11080063CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10640 MARTINWOOD WAY CONTRACTOR: TF DESIGN INC PERMIT NO: 11080063
OWNER'S NAME: 3957 VIA SALICE DATE ISSUED: 09/01/2011
OWNER'S PHONE: CAMPBELL, CA 95008 PHONE NO: (408) 438-0432
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 18 Lic. #d n ,L/� b Sin (�T_
Contractor Date 1
I hereby affirm 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.
l 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. 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 4 I
❑ OWNER -BUILDER DECLARATION
I hereby affirm that l 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:
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.
l 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,
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.
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r
MECH r RESIDENTIAL r— COMMERCIAL r
JOB DESCRIPTION: REMODEL MASTER SUITE (315 SF), KITCHEN (153 SF),
RELOCATE LAUNDRY ROOM (175 SF) TO MUD ROOM.
Sq. Ft Floor Area: I Valuation: $35000
APN Number: 36935038.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY$ FROM LAST CALLED INSPECTION.
Issued by: - 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.I2 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.
Owny+� o authorized entQ q !
Date: i
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed Professional.
CITY OF CUPERTINO BUILDING PERMITMSIGN # 1 1-? 1
BUILDING ADDRESS: 10640 MARTINWOOD WAY
OWNER'S NAME:
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class I Lic. N O 0 5`0 �} y
Contractor _Tylo-, --I-+ ' -2 -Q3— Date_ 3— —
1 hereby affirm 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.
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. 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 5 — I — 1 ,0\
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
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.
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.
CONTRACTOR: TF DESIGN IVAN v 3
3957 VIA SALICE DATE ISSUED: 09/01/201 1
CAMPBELL, CA 95008 PHONE NO: (408) 438-0432
I F_ F_
BUILDING PFWMIT INFO: BLDG F.LF,CT PLUMB
F_ I— F_
MF,CII RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: REMODEL MASTER SUITE (315 SF), KITCHEN (153 SF),
RELOCATE LAUNDRY ROOM (175 SF) TO MUD ROOM.
REVISION NI- REVISE HOLDOWNS & STRAPS ALONG GRID LINE A & CHANGE.
DOORS TO WINDOWS AT 2ND STORY- ISSD 3/1/2012
Sq. Ft Floor Area: I Valuation: $35000
AI'N Number: 36935038.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
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 BE7-I'ER
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 1 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 or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby aliinn 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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professi
Signature Date
ORM-No,
CITY OFCUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10640 Martinwood Way
DATE: 03/01/2012
REVIEWED BY:
APN:
BP#: 11080063
"VALUATION: Iso
}PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION
PERMIT TYPE:
WORK
Revision #1: Revise holdowns and straps along rid line A and change doors to windows at second
SCOPE
Story.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Distrie4 School
District, eta). These Dees are based on the prelininary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-05; Elf ?'1..'11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl, PC Fee: ) Reg. () OT
1.0
1 hrs
$130.00
PME Plan Check:
ISUPPKFEE
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_
0
G
Work Without Permit? Yes (F) No
$0.00
Advanced Plannin& Fee:
$0.00
Select allon-Residential
Building or Structure
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$130.00
$0.00
TOTAL FEE:
$130.00
Revised: 19/20
CITY OF CUPERTINO
FM-,7, FEE ESTIMATOR - BUILDING DIVISION
��Ory�)(as
ADDRESS: 10640 martinwood way
DATE: 08/08/2011
REVIEWED BY: bob s.
APN:
BP#: Q 3 g
"VALUATION:
1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
remodel master suite kitchen relocate laundry room to mud room.
SCOPE
Mech. Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs
NOTE. These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
153 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: (F) Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
175 s.f. Remodel, Bath (<=300 sf)
$588.00 1REMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
= s.f Remodel, Other
$457.00 1REA92ESOTIi
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
L_Lj #
$130.00
Mechanical
IMFR=<100 Furnace, Forced -Air
"
Acoustical Fee: 0 Yes (E) 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
Travel Documentation Fee: ITRAVDOC
$44.00
Strom Motion Fee: IBSEISMICR
$3.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$93.50
$1,763.00J
TOTAL FEE:
1 $1,856.50
Revised: 07104/2011