14050020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19060 BARNHART AVE CONTRACTOR:TEAM CAMINERO PERMIT NO: 14050020
FRAMING
OWNER'S NAME: VICKI A&GARY P BERCHEM 32353 UTICA ST DATE ISSUED:06/25/2014
OWNER'S PHONE: 4085955675 HAYWARD,CA 94544 PHONE NO:(650)400-5524
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT ONE STORY ADDITIONS (468 SQ FT);
License Class__ Lic.# 9 S 2 7 7 INTERIOR REMODEL(183 SQ FT); ELEC PANEL UPGRADE
I (200 AMP).
Contractor T,`am C n,ty t?,7 Date O Z/
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. Sq.Ft Floor Area: Valuation:$120000
l 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:37537036.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PER T EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WIT 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 DAY AST CALLED INS ECTION.
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: Date: Z /
with all non-point soure atm t Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature ! Date Z 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
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 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(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 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,S ions 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 agenC. Date: /n 1
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,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
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 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.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 19060 barnhart ave DATE: 10/02/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: Iso
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1GENRE
USE: PERMIT TYPE:
WORK revision #1- chane pitch of roof, structural modifications
SCOPE
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 Dept-for addn'1 info,
FEE ITEMS (Fee Resolution 11-053_1_,"f: 7i1 13� FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (2) No $0.00 0 hours Plan Check, Hourly
Suppl. PC Fee: (j) Reg. () OT0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes Q No $0.00
Suppl. Insp. Feer Reg. Q OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
i
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg_Stds Commission Fee: $0.00 $143.00 ISTINSP Inspection, Hourly
SUBTOTALS: $0.00 $286.00 TOTAL FEE: 1 $286.00
Revised: 08/20/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19060 BARNHART AVE CONTRACTOR`"T4" TSF PERMIT NO: 14050020
LXUR H"n
OWNER'S NAME: VICKI A&GARY P BERCHEM �U DATE ISSUED:06/25/2014
OWNER'S PHONE: 4085955675 r Vis[ PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CONSTRUCT ONE STORY ADDITIONS (468 SQ FT);
License Class Lic.# qS 2— 7 -7 INTERIOR REMODEL(183 SQ FT); ELEC PANEL UPGRADE
Contractorf ti,f) Ca�� �C,p F1_6'A'Date (0 (2gJi 4 (200 AMP).
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 Iicense 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:$120000
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 APN Number:37537036.00 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. I agree to comply with all city and county ordinances and state laws relating WITHI "��QF 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 D YS FROM LAST CALLEDINSP CT ON.
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: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18,
RE-ROOFS:
Signature Date IO ZS/t 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
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
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 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.I2 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 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 theerformance of the work for which this
p Owner or authorized agent: U Date:
permit is issued. L�5
I certify that in the performance of the work for which this permit is issued,1 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
1 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
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 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
FEE ESTIMATOR- BUILDING DIVISION
W-'PERMIT
DDRESS: 19060 BARNHART AVE DATE: 05/02/2014 REVIEWED BY: MELISSA
PN: 375 37 036 BP#: yU06� °VALUATION: $120,000
PE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? Yes No PENTAMATION
USE: SFD or Duplex TOTC? ®Yes (F)No PERMIT TYPE: 1 R3SFDADD
WORK ADD 468 S.F. TO CREATE N MASTER BEDRM & ENLARGE E FAMILY RM. REMODEL 183 S.F.
SCOPE TO ADD (N) BATHROOM & RECONFIGURE CLOSET/HALLWAY. UPGRADE PANEL TO 200AMPS
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,N,V-B 468 $1,579.00 IADDPLCK $1,284.00 IADDINSP
TOTALS: 468 $1,579.00 $1,284.00
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes 0 No
Elec. Plan Check 0.0 1 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elec.Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees 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 Elf 71/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,579.00 = s.f. Remodel,Other
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $418.00 IREbfRESOTx 14
PME Plan Check: $0.00 200 amps Electrical
Permit Fee: $1,284.00 $47.00 IBELEC200 Services
Suppl. Insp. Fee:E) Reg. Q OT 1 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
4
Work Without Permit? ® Yes No $0.00 7 E)
Advanced Planning I'ee. IPLLONGR $65.52 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $12.00 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $5.00
SUBTOTALS: 1 $3,039.52 $465.00 TOTAL FEE: F $3,504.52
Revised: 04/01/2014