11040032 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22080 SAN FERNANDO CT CONTRACTOR:MOR12 LAND PERMIT NO: 11040032
CONSTRUCTION
OWNER'S NAME: RONSDALE MANAGEMNET&AZ CIIEMICAL 5514 AMBY DR DATE ISSUED: 11/01/2011
EN'S PHONE: 4088899933 SAN JOSE,CA 95124 PUONE NO:(408)221.0892
K01 LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r
MECH RESIDENTIAL COMMERCIAL
Guntructor � �L�C3I s�verc�atc l l\
els �pi zl P Iti,a+G 5 11lilt�� ff+VY� 'i+'ntWi9p14,, JOB DESCRIPTION NEW IW0.510RYSINCLEFAMILY DWELLING(4128),
I hereM1ffi
y arm thot 1 am Incensedlunderthe'pr'ovnaione of,Chapter 0 ,;ih. ("
t.. ;PORCH(459SQFT)&A'ITACHED GARAGE(4 I OSQI'1)
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have raid will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,I'or the
performance of the work for which(his permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the labor Code,for die performance of the work for which this Sq.Ft Floor Area: Valuation:$600000
permit is issued.
APPLICANT CERTIFICATION APN Number:35712011.00 Occupancy'I'ype:
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
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 this 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
9.18.
Signature Issued Date:
by>
OWNER-BUILDER DECLARATION
RE-ROOFS:
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
(he following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of ApplicanC_ Date:
I,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 site 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 under Chapter 6.95 of the
performance of the work for which this permit is issued. California health&Safely Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work I'or which this Safety Code,Section 25532(0)should I store or handle hazardous ml
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 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 making this certificate of exemption I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner-ora t r nt _
furthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that l have read this application and stale that the above information is I hereby affirm that there is a construction lending agency for the perlbrmamee o1'work's
correct.I agree to comply with all city and county ordinances mid 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
and expenses which may accrue against said City in Consequence of the
inof this permit.Additionally,the np ificnnl understands and will comply Lm,RCHITF.CI"5 DECLARATION
h all nob-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
ReAral
CITY OF CUPERTINO BUILDING:PERMIT
BUIEDINC ADDRESS: 22080 SAN FERNANDO CT CONTRACTOR:MORE LAND PERMIT NO: 11040032
CONSTRUCTION ,
OWNER'S NAME: RONSDALE MANAGEMNET&AZ CHEMICAL 1454 HUSTED AVE DATE ISSUED: 11/01/2011
OWNER'S PHONE:4088899933 ,SAN JOSE,CA 95125 PHONE-NO:(408)221-0892
'❑ LICENSED CONTRACTOR'S DECLARATION C
1 BUILDING PERMIT INFO: BLDG ELECT PLUMB
.License Class Lic.# � '� "�.1 '
` I MECH RESIDENTIAL COMMERCIAL:� -
Contractor �J l�C. �c Rcuet Date . °L
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW TWO-STORY SFDWL(4128),PORCH,(459SQFT)&
(commencing with Section 7000)of Division of the Business&Professions ATTACHED GARAGE(4 I OSQFT)
Code and that my license.is in full force and effect. 8/22/2012-REV#1 ADD ATTIC HVAC UNIT-REV#I ISS'D 8/22/2012
1 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 ofthe LaborCode,for the performance ofthe work for which this Sq.Ft Floor Area: Valuation:$600000
permit is issued.
APPLICANT CERTIFICATION APN Number:35712011.00 Occupancy Type:
I cenify'.that I have read this,application and state that the above information,is
correct. I agree tacomply 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 propertyfor inspection purposes. (We)agree tosave PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify'and keep harmless the City of Cupertino against liabilities,judgments,
costs;and expenses which may accrue against said City in consequence of the WITH-IN 180 DAYS OF PERMIT ISSUANCE.OR
granting of this permit. Additionally,the.applicant understands and will comply 180 D YS FROM L T CALLED INSPECTION.
with all non-point source regulaiions-per the Cupertino Municipal,Code,Section -
9.1a. - �.1.1 °f�
Issued by: Date:
Signature Date °Z Z
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
7"hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed'Af a roof,is
the4ollowing two reasons: installed without first obtaining an'inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the-structure is not intended or offered for'sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
l,,,as owner of the property;am exclusively contract ing'•with,Iicensed.contractors to
construct the project(Sec:7044,Business&Professions Code). ALL ROOF COVERINGS.TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of-the followingsthree
declaration§: HAZARDOUS MATERIALS DISCLOSURE.
