding Glass Door
$533.00 I WINREP Replacement
Administrative Fee: 1ADMIN $42.00 1 1 # Mechanical
Work Without Permit? ® Yes (F) No $0.00 $133.00 IMFR=<100 Furnace,Forced-Air E)
Advanced Planning Fee: $0.00 = # Plumbing Q
Travel Documentation Fee: ITRA VDOC $45.00 $27.00 1PRWHEATR Water Heater
Strong Motion Fee: IBSEISMICR $10.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $191.00 $2,494.00 TOTAL FEE: F $2,685.00
Revised: 04/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 11109 Sutherland Ave DATE: 04/18/2013 REVIEWED BY: Sean
APN: BP#: o V 'VALUATION:
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP11
USE: PERMIT TYPE:
WORK REMODEL KITCHEN/LAUNDRY 234 SQ FT); REMODEL 3 BATHROOMS 206 SQ FT); REMODEL
SCOPE OTHER (938 SQ FT); REMOVE/REPLACE/ADD (14) WINDOWS AND DOORS; REMOVE AND
Elec.Plan Check 0.0 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elea.Insp. 0.0 hrs $45.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $67.00 IBREMFIXT Fixtures,Lighting
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. () OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
C,1,11,,; : , :-, ,',;i, JIU, F
Administrative Fee: IADMIN $42.00 0
Work Without Permit? ® Yes (2) No $0.00 G
Advanced Planning Fee: $0.00 0
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $132.00 $67.00 TOTALFEEF: $199.00
Revised: 04/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 11109 SUTHERLAND DATE: 04/09/2013 REVIEWED BY: MELISSA
APN: 356 17 061 BP#: *VALUATION: $100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK ADD 2 N BAY WINDOWS AND REMODEL E KITCHEN & E MASTER BATH & E HALL BATH
SCOPE
LJ
E3__t__ tlrt2i;i'r, ED
rr � I,J _?':.
✓'..Cjt.fr"1 �'r'c'. r... -6 I n !; ...(C:
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 11-053 F_ff 7,-1/122 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-1007 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $600.00 IREMRESKIT
PME Plan Check: $0.00 1 180 1 s.f. Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $600.00 IREMRESBAT
Suppl. Insp. Fee:Q Reg. Q OTT-0.01 hrs $0.00 L14_j s.f. Remodel,Other
PME Unit Fee: $0.00 $400.00 IREMRESOTx
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes (F) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure Q
Strong;Motion Fee: IBSEISMICR $10.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTQTALS
$14.001$1,600.001 TOTAL FEE: $1,614.00
Revised: 04/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS-,� . PW,,71 6f,'1 AW-51� a r�✓o PERMIT# 3 O 0 D /
OWNER'S NAME: c'.t/.wN :� '�/ PHONE#
GENERAL CONTRACTOR: we BUSINESS LICENSE#
ADDRESS:>7�P �.4� ,00i�V 6 .e �WjOVV CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring /Carpeting
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date