12060137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRF,SS: 11021 UU13I3 RD CONI RACTOR:JFRICI 1O ROAD 1'E 1(3111 \'0: 12060137
CONSI'RUC"TION
OWNER'S NAME:
SAN JOSE.CA 95123 n110NENO:(410N)S07-2429
❑ LICENSED CON'IRAC:TOR'S DECLARATIONf— r
BUILDING PERMIT INTO', DI,UG ELECTPLUMB1-icense Class .3 Lic.9 11394L
_ ,,//��QQ,�� ��rr �' alr:cn r Resu)r:N r1Al. r coaulr:RCL\I, r
ConlractorN s—Illue/-1/cI wl, 4,rv, Date a .0-0.9 2
I hereby affirm that 1 ant licensed under the provisions of Chapter 9 JOB DESCRIP I ION: REMODEL 3 IIA I'I IROOMIS(157 SO 1:1)JOARAT AND
(commencing with Section 7000)of Division 3 of the Business& Professions RI'I OCA I'I'NEW FIIRNAC'I'.N CRAWLSPAC-I(,INS ALL
Code and that in% license is in full force and effect. S I ACKA6I.I'.WW
AND DRYRR IN OLD FURNACE
1 hereby affirm under penalty of perjury'one of the fallowing nyo declarations:
I have and will maintain;I certificate of consent to sell'-insure for Worker's
Contperosation,as provided for by Section 3700 of Ilse Labor Code,for the
performance of Elie work for%%hick 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.Fl Floor Area: Valuation:510000
pools is issued.
APPLICANT CERTIFICATION APN Number:35618024.00 Occupamq.'I'ypc:
I certifN that I hate read this application and state that the above information is
correct I agree to comply with all cit'and county ordinances and state lasts 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
iodemnik.and keep harmless the City in Cupertino against liabilities.judgments.
costs,and expenses which stay accrue against said City in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting ol'tllis permil. Additiunallyt the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
S11111 Uatc G•ZZ•ZO/Z Issued by:
❑ OW NE1(-Br ll.ora(1)ECLARATI ON
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior m any rouling material beim, installed. 114 roof is
the following two reasons: installed wilhoul lint obtaining an inspection,I agree to remove all oe%% materials lir
1.as owner of Elle property,or my employees with wages as their sole compensation, inspection.
will do Elie work,and[lie structure is not intended or offered for sale(Sce.7044,
Business&Professions Code) Signature of Applicant: hate.
I,as owner of the properly,;,in exclusively contracting with licensed contractors to
consirud the project(See 7044.DnsllICSS&Professions Code).
ALL ROOF CO\'t;ItIN'GS'I'O ISI:CL:\SS":\"OR BE Ffrat
1 hereby affirm under penally of perjury one of the following three
declarations:
I hove:tad will maintain it Certificate ol'Consent to self-insure for Worker's IIA%ARDOUSNIA'IT RIALS DISCLOSURE
Compensation. is provided lir by Section 3700 of the Labor Code,for Elie 1 have read the hazardous materials requirements under Chapter 6.95 of[[I,-
performance
heperfrmance of the work lir which this permit is issued. California health&Safet'Code.Sections 25505,25533.and 25534. I%rill maintain
I have and%will maintain W'orker's Compensation Insurance as provided for by compliance xxith the Cupertino Municipal Code,Chapter 9.12 and the Ile:ddu&
Section 3700 ol'Ihe Labor Code,for the performance ofiltc work fur which this Safety Cade.Section 25532(x)should I%tare or Ila little hazardous material.
permit is issued Additionally,should 1 use equipment or devices%%hick emil hazardous air
contaminants:s defined by the Bay Area Air Qu:llty NIanaL'err'rlt District 1 will
I certify that in the perfnrmmnce of the work lir%'Inch this permit is issued.I shall otninain compliance 11ilh the Cupertino\I unicipxl Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Workers Ileallh&Safely Code,Sections 255115,25533.and 25534.
Compensation lags ol'Calilirnia. I(,alter making this certificate of exemption,I
become subject In the Workcr's Compensation provisions of the Labor Code.I must O"� •'r xis hor'':ed aecnt:
l imhwith c0inply with such provisions or this permit shall be deaned revoked ,/�` IAde:G •212 L
APPLICANT CERTIFICATION CONS"I'RCC"IION LENDING:\GF:S( I'
I certify that I have read this application and stile tot the above information is I hereby affirm than there is a construction Icnding ogenc% lir the perliunumcc ul'%rork's
correct. I agree lis comply with all cif)'and county ordinances and state hxvs relating for which this permit is issued(See 3097,Civ C.)
al 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
ndcmnify and keep harmless the City of Cupcnino against liabilities,judgments, Lender's Address
cuss,and expenses%'loch nnay accrue against said City in consequence ofllte
__ranting al this permit Additionally.Elie applicant understands and will comply
frith all non-point source regulations per the Cupertino Municipal Code.Section :\RCIII'fr:(:'I"S UF.CL:\I(:\LION
9.18, 1 understand nhy plans Shall he used as public recunls.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11021 BUBB RD CONTRACTOR: JERICHO ROAD PERMIT NO: 12060137
CONSTRUCTION
OWNER'S NAME:
JOB DESCRIPTION: RESIDENTIAL ❑ S
COMMERCIAL
License Class Lic. # `?J ��/Z REMODEL 3 BATHROOMS (157 SQ FT),REMOVE AND
RELOCATE NEW FURNACE IN CRAWLSPACE, INSTALL
Contractor Date' " s 4:7 STACKABLE WASHER AND DRYER IN OLD FURNACE
I hereby provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions REVISION #I- REMODEL KITCHEN 198 SQ FT
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. Sq. Ft Floor Area: Valuation: $50000
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 APN Number: 35618024.00 Occupancy Type:
permit is issued.
