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12040059CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10920 KESTER DR I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 12040059 1 I OWNER'S NAME: DECLARATION License ClassEZ T Contractor E ©e,t irk Date ((` ( k 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. 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 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, t osts, and exp4�nsos which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with 41I non:poiuk Wurce regulations per the Cupertino Municipal Code, Section 9�I$. .. Date -- (I 4 ❑ 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). 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB 1, MECH F RESIDENTIAL 1— COMMERCIAL F JOB DESCRIPTION: NEW 4 X 4 WINDOWS AT REAR OF RESIDENCE. Sq. Ft Floor Area: I Valuation: $1600 APN Number: 35628018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: —mot 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 ofAppli Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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, Sections 25505, 25533, and 25534. er : `C 7, CONSTRUCTION LENDING AGENCY 1 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 I understand my plans shall be used as public records. Licensed Professional Signature Date I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10920 KESTER DR I CON R ACTOR: TBD - TO BE I PERMIT NO: 12040059 OWNER'S NAME: 1 1 1PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION I JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 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. Signature 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). 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, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. 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, 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. , NEW 4 X 4 WINDOWS AT REAR OF RESIDENCE. 5/1/2012- REVISION TO ADD 4 LIGHTS AND 3 OUTLETS ,ln rkazl l.' Ax�� Sq. Ft Floor Area: I Valuation: $1600 APN Number: 35628018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ^� r Issued by: Date: ^ l 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(s) 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, ections 25505, 25533, and 25534. Owner or auihorized agent. % Date: rj - I CONSTRUCTION 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 I understand my plans shall be used as public records. Licensed Professional Date ( — 1 7i CITY OF CUPERTINO F FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10920 Kester Drive DATE: 04/11/2012 REVIEWED BY: Sean APN: �o O U� BP#: "VALUATION: 1$1,600 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: 19 WORK New 4 x 4 window at rear of residence. SCOPE e T::�•` 4• ref >. - % = n ..i.• ,•s. s I: �:•, h. (�1;,; t 'r,: : m Pluoib. Plun Check 1'h•ct Mo.r Check )l ld��..... /1"i Foe: Plush. "(.z;w:ie Pre. F,1, Permit 1 ce. �H„^. .'!.Y<<•�(:'. il;+;%: (la;.ep.Li Other Fl(,(, lnsp- Li F'e(t. P eirrb. hop. Fce: Elec. lwp, l'cc. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminarv, information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# Window / Sliding Glass Door $457.00 IWINNEWNST New (Non -Structural) Suppl, PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (7onswuction Tax: 'Idi iini,straliveFec. 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 1"1•:i: �>I Doclonentulion Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ---' ......._<. ..,Zi•_ $1.50 ; �J° ::�^� ul;:l '?i. r ': fl 'G�1`•i isle Revised: 04/01 /2012 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 14-� /,204005 ' imADDRESS: 10920 Kester Dr DATE: 05/01/2012 REVIEWED BY: Sean l APN: BP#: Q *VALUATION: $1,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1REAP11 PERMIT TYPE: WORK Revision #1: Add 4 lights and 3 outlets in master bedroom. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 4 # $65 Recep/Switch/Outlets 1BREMRECEP 3 # $44 TOTALS: $109.00 ;•;•>,;;- -z?i Lv • i' f fn• 'ir+ :tiff .''i•!' i .�'.f•-� r• 5� C'.r��t �`,!'i.:::-:fi%`%i::: ?: _-;;;:":�c`.• '';y-%` rn :.:[ ;!,;:.+ t:'4-cc-!: Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT L3;i;r •';1,,. f);;,,,, , ,,,,,,,,V,; Other Elec. Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These ees are based on the prelflimina information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $109.00 PME Permit Fee: $44.00 ( u; s,' action Tax, Administrative Fee: IADMIN $41.00 Work Without Permit? Q Yes 0 No $0.00 tie", Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 0 $239.50 $0.00 •+rlM1::;,; 239.50 Revised: 04/01/2012