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11100211CITY OF CUPERTINO BUILDING PERMIT BUILDING CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. N MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFD ONE STORY ADDITION, 416 SF TOTAL TO MASTER (commencing with Section 7000) of Division 3 of the Business & Professions BEDROOM, MASTER BATH, NEW 1/2 BATH. 404 SF Code and that my license is in full force and effect. REMODEL INCLUDING 99 SF IN BATH, I COVERED PORCH, 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 Sq. Ft Floor Area: Valuation: $120000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36618001.00 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 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 being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove al I new materials for 1, 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 construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the 1 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(s) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. 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 maintain 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 Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of Califomia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Owner or : I di1 O forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Hork's correct. I 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 liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional w.i.rTr%r&r% $ 1 CITY OF CUPERTINO BUILDING PERMIT ATE BUILDING ADDRESS: 7497 PLUM BLOSSOM DR CONTRACTOR: ANIL & MONICA SHAH PERMIT NO: 11100211 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH r RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFD ONE STORY ADDITION, 416 SF TOTAL TO MASTER (commencing with Section 7000) of Division 3 of the Business & Professions BEDROOM, MASTER BATH, NEW 1/2 BATH. 404 SF Code and that my license is in full force and effect. REMODEL INCLUDING 99 SF IN BATH, I COVERED PORCH, 11/28/2011-DEF# I- DEFERRED TRUSS CALCS-12/08/2011 DEF#1 ISS'D 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 Sq. Ft Floor Area: Valuation: $120000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36618001.00 Occupancy Type: 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 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. �p Issued by: Dater O-aI%! Signature Date C� OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that 1 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 1, 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: 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 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 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 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. 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 maintain 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 Health & 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 Owner or thori : Date: 2 Q forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of %ork's correct. I 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 liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional � CITY OF CUPERTINO I-1 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7497 plum blossom dr. DATE: 11/28/2011 REVIEWED BY: bobs. APN: BP#: 11100211 "VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK deferred truss talcs. SCOPE Dec. Psort Che•ct.Li •fr.... tee.;.,; f ev 1?':r.,., 'n,•t-. !-: � . �, , NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictriet. etc ). These fees are hated on the nrelimna" information ovailah/e and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Lff. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (:) No $0.00 F__47 hours Plan Check, Hourly $520.00 1STPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ( 'ONStf-t7r'!i(}7i I fd.t Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 1 1 G 0 i Tr:.,:., r 0. Stron Motion Fee: $0.001 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $520.00 TOTAL FEE: 1 $520.00 Revised: 10/01 /2011 FM__7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 2�I �\\00 ADDRESS: 1497 Plum Blossom Dr. DATE: 10/31/2011 REVIEWED BY: gs APN: BP#: "VALUATION: 1$120,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD Or Duplex USE: P 2nd Unit? Yes •� No OTC? Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK 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 416 $1,482.00 IADDPLCK $1,205.00 IADDINSP TOTALS: 416 $1,482.00 $1,205.00 MECH, HOURLY 0 Yes (E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY © Yes Q No Cnecii Lj 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 Dreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Tee Resolution 11-053 Eff. 7111111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,482.00 99 s.f. $588.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F 1 1# Covered Porch $914.00 ICOVPORCH Permit Fee: $1,205.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 F-2047 s.f. Remodel, Other $392.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 i.�Faf3�l''IitJ�IttYJ l�r.� 0 Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: PLLONGRNGR $54.08 Select a Non -Residential Building or Structure Q 0 i 7 �iVvi 1.3ocioneerwirm leers. Strong Motion Fee: IBSEISMICR $12.00 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $2,758.08 $1,894.00 TOTAL FEE, $4,652.08 Revised: 10/01 /2011