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,
Signature Date s-' `�3 f 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, 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(x) 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,
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 Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional
9.18,
Signature Date
NOTE: This estimate does not irrc(udejees due to other Departments ((.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dis►r(cl, etc.). These Pees are based on the pre((nr1►rary information available and are on(V an es!(nrale. Contact the Dep/for �i�
CITY OF CUPERTINO
QTY(FEE
MISC ITEMS
FEE ESTIMATOR - BUILDING DIVISION
sit
ADDRESS: 11021 Bubb Road
DATE: 06/22/2012
F.h,. 1'hrrr carr<:k
REVIEWED BY:
Sean
Lla
APN:
1'lrunh. Pavmir l�re:
BP#:
Other Mech. Insp.
'VALUATION:
$40,000
*PERMIT TYPE:
Building Permit
PLAN CHECK TYPE:
Alteration
/Repair
PRIMARY SFp or Duplex
a
1111aub. 1nsp. Fee,,I{!rr-,
PENTAMATION
1R3SFDREM
USE:
,aaaaaaaaaPME Unit Fee:
$0,00
PME Permit Fee:
PERMIT TYPE:
Ad
WORK
Remodel
three bathrooms 157 sq ft remove and relocated new
furnace in crawls ace install
SCOPE
stackable
washer and dryer in old furnace location.
Administrative Fee:
(ADMIN
NOTE: This estimate does not irrc(udejees due to other Departments ((.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dis►r(cl, etc.). These Pees are based on the pre((nr1►rary information available and are on(V an es!(nrale. Contact the Dep/for �i�
FEE
QTY(FEE
MISC ITEMS
Mech. Plan Check0.0
hrs
$0.00
aaaaaaa
I'lrunh. Thin Chcrrk
F.h,. 1'hrrr carr<:k
Mech.
Permit
Fee:
1MPERMIT
1'lrunh. Pavmir l�re:
l;L:r. !'(:r•rnlr F:.••
Other Mech. Insp.
LA
hrs
$44.00
!)/her 11111mb Insp.
01he010 lfl,rr. Insp. E3
Jlrr h. hl%p. Vol!
OT0
0
a
1111aub. 1nsp. Fee,,I{!rr-,
law- F4',?:
arida'! ln.
FEE ITEMS f{"er' Resuhrtion 11-05
1 L/L7/I/L1)
FEE
QTY(FEE
MISC ITEMS
Plan Check Fee:
$0.00
157 s. f.
$588.00
Remodel, Bath (<=300 so
1REAIRESBAT
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
71 #
$130.00
Mechanical
1XfFR=<100 Furnace, Forced -Air
Permit Fee:
$0.00
Suppl. Insp. FeelD Reg. Q
OT0
0
hrs
$0.00
1 #
$65.00
Mechanical
IBAPPLOT Other Appliance/Equip
,aaaaaaaaaPME Unit Fee:
$0,00
PME Permit Fee:
$44.00
In
rrrriun Ta.r:
Administrative Fee:
(ADMIN
$41.00
O
O
Work Without Permit? O Yes (j) No
$0.00
Advanced PlanninL hee:
$0.00
Select a Non -Residential
Building or Structure
G
Q
i
Travel Documentation Fee: ITRA VDOC
$44.00
Strom) Motion Fee:
1BSEISAIICR
$4.00
Select an Administrative (tern
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$135.00
$783.00
TOTAL FEE.
$918.00
Revised: 06/30/2012
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Q*DUnX41r9r
11021 Bubb Rd
Elec. Plan Check
DATE, 09/25/2012
REVIEWED BY:Sean
F,lec, Permit F`ee:
7ADDRESS:
BP#: 12060137
*VALUATION:
$10,000
TYPE: Building Permit
Elec. Insp, Fen:
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
$0.00
PME Plan Check:
PENTAMATION 1R3SFDRE
PERMIT TYPE:
WORK
Revision #1: Kitchen remodel
198 s ft).
SCOPE
Permit Fee: 4
$0.00
Suppl. Insp. Fee:Q Reg.
OT0,0
hrs
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Soper District, School
District, etc .These foes
loch, Playa Check
Plumb, Plcni Cheek
Elec. Plan Check
ilekch, Permil FCB:
PFlls)xh. Perinll lee:
F,lec, Permit F`ee:
Other lunch, hasp.
Other PFtu11b lnsp.Ll
Other Elee. Jay, Li
!Heck hasp. Pee:
Phnnh, hasp, Fee;
Elec. Insp, Fen:
are based on the relimina in ormation available and are onl an estimate Contact the De t or addn'1 in o.Nompow
Coo
FEE ITEMS (Fee Resolution 11-053 E{f.'
Revised: 07/01/2012
7/1/11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
198 s.£
$600.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
i
Suppl. PC Fee: (j) Reg. OT
0.0
hes
$0.00
PME Plan Check:
$0.00
Permit Fee: 4
$0.00
Suppl. Insp. Fee:Q Reg.
OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruclion Tm-:
116h14hiisiloaliveFec,
E)
Work Without Permit? Yes 0 No
$0.00
Advanced Planning Fce:
$0.00
Select a Non -Residential
Building or Structure
E)
Tr<n�el Doc°rnnef�tativrl Fees:
Strong Motion Fee:
IBSEISMICR
$1.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.00
$600.00
TOTAL FEE:
$602.00