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11100033CITY OF CUPERTINO BUILDING PERMITd- BUILDING ADDRESS: 22022 LINDY LN OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. it q i0- % Contractor S✓�f��`� �� ��`ate J I hereby affirm that I am licensed under the provisions if Ch pter 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 the work for which this permit is issued. APPLICANT CERTIFICATION l 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. Signature Date b S Zh i ❑ OWNER -BUILDER 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: SUNZERI CONSTRLTCTION PERMIT NO: 11100033 36 RAILWAY AVE DATE ISSUED: 02/10/2012 CAMPBELL, CA 95008 PHONE NO: (408) 963-8843 BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB F MECH r— RESIDENTIAL J— COMMERCIAL J— JOB DESCRIPTION: HILLSIDE-SFDWL MASTER SUITE ADDITION & BATH(300SQFT), REPLACE FURNACE & ADD NEW A/C UNIT 5/29/2012 - REV#I - CHANGE BAY WINDOW PORTION OF NEWADDITION TO FLAT WALL.MOVE HALLWAY SLIDER DOOR TO NEW LOCATION IN ROOM AND REPLACE WITH NEW WINDOW-REV#I ISS'D 5/29/2012 Sq. Ft Floor Area: I Valuation: $100000 APN Number: 35627011.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPElCTION. Issued by: �E,q�✓ L�T�''/ Date: •%(?— RE -ROOFS: All roofs shall be inspected prior to any roofing material berg 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. 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 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. Owner thorized agent: Date: CONSTRUCTION LENDING 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 Address ARCHITECT'S DECLARATION Date I understand my plans shall be used as public records. Licensed FM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22022 LINDY LANE DATE: 05/29/2012 REVIEWED BY: SEAN APN: 35627011 BP#: 11100033 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRE PERMIT TYPE: WORK REVISION #1: CHANGE BAY WIDOW PORTION OF N ADDITION TO FLAT WALL. MOVE SCOPE HALLWAY SLIDER DOOR TO NEW LOCATION IN ROOM AND REPLACE WITH NEW WINDOW. 0 i lwO PCun C!:__,_ EkL. Plai (h; :. _ !"cfr. Imp. �Jrin�r , Urhur / icf. . lv.ip. i ,, "' )''c:". 1'Irn„r•,. ,`,InF:. i de': )'In. lrr.11 I co. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 1 hours Plan Check, Hourly $130.00 ISTPLNCK Suppl. PC Fee: 0 Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 0 No $0.00 Suppl. Insp. Fee:O Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 � l)iI.Sl1'1tr,'til7yT TCd_1-: r1 CII.'"1f17f.4l1' /!14'C % c C. 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 1� hours Inspections $130.00 1STINSP Inspection, Hourly 0 0 Pro %,°I 1'c'e'S°: Strong Motion Fee: $0.00 Select an Administrative Item BIdp, Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.001 $260.00 TOTAL FEE; $260.00 Revised: 05/01 /2012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22022 LINDY LN CONTRACTOR: RODNEY AND MICHELE PERMIT NO: 11100033 JENNY OWNER'S NAME: � BUILDING PERMIT INFO: BLDG ELECT � PLUMB License Class Lic. k 'r 1— MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: HILLSIDE-SFDWL MASTER SUITE ADDITION & (commencing with Section 7000) of Division 3 of the Business & Professions BATH(300SQFT), REPLACE FURNACE & ADD NEW A/C UNIT Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: [ 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 Sq. Ft Floor Area: Valuation: $100000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35627011.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued by• Date: Signature Date OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: [ 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this 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 contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall m i in compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's H Safety Code, Sections 25505, 25533, and 25534. 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 LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that the construction lending agency for the performance of work's correct. 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to 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 indemnify and keep harmless the City of Cupertino against I iabilities, judgments, Lender's Address costs, and enses which may accrue against said City in consequence of the granting of is permit. Additionally, the applicant understands and will comply with all no o source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. � 2 I understand my plans shall be used as public records. Signature Date l Id Licensed Professional CITY OF CUPERTINO BUILDING PERMIT -,--I - R BUILDING ADDRESS: 22022 LINDY LN CONTRACTOR: I PERMIT NO: 11100033 SUNZERI CONSTRUCTION OWNER'S NAME: 1 I PHONF NO: Er LICENSED CONTRACTOR'S DECLARATION License Class f2 >U7 Z�Jh Contractor - Date I hereby a trm 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 the work for which this permit is issued. �/� APPLICANT CERTIFICATION ry� 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. Signature Date �� Z Af ❑ OWNER -BUILDER DECLARATION 1 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 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 PERNhT INFO: BLDG ELECT F_ PLUMB tr MECH f— RESIDENTIAL COMMERCIAL JOB DESCRIPTION: HILLSIDE-SFDWL MASTER SUITE ADDITION & BATH(300SQFT), REPLACE FURNACE & ADD NEW A/C UNIT Sq. Ft Floor Area: I Valuation: $100000 APN Number: 3562701 1.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 WDAYSRM LAST CALLED INSPECTION. Issue `- 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 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. 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 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. Owner r ized agent: Date: dl/ / CONSTRUCTION LENDING 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 I understand my plans shall be used as public records. Sign Date Licensed Professional CITY OF CUPERTINO IpDyJ FEE ESTIMATOR - BUILDING DIVISION WIM ADDRESS: 22022 lindy lane DATE: 1010612011 REVIEWED BY: bobs. APN: BP#: "VALUATION: j$100,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? Yes • No OTC? 0 Yes � No PENTAMATION 1 R3SFDADD . PERMIT TYPE: WORK add master suite and bath 300 s.f., replace furnace add new A/C unit �sfd SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,III-B,IV,V-B 300 $4,511.00 IR3HPLNCK $1,731.00 IR3HINSP TOTALS: 300 $4,511.00 $1,731.00 MECH, HOURLY Yes (E) No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No Mech. Plan Check 1-0-.0-1hrs $0.00 Mech. Permit Fee: IMPERMIT -I- Other Mech. Insp. 0.0 hrs $44.00 r,-, ,. El NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc. ). These fees are based on the nrelininary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (f ee Resolution 11-053 G . 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $4,511.00 F 1 1# $130.00 Mechanical 1MPR=<100 I Furnace, Forced -Air Suppl. PC Fee: (F) Reg. © OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F-17 # Mechanical $65.00 IBRENIAIR A/C Units (<=10K cfm) Permit Fee: $1,731.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 lilminr:tirvativf Vie. 0 0 Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: PLLONGRNGR $39.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITPA VDOC $44.00 Strong Motion Fee: IBSEISMICR $10.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $4.00 SUBTOTALS: 1 $6,383.001 $195.001 TOTAL FEE: 1 $6,578.00 Revised: 1010112011