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10120008CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10385 NORW ICH AVE CONTRACTOR HOMG-JLE HO PERMIT NO: 10120008 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 150 SQFT ON EXISITNG MASTER BEDROOM & 33 (commencing with Section 7000) of Division 3 of the Business & Professions SQFT ON ENTRANCE;NO RE -ROOF & HAS STRUCTURALNO Code and that my license is in full force and effect. PRE -PLANNING APPROVAL 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 Sq. Ft Floor Area: Valuation: $14000 permit is issued. APPLICANT CERTIFICATION APN Number: 31629079.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued b OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business &Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. 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. Owner or authorized agent: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. Signature Date[Z�i v I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO Fm_� FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10385 norwich ave. DATE: 12/02/2010 REVIEWED BY: bobs. IME APN: BP#: 'VALUATION: 1$14,000 I *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: OVER THE COUNTER. Q Yes Q No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK master bedporch. [sKadd 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 183 $965.00 IADDPLCK $934.00 IADDINSP TOTALS: 183 $965.00 $934.00 MECH, HOURLY Q Yes (D No PLUMB, 111OURLY Q Yes Q No ELEC, 1fIOTTRLY Q Yes Q No Llrch. Plan Check I"iw:b. I'Itrar C,hcvl, � Eh,-:_ Plan Che:c;ri hfeelr. Perlrw Fee, Md nzh. Pcrnail . -r tiizr. Ped-nuf /'ct Of/lei, 'b/ucA. Imp Oho, Pltrmh Inuy;. Li O/he;' Ahvh. Illy. Pc:c. Numbhi.,p, bv'.. I'lo. /;�vp. /4.r. NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff. 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $965.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: G Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $934.00 Suppl. Insp. Feed Reg. Q OT 0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax Acoustical Fee: © Yes Q No $0.00 Q 0 Work Without Permit? Q Yes 0 No $0.00 Planning Fee: PLLONGRNGR $23.79 Select a Non -Residential Q Building or Structure Q i Truvel Documentation Fces_ Strong Motion Fee: IBSEISMICR $1.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1,925.19 $0.00 TOTAL FEE: F $1,925.19 Revised: 11 /08/2010