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11010103 (3)I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10450 LANSDALE AVE CONTRACTOR: I PERMIT NO: 110 10 103 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION g License Class Lie. # [ 2-0 S/ 2— rS Contractor Date 1 hereby Arm 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: 1 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 1 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 pennit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature to ❑ 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, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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, T. 1t7 , . I PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: CONSTRUCT NEW ARCH OVER EXISTING PATIO, REPLACE WINDOWS, 2 DOORS, REPAIR 50SQ Fr STUCCO Sq. Ft Floor Area: I Valuation: $26000 APN Number: 36912002.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b ate: 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. 1 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. Owe or authorised agent: /�� Date: CONSTRUCTION LENDIIVG 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 ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 104501ANSDALE AVE OWNER'S NAME: 1 ROHNERT PARK, CA 94925 1 PHONE NO: (415) 84&1053 1 ❑ LICENSED CONTRACTOR'S DECLARATTIION License Class `J Lie. # (-Z0 6? Zy Contractor I hereby affirm that I am licensed under the provisions of Aapter 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. 1 agree to comply with all city and county ordinancesand 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 -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. 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. 1 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, 1 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 1 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. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: CONSTRUCT NEW ARCH OVER EXISTING PATIO, REPLACE WINDOWS, 2 DOORS, REPAIR 50SQ Fr STUCCO Sq. Ft Floor Area: I Valuation: $26000 APN Number: 36912002.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: I? -- RE -ROOFS: 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. Signature of Applicant: 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 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or authorized 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 ARCHITECT'S DECLARATION Date I understand my plans shall be used as public records. Licensed Professional F-M-7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10450 landsdale ave. DATE: 01/25/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$14,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise pool bonding at existinq sfd rear pool, add landscaping lighting, add two new fixtures at new SCOPE arch. Lh�ch. P1an C.7�ec k Plumr`�. Pl rrr Check F.te�'. !'Ian Cheek 1tech. Permit Foe: f4rr:rrh. N'rmir Fec: h-le( Por�nr ""'T. other Ai&t_ 4. Imp Ofhcr Numb Imp. olhr= I ' i . b.:;,ET Akch. trap. P'cc. Plumh. hup, l vc: Elec_ &,asp. Pee NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dept for addn 7 info. FEE ITEMS free Resohrtion 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes E) No $0.00 hours Plan Check, Hourly $252.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feed Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Trulel Dnctunenturinr� lees: Strong Motion Fee: IBSEISMICR $1.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.40 $252.00 TOTAL FEE: $254.40 Revised: 01/15/2011 CITY OF CUPERTINO F-M-7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10450 landsdale ave. DATE: 01/18/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$26,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK construct new arch over existing patio, replace 7 windows 2 doors repair 50sq ft stucco. SCOPE Alleeh. Plan Check Plrinlh. Phnr L'wck J-hc. Plan Check Flech. Pcrwil [ce: plilnrtl, Per7111r fee, lilr'.L'. Pe17N:r h Oihei d9ech. Ins/,. 0N1- ° Plrrrnh Insp. O/ho-Flee. Imp. Alech. ln.,p. Face: Plunrh. hl.ryl. Fcc: /i/A:r. Insp. h«e: NOTE. These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Covered Porch $887.00 ICOVPORCH Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 0 # Window / Sliding Glass Door $506.00 1WINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee10 Reg. © OT 0.0 hrs $0.00 = s.f. Restucco $443.00 ISTUCOAPP PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cons'Inntion Tax Acoustical Fee: 0 Yes (E) No $0.00 Q Work Without Permit? 0 Yes 0 No $0.00 Plannin, Fee: $0.00 0 I Trovel Documentunon Foes: Stroniz Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 ST...BTO'1'ALS: $4.60 $1,836.00 TOTAL FEE: 1 $1,840.60 Revised: 01/03/2011