11070001 CITY OF CUPERTINO BUILDING PERMIT
BLILDING ADDRESS: 21888 GARDENVII-W LN CONTRACTOR:CW BUILDERS PERMIT NO: 11070001
OWN'ER'S NAME:
SARATOGA,CA 95070 PHONE NO:(408)378-4323
IJCENSLD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F- ELECT r- PLUMB I—
License Classl_ic. _ Z C ( -
n r
MECH RESIDENTIAL COMMERCIAL
C'untractor
Date_ a
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD MASTER SUITE(1982SQFT),GAME
(commencing with Section 7000)of Division 3 of the Business&Professions &RF-ROROOM,SOF 19825 ENLARGE.FAMILY ROOM,ENTRY PORCH
('ode and that my license is in full force and effect. &RE-ROOF 1982SQFT
hereby affirm tinder penalty of perjury one of the following two declarations:
1 have and will maintain it ccrulicatc of consent to self-insure for Worker's
ompcnsauon.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:$130000
permit is issued.
APPLICANT CERTIFICATION APN Number:32619093.21888 Occupancy Type:
I certiti 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 huildine 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
indcmnit� 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
F ONN'NER-BUILDER DECLARATION
RE-ROOFS:
I 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
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
L 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,
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 one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compcnsation.as provided for by Section 3700 of the Labor Code,for the 1 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 for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Srction 3700 of the I-abor Code, for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
perms is issued contaminants as defined by the Bay Area Air Quality Management District 1 will
I certUfv 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
fortlnh�itcomply with such provisions or this permit shall be deemed revoked. Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
1 ccitilN that I 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 vvork'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 of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnifv and 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
ng -
of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
1 nor point sn"rce regulatitvis per the Cupertino Municipal Code,.SectlOn
I understand my plans shall be used as public records.
SIS_nature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21888 GARDENVIEW LN
CONTRACTOR: CW BUILDERS
PERMIT NO: 11070001
OWNER'S NAME:
SARATOGA, CA 95070
PHONE NO: (408)378-4323
L( LICENSED CONTRACTOR'S DECLARATION
F r r
License Class Lic. # gZp 3 f
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r �
MECH F RESIDENTIAL COMMERCIAL
Contractor � A �� I ae�-� Date � (
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD MASTER SUITE(1982SQFT),GAME
(commencing with Section 7000) of Division 3 of the Business &Professions
ROOM,STORAGE,ENLARGE FAMILY ROOM,ENTRY PORCH
Code and that my license is in full force and effect
&RE ROOF 1982SQFT
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
Sq. Ft Floor Area:
Valuation: $130000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32619093.21888
Occupancy Type:
APPLICANT CERTIFICATION
l 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 er the Cupertino Municipal Code, Section
9.18.
Signature Date
GG
Issued by: — Date: /� dfi
-
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
Al I roofs shall be inspected prior to any roofing material berg installed. If a 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 the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, 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 one of the following three
declarations:
l 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 & Safety Code, Sections 25505, 25533, and 25534. I will maintain
1 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 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 Management 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 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
Own �
= Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I 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 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 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
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
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
Fm-7,
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21888 gardenview In.
DATE: 09/21/2011
REVIEWED BY: bobs.
APN: /g &'� y3
I BP#: ��00 /
"VALUATION:
$300
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
revise garne room opening.
SCOPE
P.1 "Ifs+i S:C2� �!. 1iFS(1.
(J7f�r'r j'ii i�„ �;
f,�9i.� � .•`... T�7�t.Li
hm;p FC'C.'.'
fl'Z�tjgl. h,qy F�„�;
ii1Mr
NOTE. This estimate does not include fees due to other Depts (Le- Public Works, Sanitary Sewer District, School District, etc.).
These lees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resohition 11-053 Eff 7/1/1.1)
FEE
QTY/FEE
7 MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (F) No
$0.00
0 hours
$130.00
Plan Check, Hourly
1STPGNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�,flt iY'�li11i:dt7 1 r;.t
?e 3tiYi1a 1'c Ltl'!' V ee
0
0
Work Without Permit? Q Yes Q No
$0.00
Advanced Planning? Fee.
$0.00
Select a Non -Residential E)
Building or Structure 0
i
T,avv� /'?roc r� ::, r -
Strong Motion Fee: IBSEISMCR
$0.50
0.5 hrs
$41.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:
$1.501
$171.001
TOTAL FEE:
$172.50
Revised: 0910212011
FM_7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 21888 gardenview In.
DATE: 07/01/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$130,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du 12X
USE: P
2nd Unit? , Yes No
OTC? 0 Yes ONo
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK I
sfd add master suitegame room storage, family,entry porch,re-roof.
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,III-B,MV-B
1,176
$2,385.52
1R3PLNCK
$1,604.84
1R3INSP
TOTALS:
1,176
$2,385.52
$1,604.84
MECH, HOURLY 0 Yes (F) No
PLUMB, HOURLY Q Yes (F) No
ELEC, HOURLY Q Yes Q No
. i'.``ffTi' 9?[•: 72. I1Y.Si3,
i:3�iif.'• ��. "it�=: ,': '.i�J.EIF
..Lj L__
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dew for addn7 info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTVIFEE
MISC ITEMS
Plan Check Fee:
$2,385.52
1,982 s.f.
$2 0
Re -roof
EROOFRES
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0,
Permit Fee:
$1,604.84
Suppl. Insp. Fee-0 Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
11,on_�IrllclioF7 Tat
F71
Acoustical Fee:
0 Yes (F) No
$0.00
Q
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$152.88
Select a Non -Residential
Building or Structure
O
0
A
s�1l1c,r:F,rrcf:r:rrr�+t1`-",.
Strong Motion Fee:
IBSEISMICR
$13.00
Select an Administrative Item
Bldg; Stds Commission Fee: 1BCBSC
$6.00
SUBTOTALS:
$4,162.24
$260.00
TOTAL
FEE: $4,422
Revised:072"
11 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21888 GARDENVIEW LN
CONTRACTOR: CW BUILDERS
PERMIT NO: 11070001
OWNER'S NAME:
SARATOGA, CA 95070
PHONE NO: (408)378-4323
LICENSED CONTRACTOR'S DECLARATION
r r
PLUMB
License Class Lic. N 3
BUILDING PERMIT INFO: BLDG ELECT
r r r
MECH RESIDENTIAL COMMERCIAL
Contractor L , R(/Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD MASTER SUITE(1982SQFT),GAME
(commencing with Section 7000) of Division 3 of the Business & Professions
ENLARGE FAMILY ROOM,ENTRY PORCH
Code and that my license is in full force and effect.
&RE -ROOF 1982SQFT
&RE-ROROOM,SOF 1982S
1 hereby affirm under penalty of perjury one of the following two declarations:
9/21/11 REVISION N 1 RELOCATE & ENLARGE GAME ROOM OPENING.
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
Sq. Ft Floor Area:
Valuation: $130000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32619093.21888
Occupancy Type:
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
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 ce ions per the Cupertino Municipal Code, Section
9.18.
Signature Date Z(
Issued by: Date�2J L1
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I 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. If a roof is
the 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 Applicant: Date:
1, 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
1 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
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 & 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 Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should 1 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 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 ofexemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner a agen 2 r
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that i 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 work's
correct. 1 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 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
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
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional