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10090200CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22620 RICARDO RD CONTRACTOR: DAVID & LOUISE SCHIE PERMIT NO: 10090200 OWNER'S NAME: DAVID & LOUISE SCHIE 22620 RICARDO RD DATE ISSUED: 01/28/2011 OWNER'S PHONE: 4085646833 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRWTION: (813SQ)ADD MASTER BEDROOM,MASTER (commencing with Section 7000) of Division 3 of the Business & Professions BATHROOM,WALK-IN CLOSET,EXERCISE ROOM; REMODEL(1050SQ)3 BEDROOMS, Code and that my license is in full force and effect. LAUNDRY ROOM, 2 BATHROOMS;INCLUDES RE -ROOF & HAS 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 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $225000 permit is issued. APPLICANT CERTIFICATION APN Number: 35601055.00 Occupancy Type: 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 relatin 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 liabilitie 'udgments, P IT EXPI IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequen the granting of this permit. Additionally, the applicant understands and wi ly WI 180 S OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, 180 D F M LAST CALLED INSPECTION. 9.18. Signature Date hu ed byl Date:�i�� Er/ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contract icense La ne of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with a their sole compensa installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended o fle for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with sed tors to gnature of Applicant: Date: construct the project (Sec.7044, Business &Professions Code). 7c I hereby affirm under penalty of perjury on the following th ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consen self -insure for Worke HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 o Labor Code, for the performance of the work for which this permit is iss I have read the hazardous materials requirements under Chapter 6.95 of the h 1 have and will maintain Worker's Compensation tnsu as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of ork for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the perfo of the work for which this pe ' is issued, I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any r so as to become subject to Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. aking this certificate emption, 1 Health & a Code, See ' us 25505, 25533, and 25534. become subject to the Worker's Compensa ions of the Lab ode, I ust forthwith comply with such provisions or this perm deemed r ed. Owner uthor•ze age ' Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this it. Additionally, the applicant understands and will comply with all non -pot t urce regula s r the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature O Date i Licensed Professional FM-7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: DATE: REVIEWED BY: PC FEE ID APN: BP#: `VALUATION: $225,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: OVER THE COUNTER. © Yes Q No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Oa. imp. t,r'e: 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 813 $2,349.00 IR3PLNCK $1,474.00 IR3INSP Oa. imp. t,r'e: PME Plan Check: $0.00 = s.f. $569.00 Remodel, Other 1 IREMRESOTH Permit Fee: $1,474.00 Suppl. Insp. Fee'O Reg. 0 OT 0.0 hrs $0.00 $126.00 Mechanical IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 813 $2,349.00 $1,474.00 MEC..'H, HOURLY 0 Yes (E) bio PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY D Ye.s E] No Mech. Plan Check 0.0 hrs $0.00 Phmih. Plan Chen, E/ec. PInn Chock Meeh. Permit Fee: 1MPERMIT Plrrmh. Permit Fco. Elec. Perrrrit l " Other Mech. Insp. 0.0 hrs $42.00 Ot;ic". Phow, Li OtherElee. Insp, ET Akch. Insp. Fee: plianh. lj cy. Fee. Oa. imp. t,r'e: NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7111110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 126 s.f. $570.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 = s.f. $569.00 Remodel, Other 1 IREMRESOTH Permit Fee: $1,474.00 Suppl. Insp. Fee'O Reg. 0 OT 0.0 hrs $0.00 $126.00 Mechanical IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $42.00 2,287 s.f. $299.00 Re -roof IREROOFRES Consiruction .Ta __F_T Acoustical Fee: ® Yes E) No $0.00 0 Work Without Permit? Q Yes 0 No $0.00 Planniniz Fee: PLLONGRNGR $105.69 Select a Non -Residential Building or Structure E) Travel Documentation Fee: 1TRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $22.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSCI $9.00 IT SUBTOTALS: 1 $4,044.19 $1,564.00 TOTAL FEE: 1 $5,608.19 Revised: 9/14/2010