I have,and will maintain a"Certilicate-ofConsent to selfinsure for Worker's
Compensation,as provided for by Section-3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6:95 of the
performance�of the work for which,this permit is'issued. California Health&Safety Code,Sections 25505,25533,.-and 25534. 1 will maintain
I have and will"maintain Worker's Compensation Insurance,as provided forby compliance with the Cuperiino.Municipal Code,Chapter 9.12 and the-Health&
Section 3700 of the Labor Code,forr 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. contaminants as defined by the Bay Area Air Quality,Mygagement•District 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 anyperson: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"making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aut t.
forthwith comply with such provisions or this permit shall be deemed revoked. Date: f
APPLICANT CERTIFICATION CONSTRUCTION LENDING.AGENCY
I certify that I have read this application and,state that the above information is l hereby affirm that there is a construction lending agency for the performance of work'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 ofthis-city to enter Lender'i Name,
upon the,above-mentioned property for inspection purposes.(We)agree to save
indenmifyand 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 ARCHITECT'S DECLARATION
with-all non-point source regulations per the Cupertino Municipal Code,Section
9.f8. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY:OF CUPERTINO BUILDING PERMIT
BUILDING-ADDRESS: 22080 SAN FERNANDO CT CONTRACTOR:MORE LAND PERMIT NO: 11040032
CONSTRUCTION
OWNER'S NAME: RONSDALE MANAGEMNET&AZ.CHEMICAL, 5514 AMBY,DR DATE ISSUED: 11/01/2011
OWNER'S PHONE:.4088899933 SAN JOSE,CA 95124 PHONE NO:,(468j221-0892
❑ LICENSED CONTRACTOR'S DECLARATION' C,' r; C`
p BUILDING�PERMIT INFO: BLDGELECT "` PLUMB
License Class Lia`# 8 t l ri
_
' MECH RESIDENTIAL—l COMMERCIAL
Contractor `Lko I P Lo2-1'GPate L k\
hereby affirm that-I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW'TWO=STORY SINGLE FAMILY DWELLING(4128),
(commencing with'Section 70100), of Division:3 of:the Business„&Professions PORCH(459SQFT)&ATTACHED GARAGE(410SQFT)
Code and that my license is,in full,force and effect.
!:hereby affirm under penalty of perjury one of the following two declarations:
Lhaverand 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
performanceof 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 'Sq.,Ft.Floor Area:' Valuation:$600000
permit,is issued.
APPLICANT CERTIFICATION APN Number:35112011.00 Occupancy Type:
I certify that I have;read thisapplicationandstate-that he,aboye:information is
correct:1,agree to comply with all city and county ordinancessand,state laws relating
to building construction,and hereby author ize,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
,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 ofahis permit. Additionally;the applicant understands and.will comply 180 DAYS FROM.LAST CALLED INSPECTION.
with all non-point source regulationsper the Cupertino Municipal Code,Section
9.18.
Issued byr, Date:.
Signature Date
6
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
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 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.thestructure isnot intended or offered for sale(Sec.7644,
-Business&'Professions Code) Signature of Applicant: Date:
.I,as owner of the property,am exclusively'contraciing)withlicensed contractors4o
construct tfie.project(Sec7044,.Business,&Professions Code): ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
vafions:
I have
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'LaboF'Code;for the; I have:read the•hazardous materials requirements underChapter,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 and the'Health&,
Section 3700 of the Cabor,Code,for the performance of the work•forwhichthis Safety Code,Section 25532(a)should 1 store or handle hazardous'material.
