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11080119CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10218 ORANGE AVE OWNER'S NAME: XCHANGE SOLUTIONS INC OWNER'S PHONE: 4082344835 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Addition 113 the applicant understands and will comply with all non-poin urce regula, s per the Cupertino Municipal Code, Section 9.18. t !� Signature Date_ CONTRACTOR: XCHANGE SOLUTIONS PERMIT NO: 11080119 INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 SAN JOSE, CA 95125 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT F PLUMB MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 SQFT. Sq. Ft Floor Area: Valuation: $600000 APN Number: 35718031.10218 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b" . Date:R'' 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Healt"fety C de, Sections 25505, 25533, and 25534. Owne� � the z c]lage t:�' "� Date: 16 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Nvork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMITT BUILDING ADDRESS: 10218 ORANGE AVE OWNER'S NAME: XCHANGE SOLUTIONS INC OWNER'S PHONE: 4082344835 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that I am licensed corder 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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this. erri I. Add'tionally, the applicant understands and will comply with all non-pdiin rce re� dations per the Cupertino Municipal Code, Section 9.18. 9 2 Signature Date j CONTRACTOR: XCHANGE SOLUTIONS PERMIT NO: 11080119 INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 SAN JOSE, CA 95125 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r- RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 SQFT 7/16/12 - REV #3 - REVISE GARAGE FLOOR SLAB WITH STRUCTURAL CALCS- 8/28/2012 REV#3 ISS'D Sq. Ft Floor Area: I Valuation: $600000 APN Number: 35718031.10218 ( Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by.--*--,--` Dater`- 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, SecOons 25505, 25533, and 25534. r Own e o"-ythorized agpn ; Date: iii {ry CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of twrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10218 ORANGE AVE CONT'RACT'OR: XCHANGE P RN41T NO, 01 19 _ SOLUTIONS INC OMINER'S NAME: XCHANGE SOLUTIONS INC 3031 TISH WAY SUITE 9`' � _ ._ _ SUED: 10/12/2011 OWNER'S PHONE: 4082344835 SAN JOSE, CA 95125 MR PHONE NO: ❑ LICENSED CON'TRACTOR'S DECLARATION F F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # ' ..- 1--- I-- Contractor Date \TECH RESIDENTIAL CONINIERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. PORCH 3,964 SQFT &ATTACHED GARAGE 424 SQFT. TOTAL 4,388 SQFT I hereby affirm under penalty of perjury one of the following hvo declarations: 10/31/2011 -#1 -DEFERRED ROOF & FLOOR'rRUSS CALCS- ISSD 1/6/2012 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: $600000 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 permit is issued. APN Number: 35718031.10218 Occupancy Type: 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 tocomply with all city and county ordinances and state laws relating to building constrtr uction, 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 ✓ J� Issuectbyc Date: / � C with all non -point source regulations per the Cupertino Municipal Code, Section �_ 9.18. Signature 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 inspection. 'r OWNER -BUILDER DECLARA'I TON I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 NIATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Nlunicipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(x) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Nlanagement District 1 performance of the work for which this permit is issued, will maintain compliance with the Cupertinp Municipal Code, Chapter 9.12 alid I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sccti4ps125505 j�§533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this (((1 ( t� permit is issued. Owner or authorized agent: Date ' 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 ame Lender's Address APPLICANT CERTIFICATION 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.liarnile4the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expe scs i vhich rn }y accrue against said City in consequence of the granting of this p4inl't. Additionally, the applicant understands I understand my plans shall be used as public records. rid will comply with all non -poi: source regulaiions_perthe Cupertino Municippl Cede, Section Licensed Professional 9.18. �,Id Lo % Signature Date lr"? L CITY OF CUPERTI BUILDING ADDRESS: 10218 ORANGE AVE OWNER'S NAME: XCHANGE SOLUTIONS INC OWNER'S PHONE: 4082344835 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.