12030084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10324 VISTA DR CONTRACTOR:ROSS PERMIT NO: 12030084
CONSTRUCTION
OWNER'S NAME: HERR HEDY 4984 WELLINGTON PARK DR DATE ISSUED:06/08/2012
OWNER'S PHONE: 4084462177 SAN JOSE,CA 95136 PHONE NO:(408)891-6810
0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r, PLUMB
License Class
Lic.# (a C2 1 6q 0
Contractor P 09S 60 tu S I— Date__(c, MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: UNIT B-ADD 127SQFT TO UNITB KITC14EN NOOK,ADD
I hereby affirm that I am licensed under the provisions of Chapter 9 BAY WINDOW TO LIVING ROOM(20SQFT)FOR TO`I-AL OF 147
(commencing with Section 7000)of Division 3 of the Business&Professions SQ FT.
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;$59000
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
APN Number:31633124.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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
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.
Z
Signature_ 11"�1114 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
El OWNER-BUILDER DECLARATION inspection,
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 25.134. 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 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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized Dxte
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,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 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: 10324 vista drive,apt b DATE: 03/19/2012 REVIEWED BY: larrys
APN: BP#: "VALUATION: 9,000
*PERMIT TYPE: Building Permit T_ PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes G No I PENTAATI
MON IR3SFDADD
USE: I OTC? 0 Yes G No I PE RMIT TYPE:
ENN,oRK add 127 sq ft to unit b kitchen nook. add bay window to linin q room (20 sq ft)for a total of 147 sq ft
(�RK
SCOPE addes. 200 amp service panel upgrade.
TYPE OF FLR AREA
OCCUPANCY TYPE: PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR.
R-3(Custom) 11-Bj11-B,1V,V-B 147 $994.00 IADDPLCK $963.00 JADDINST
$96
TOTALS: 147 $994.00 $963.00
MEC11,HOURLY 0 Yes 19 No' PLUMB,HOIS. LV 0 Yes 0 No' ]PLC,C,"HOURLY, '0 Yes 0 No
Efec,Plan Check=0.0hrs $0.00
FE fee.Permit Fee: ]EPERMIT
�Other Flee.Insp. hrs $44.00
NOTF. This estimate does not includefeev due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are gal orx the relinina inrmadon a
.formation a * ble and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 L"If "',7Lj�77 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $994.00 It 200 1 amps Electrical
Suppl.PC Fee: (E) Re& 0 OT 0.0 hrs KOO 1 $44.001 !ERT<200 I Services
PME Plan Check: $0.00
Permit Fee: $963.00
Suppl.Insp.Fee: Reg. 0 OLTE00'Lhjs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $44.00
Work Without Permit? 0 Yes (E) No $0.00
Advanced Pla-mirw,Fee: PLLONGRNGKI $19.11 Select a Non-Residential
Travel Documentation Fee: I TPA TIDOC $44.00 Building or Structure
SIMII&ITYL21ti,on Fee- IBSEISMCR $5.90 Select an Administrative Item
Bldv,SWs Con'tmission Fee: IBCBSC $3.00
SUPTOTALS:1 $2.073.01 X44,00 T TOOTTAL EFE: $�2,1 17.�01
...........
Revised: 1/19/2012