Additionally,should Luse egy_ipment or devices which emit hazardous,air
permit.is issued. contaminants as•defined b•the Ba” Area Air
y y Quality-Management District.I will
I certify'that in,tfie'perforrimance ofthe,work forwhichthis permit.is issued,I'shall maintain compliance with the^Cupertino Municipal.Code,Chapter 9.12 and the
not-employ any person in any mannerso as to.becomesubject to the Worker's Health&Safety"Code;Seciions'25505,25533,and 25534.
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 Owner or' t or' ent:'
forthwith comply,withtsuch provisions,or this permit shall'be deemed,revoked. Date: �
APPLICANT CERTIFICATION' CONSTRUCTION LENDING AGENCY
I certifythat.l 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 Mrk's
correct.I agree to+comply witball city and county,ordinances•and•state laws relating for whichAis',permit is i'ssued,(Sec.3097,Civ C:)
to building:construction,and,hereby,authorize representatives of this city to enter Lender's Name
uponthe;above:mentioned property for inspection purposes.(We)agree tosave
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lend er's•Address
costs,.and'expenses which mayaccrue against said City in consequence of the
granting of this—permit—Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
withsall non-point source,regulaticns per the Cupertino Muni cipal.Code,;Section
9.18.. 1 understand my plans shal]'be used as public records.
Signature Date Licensed Professional,
CITY OF CUPERTIN"O
FEE,ESTIMATOR— BUILDING DIVISION
ADDRESS: 22080 San Fernando Ct. DA . • 08/22/2012 REVIEWED BY: larrys
APN: B : 11040032 VALUATION: 1$4,000
XP•ERMIT'TYPE: Mechanical PermitPLAN C K TYPE: Alteration /Addition,/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A i
�
WORK' add attic hvac unit '
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
t '
Furnace,.F'orced=Air1MFR=<100 1 # $133
TOTALS: $133 00 s��
a
9. r.y..R . .
Meeh.Plan Check0..0 firs. $0.00 Phunb..Plan Check P'lec.Plan Check
Mech.Permit,Fee: IMPERMIT Phrmh. Permit Fee: hlec. Permir Fee:
Lr"Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. LI Other Elec.Insp. Li
.Insp.tee: Plumb. Insp. llee' Elft". Insp. Fee
NOTE: Thisxstimate,does not'include fees,due to other Departments(i.e.Planning;Public:Works;,Fire,Sanitary Sewer District;School
District,etc. . Themfees are based on the prelimina information available.and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS"(Fee Resolutioa 1 f-053 Eft.' 7/,1117.) FEE QTY/FEE MISC ITEMS
]Tarr Check Fee:
SuppL .PC T ee
PME'Plan Check: $0.00
f'errnit.Fce:
-Supp/. Insp:Fee
PME Unit Fee: $133.00
.PME Permit Fee: $45.00
Construction RIX.,
Administrative Fee: 1ADMIN $42.00
Work Without Permit? 0 Yes (j) No $0.00
Advaiie-ed Plon ng Fees:
Travel Documentation-.Fee: ITRA VDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1..00
- 41
- � SUBTOTAL
s.. $266.50 $0.00 : - �TOTAL6FEE° $266.50
Revised: 07/01/2012
CITY OF CUPERTINO.
FEE ESTIMATOR—BUILDING DIVISION .
ADDRESS,22080 san fernando ct. DATE:, 04/05%2011 REVIEWED BY- bob s.
APN:. BP# D 3 `VALUATION: $600,000
"rPERMITTYPE: Building Permit PLAN CHECK-TYPE: New:Construction
PRIMARY 2nd•Unit? Yes NoPENTAIVIATION.
USE. SFD or'Duplex iP.ERMIT TYPE: 1 R3SFDW
WORK construct new.2 story sfd. °
S,COPE
TYPE OF FLR AREA
OCCUPANCY TYPE: C`EEE$: PC FEE ID BP FEES BP FEE.ID
CONSTR. s.f:
R=3(Custom) `11-8;,111-B;IV;V=B: 4,997 $2;966:40, IR3PLNCK $3,.6.2.7.30 1,RHATSP
TOTALS: 4,,997 $2;966.40(r $3 627 30 �s
a� ,. .
