Loading...
11110014CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10786 BROOKWELL DR CONTRACTOR: PETER PERMIT NO: 1. 1 1 10014 CONSTRUCTION OWNER'S NAME: SAN JOSE, CA 95129 PHONE NO: (408) 529-6412 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. H r r r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFDWL ADDITION OF ENTRY,LIVING ROOM,BEDROOM,BATH(646SQFT)&ADD I WINDOW & (commencing with Section 7000) of Division 3 of the Business & Professions RE-ROOF(20SQFT)&RE-LOCATE DRIVEWAY 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 Sq. Ft Floor Area: Valuation: $90000 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: 36921035.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 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 Issued Date: granting of this permit. Additionally, the applicant understands and will comply b. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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. / �/ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect' ns 25505. 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: V L_1n3._�N 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 Califomia. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must 1 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 Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FM_7FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10786 brookwell dr. DATE: 11/03/2011 REVIEWED BY: bobs. APN: BP#: '"VALUATION: 1$90,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? Yes • No OTC? 0 Yes DNo PENTAMATION 1R3SFDADD PERMIT TYPE: WORK sfd add entry, living room bedroom bath add 1 window, 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,IV,V-B 646 $2,420.00 IR3PLNCK $1,519.00 IRRNSP TOTALS: 646 $2,420.00 $1,519.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No ET_1__ El 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 Drelin=nary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (! ee Resolution 11-053 L; . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,420.00 1 I# Window / Sliding Glass Door $783.00 iwwN EwsTR New (Shearwall/Masonry) Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 2,000 s.f. Re -roof $280.00 IREROOFRES Permit Fee: $1,519.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,'GC/J7tiFilh`t!"tlttlie.' le'E,'" 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: PLLONGRNGR $83.98 Select a Non -Residential 0 Building or Structure 0 i °c;v�! LYo<rrrrrcrnTcFru�rr_ Ic�w Strong Motion Fee: IBSEISMICR $9.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $4,035.98 $1,063.00 TOTAL FEE: 1 $5,098.98 Revised: 10/01 /2011