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11070145CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 919 NEW HAVEN CT CONTRACTOR: CONS'rRUCTION PERMIT NO: 11070145 SERVICES OWNER'S NAME: PESCADERO, CA 94060 PHONE NO: (650)879-1828 ❑ LICENSED CONTRACTOR'S DECLARATION r— F- PLUMB F- BUILDING PERMIT INFO: BLDG ELECT License Class Lic. # r r r cic-e $ Z MECH RESIDENTIAL COMMERCIAL Contractor 8 �'`VDate 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 2ND FLOOR ADDITION- MASTER SUITE (commencing with Section 7000) of Division 3 of the Business & Professions W/GYM(537SQFT)& Code and that my license is in full force and effect, REMODEL IST FLOOR,ADD STAIRS,REMODEL13ATHROOM(45SQFr)& REMOVE FIREPLACE & CHIMNEY 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 Sq. Ft Floor Area: Valuation: $150000 permit is issued. APPLICANT CERTIFICATION APN Number: 3561 1044.00 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 sour c egulations per Lhe Cupertino Municipal ode, Se tion 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date v Issued by: ate: 2 �'— ❑ 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 BE'I-FER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's IIA7_ARDOUS 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 orthe 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 1 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, f 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, an 25534. become subject to the Worker's Compensation provisions orthe Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. O n r► / 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 919 new haven ct. DATE: 07/20/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: p 2nd Unit? % Yes • No OTC? 0 Yes (E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK sfd 2nd floor addition master suite m remodel 1st floor add new stair, remodel bathroom remove SCOPE existing chimney, add new gas fireplace. 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 537 $2,420.00 /R3PLNCK $1,519.00 /RNNSP TOTALS: 537 $2,420.00 $1,519.00 MECH, HOURLY 0 Yes O No PLUMB, HOURLY © Yes Q No ELEC, HOURLY Q Yes Q No Mech. Plan Check 0.0 hrs $0.00 - .r < t, E k Mech. Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs $44.00 r;::. .,.. NOTE: These lees are based on the vreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 7i1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,420.00 0 # $327.00 Stairs ISTAIRS (Specify # of Flights of Stairs) Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 = s.f. Remodel, Bath (<=300 sf) $588.00 1REMRESBAT Permit Fee: $1,519.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 1 hrs $0.00 0 # Mechanical $65.00 1BAPPLOT Other Appliance/Equip PME Unit Fee: $0.00 PME Permit Fee: $44.00 �.rra1�'lrrt�°ikr�t 1�r.� Acoustical Fee: 0 Yes 0 No $0.00 Q 0 Work Without Permit? 0 Yes G No $0.00 Planning Fee: PLLONGRNGR $69.81 Select a Non -Residential Building or Structure Q 0 Travel Documentation Fee: ITPA VDOC $44.00 Strong Motion Fee: 1BSEIS1vflCR $15.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $4,117.81 $980.00 TOTAL FEE: $5,097.81 Revised: 07/04/2011