33 ag ^g «'d 1 € 3 33
3 �
Bit
;
i Cel. "7`.;t
Ll Ll
._. -Ott.-'r�:--C,r-; ✓>,E,r rlj,_ -_. --�..IY, 1.r?: .
NOTE:These..ees arebased;:on the.' reliinin'kry,in�,orma{ion.availableand'are,.onl ,an estimate. Con"taet'7heDebt-o_r addn'1``in o:,
FEE ITEMS, FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,965.40 Select a 1Vlisc Bldg/Structure
Supp]:PC:V ' : E) Reg. :OT 0:0 hrs $0.00 or:'Element of a:Building
Piv tAldn.Check: $0.00
Permit Fee: '$3,627'.X.
SuppL.Ins,p. Fee-E),Reg. 01:0T 0.0 firs $0.00
RME Unit Fee- $0.00
PME Perinit Fee-
C'onstr-. Tax: rac0NSr9 YR 1' # $558.80
units
Acoustical,Fee:f 01,6s ,(F)"No $0.00 0
Work`WithouYPertnit?' b Y`e's G No
01anni'tig,Fee' PaoNGRNGR' $649.61;. . `Selec"t a,Non=Residential. G
Building or Structure 0
Str6iig Motion Fee: LBSEISAKCR $60.00' Select'an Administrative Item
€, Co'ni—missio .Fee: IBCBSC -
1314 7 Suis: _n $24,00
SU.,.TOTALS $7,'885 11 $0 00TO NAL FEI ,; $�7 885,11
1
, �.a
Revised: OliW2011
GENERAL PERMIT APPLICATION M E NP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION' I
1.0300 TORRE:AV�NUE •CUPERTINO, CA 95019-3255
MAN ' (408) 777-3228- FAX(4'08)r77-3333• buildincguoerino.ora - Is
CUPERTWO
El PLUMBING ❑MEC-L LAICAL [ELECTRICAL ❑MISCELLANEOUS
PRO=ADDRESS I 4.P*(R
Z< d ��� ciN 0 @tF
OWNER NAME PHONE E-MAIL
S7 BET ADDRESS CITY,STAT"ZP FAX
CON'rACT NAME PHONE MAIL
STREc7 ADDRESS CII Y,STATE ZIP, FAX
❑ OWNER ❑ OWNER'-BUILDER ❑ OWNER ACENT' ❑ CON7RACTOR ❑CONTRACTOR AGc7JT 0 ARC:T'CT ❑ENGINEER ❑ DE MOPER ❑ T--NANT-
CO mCTOR NAME ` LICENSE NUMBER 1' LICENSEE TYPE BUS.L;C
COMPANY NAME E-MAIL FAX
3717,=ADDRESSC1 1 U CI7Y,STA7•E ZIP �QNSOI ` PAONC�
ARCH=-CT/ENGINE.Z NA.MB LICENSFNJMBER { BUS:LIC'# 1
COMPANY NAME' E-MAIL FAX
STRELI ADDRESS CI77f,STA7E ZIP PHONE
USE OF SID or DUPLEX ❑ MULTI=FAMILY PROSECT IN WILDLAND ❑ M PROJECT IN ❑ Y'ES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL .URBAN INTuZFALzAREA ❑ NO FLOOD ZONE ❑NO IIC7.:DLHOMt'-? ❑NO
DESC=ON OF WORK
TOTAL,VALUATION: i 1 p � RECEIVED BY:,
By my signat:re below,1 certify to each of the followin g: I:am,the orene-^,y owner or authorzed.agent to act on the prone:'y ewners behalf. I have read this
application and the informationI have provided is correct. I Ave read the Descnption:of Work and veriryJt is accurate. I agree to comply Arith all applicable local
ordinances.and.state laws`relating;to-building cans c' n tho ize,representatives,;of-Cupercnc:e zzizT the abovt�iden 65e,3'prope.:,:cr';ihspection pu;t)eses.
Signature ofADDlicanUAgeat Dater
SUPPLEMENTAL INFORNLA170N REQUIRED OFFICE.USVONLY
❑ O'Z R-THE-COUNTER
F ❑ EXPRESS
•J
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
M-7PMseApp_%01'1.doe revised 06/21111