#1 Contractor Date 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. 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 permit is issued. APPLICANT CERTIFICATION 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 indemnity 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the folloving three 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 permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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, costs, and expenses which may accrue against said City in consequence of the granting of this pe as n. dditionally, the applicant understands and will comply with all non -poi t sou ��tgulations per Cupertino Municip4l Cde, Section 9.18. i Date NO BUILDING PERMIT CONTRACTOR: XCIIANGE SOLUTIONS PERMIT NO: 110801 19 INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/201 SAN JOSE, CA 95125 PHONE NO: BUILDING PERMIT INFO: BLDG ELECT PLUMB i MECH ( RESIDENTIAL I COMMERCIAL i JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENTAND PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT, TOTAL 4,388 SQFT 2/6/2012- REV# I - MINOR REVISION TO FLOOR PLAN -ISSUED 3/5/12 10/31/20114 1 -DEFERRED ROOF & FLOORTRUSS CALCS- ISSD 1/6/2012 Sq. Ft Floor Area: Valuation: $600000 APN Number: 35718031.10218 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: 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, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6,95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I Will maintain compliance with the Cupertino Nfunicipal Code, Chapter 9.12 and the health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices Which emit hazardous air contamin: nts as de ned by the Bay Area Air Quality \Management District I will maintain ..plianc With the Cupertino Municipal Code, Chapter 9.12 and the Heald �iSifety Co, Sections 25505, 25533, and _534 OW cEr u�rzed ent: / Date: t� CONSTRUC'[ ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for Which this permit is issued (Sec. 3097, Civ C.) Lender's Name_ Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMI BUILDING ADDRESS: 10218 ORANGE AVE CONTRACTOR: XCHANGEPERNHT NO: 1 10801 19 SOLUTIONS INC OWNER'S NAME: XCHANGE SOLUTIONS INC 3031 TISH WAY SUITE 901 DATE ISSUED: 10/12/2011 ONNNNER'S PHONE: 4082344835 SAN JOSE, CA 95125 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F j � BUILDII\NG PERINIIT INFO: BLDG ELECT PLUNIt3 License Class Lic. # I_... I-` \IECH RESIDENTIAL CONENIERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: NEW 2 STORY SFDWL,INCLUDES BASEMENT AND (commencing with Section 7000) of Division 3 of the Business & Professions PORCH 3,964 SQFT & ATTACHED GARAGE 424 SQFT. TOTAL 4,388 Code and that my license is in full force and effect. SQFT 1 hereby affirm under penalty of perjury one of the following two declarations: REVISION #2- REVISE THE FLOOR FRAMING IN LIVING AREA- ISSD 6/8/12 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 the Sq. Ft Floor Area: Valuation: $600000 performance of the work for which this permit is issued. 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 permit is issued. APN Number: 3718031.10218 Occupancy'Type: 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 + 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 (� Z 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. Signature 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 inspection. OWNER-BUILDER DECLARATION l,hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BET"I'ER will do the work, and the structure is not intended or offered for sale (See,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). 1 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(x) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I usG'equipi cut or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Day Ar ' Air Quality Management Dit•ict I performance of the work for which this permit is issued. will maintain compliance i�/�ith'hhe C,(upe; tiro �'Iunicipal Code, Chapter 9.12 nn l 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, jSecha5�5 5533 alyd 3"5534, Section 3700 of the Labor Code, for the performance of the work for which this-� ( k �� permit is issued. Owner or authorized ;gent a` Date: , 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 decried revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address_ APPLICANT CERTIFICATION 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 apd her by authorize