11050169CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10425 BREWER AVE
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
Po
License Class Lie. # 6
Contractor ce)7'!iY-yu,[u l to i
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 flee 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 expen5rce
accrue against said City in consequence of the
granting of this d i onally, the applicant understands and will comply
with all non- Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER WILDER 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)
I, 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, 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.
CONTRACTOR: LNB CONSTRUCTION, INC PERMIT NO: 11050169
1 CORTE ANA DATE ISSUED: 09/01/2011
MILLBRAE, CA 94030 PHONE NO: (415)585-3884
BUILDING PERMIT INFO: BLDG 'r ELECT PLUMB
MECH J RESIDENTIAL F COMMERCIAL
JOB DESCRIPTION: SFD ADDITION, 1,069 ADDITION, FRONT OFFICE, ENTRY,
LIVING ROOM, MASTER SUITE, KITCHEN (REMODEL 250
SF), DINING, REMODEL BATH (100 SF), DECK, AND
Sq. Ft Floor Area: I Valuation: $70000
APN Number: 32641064.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bye- — 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
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(a) should I store or handle hazardous material.
Additionally, should fina equipment or devices which emit hazardous air
contaminants as dee by the Bay Area Air Quality Management District I will
maintailf1compliance wi h the Cupertino Municipal Code, Chapter 9.12 and the
Health S ety Code, ections 25505, 25533, and 21534.
Owner o
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed
FWR
N
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19ADDRESS:
10425 brewer ave.
DATE: 05/20/2011
REVIEWED BY: bobs.
N
APN: 32ka q
104
1 BP#:
*VALUATION: 1$70,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
or Du IeX
USE: p
2nd Unit? Yes � No
0SFD
OTC? 0 Yes (j)No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
sfd add= front addition office entry, living, master suite kitchen and dining, remodel bath deck and
SCOPE
porch.
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
1,069
$2,367.26
IR3PLNCK
$1,539.42
IR3INSP
TOTALS:
1 1,069
1 $2,367.26
1
1 $1,539.42
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes 0 No
I ELEC, HOURLY 0 Yes 0 No
.ez 1:..`h'w {�;ftcr k
'1r,��rb. , ,._.. (13w:h
Elec. Plan Check FO.0 I hrs $0.00
r°(Y r._ . Pe»,u.. F""e:
Elec. Permit Fee: IEPERMIT
E1__L_
Other Elec. Insp. El hrs $42.00
NOTE. These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS Lee Resohition 09-051 E '. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,367.26
250 s.f. Remodel, Kitchen (<=300 sf)
$570.00 IREMRESKIT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
100 s.f. Remodel, Bath (<=300 sf)
$570.00 1REMRESBAT
Permit Fee:
$1,539.42
Suppl. Insp. Fee:O Reg. 0
OT
0.0
hrs
$0.00
F-6-5-7--1 s.£ Remodel, Other
$506.00 1REMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
= # Electrical
$0.00 IBREMRECEP Recep/Switch/Outlets
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$138.97
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: 1TRAVDOC
$42.00
Strong Motion Fee:
1BSEISM1CR
$7.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS;
$4,139.65
$1,646.00 TOTAL FEE:
1 $5,785.65
Revised: 04/29/2011