12020125CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 22100 RAE LN
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. N
Contractor Date
I hereby affirm that 1 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:
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).
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
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.
NL�F
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
CONTRACTOR: PHILIP LO & MELISSA PERMIT NO: 12020125
HUANG
22100 RAE LN DATE ISSUED: 03/29/2012
CUPERTINO, CA 95014 PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r— RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADDITION/REMODEL-ADD 455
SFT(STUDY,BATH,LAUNDRY)&.
545 SQFT(GARAGE) AND REMODEL 2527 ENTIRE HOUSE
(KITCHEN 200 SQFT,OTHER 500 SQFT, BATHROOM 100SQ
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 35607058.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
3_2c?-1z.
Issued bv: 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.
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should 1 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, Sections 25505, 25533, and 25534.
ent: q
Date: Z
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
FM_17.
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
r
ADDRESS: 22100 ReazLane
DATE: 0212812012
REVIEWED BY: RDW
APN: ��& b 0
BP#: aQaO 1
"VALUATION: 1$150,000
-PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE
2nd Unit? Yes : No
OTC. 0 Yes �No 4
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
Remodel 2527 s /ft plus addition of 455 s /ft of living space and
s /ft of rage. Panel upgrade
SCOPE
for 2 meters, reroof existing 25 sq.
l7
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,IV,V-B
1,000
$2,420.00
1R3PLNCK
$1,519.00
1R31NSP
TOTALS:
1,000
$2,420.00
$1,519.00
MECH, HOURLY ® Yes (D No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY Q Yes ONO
Mech. Plan Check 0.0 hrs $0.00
Elec. Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
_
Elec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs $44.00
Other Elea Insp. 0.0 hrs $44.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These Pees are based on the prelimnary information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (1,ee Resolution 11-053I f. 7111/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,420.00
F2,527 s.f.
$5,419.00
Remodel, Other
1REMREs3
Suppl. PC Fee: (D Reg. (:) OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2,500 s.f.
$350.00
Re -roof
IREROOFRES
Permit Fee:
$1,519.00
Suppl. Insp. Fee-0 Reg. Q
OT
0.0 1
hrs
$0.00
F-200-1 amps Electrical
$44.00 IERT<200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
0 #
$130.00
Mechanical
IMFR=<100 Furnace, Forced -Air
_T7
0
G
Work Without Permit? C) Yes (D No
$0.00
Advanced Plannine Tee:
PLLONGRNGR
$130.00
Select a Non -Residential
Building or Structure
G
0
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Tee:
IBSEISMICR
$15.00
Select an Administrative Item
Bldg S�Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$4,222.00
$5,943.00J
TOTAL FEE:
1 $10,165.00
Revised: 1/1 220112 �¢�k
j