representatives of this city to enter upon the above nnentioncd�propy for inspection purposes. (We) agree to save indemnify and ke�pnarnlss IfieCity ofCupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenes whi; 1 mpy a�#n;e against said City in consequence of the I understand my plans shall be used as public records, granting of this permit nljy, the applicant-understands and will(comply t�hitlon with all non-point source regtd ions pQr.tbe Cupertino Municipajj Codd, Section Licensed Professional ,. Ir Signature Date CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ej, 7/1/11 ADDRESS: 102228 orange ave. DATE: 07/16/2012 REVIEWED BY: bobs. r "ch. PurNril Fee: APN: BP#: 11080119 *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Elec, Insp, Fire: PENTAMATION PERMIT TYPE: 1GENRE WORK revise garage floor slab with structural calcs. SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ej, 7/1/11 Alcch, Phm Chlck Plumb, Plum Check, E/ec. Phin Check r "ch. PurNril Fee: 1'11wlh, Pemlil F(e: 'kw. Nvmil Fec: oilier ;tlech. hisp, Other T'hairh Insp,Ll olht r Elec. hnp. Lj /tach. lisp, Pec: F/rrmh, Tay/). Feer: Elec, Insp, Fire: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ej, 7/1/11 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? (F) Yes Q No $0.00 hours Plan Check, Hourly $266.00 1STPLNCK i Suppl. PC Fee: Q Reg. Q OT 10.01 hr's $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:G Reg. Q OT 0,0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Colul1Y1clio}7 'Pox: ,4 (1111111l.i t ro 11 n, 0 G) Work Without Permit? © Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-ResidentialG Building or Structure 0 Trovel Doe ritll nloTior! Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.00 TOTAL FEE: 1 $266.00 Revised: 07/01/2012 CITY OF CUPERTINO / FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 10218 Orange Ave DATE: 07/10/2012 REVIEWED BY: Sean Fermi( Fee: APN: BP#: 11080119 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARYPENTAMATION USE: SFD or Duplex Phnub, has). Fee: PERMIT TYPE: 1GENRE WORK Revision #2: Revise the floor framing in living area (Structural). SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School District. eta). These fees are based on the vrelintinary information available and are only an estintata Contact the Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf. LLLIJ Mcch. Plan Check Plr1nrb. Noll Checl` Elec, Platz Check Fermi( Fee: Pl'1,1,1. Pennit Fce: Dec. Permit Fee: Other ;llech. /nsp. Other Phrmb hasp.ET-t- Other Dec. Insp, Li 1 k( h. /asp. Fere: Phnub, has). Fee: Elec. Insp. Fc c. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School District. eta). These fees are based on the vrelintinary information available and are only an estintata Contact the Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf. LLLIJ FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 hours Plan Check, Hourly $133.00 ISTPLNCx A Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OTJ 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C`olrslrrtction TON.' F-1 A(,hniii4%tr tltt'e Tec: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 0 i Tr(wcl Doc:,timentolion Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $133.00 TOTAL FEE: 1 $133.00 Revised: 07/01/2012 CITY OF CUPERTINO Fm --7 FEE ESTIMATOR - BUILDING DIVISION 10228 orange ave. ?c: r.tCiti 1,r1�C}}; DATE: 10/31/2011 REVIEWED BY: bobs. jimlADDRESS: APN: BP#: "VALUATION: $500 Y�PERMIT TYPE: Building Permit {f PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Phi"oh. bj ..: ' FCC,, , PENTAMATION 1GENRES PERMIT TYPE: WORK roof and floor truss calcs. SCOPE [deferred NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vrelininary information available and are only an estimate. Contact the Dent for addrn'1 into. FEE ITEMS (Fee Resohrtion 11-053 E . 7/1/11, ?c: r.tCiti 1,r1�C}}; ft�d'tt?;, ff Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 {f {.f%iftf:i'p(.1�1'f:. Suppl. PC Fee: Q Reg. Q OT Phi"oh. bj ..: ' FCC,, , f ieu.. fF7 v' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vrelininary information available and are only an estimate. Contact the Dent for addrn'1 into. FEE ITEMS (Fee Resohrtion 11-053 E . 7/1/11, FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 ® hours Plan Check, Hourly $520.00 ISTPLNCx Suppl. PC Fee: Q Reg. Q OT 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.(j) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G) 0 i "t :"cr'5,v1:-�;;°rig-r �;;=i:;rf.='f3iz 1-'��,�:>: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $520.00 TOTAL FEE 1 $521.50 Revised: 1,0/01/2011