11070053CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10641 N PORTAL AVE CONTRACTOR: ROCKSTRONG PERMIT NO: 11070053
DEVELOPMENT INC
OWNER'S NAME:
SAN JOSE, CA 95157 PHONE NO: (409) 694-3472
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. q 09y
Contractor �(; �a N �ev,� Date (A 4
hereby affirm that 1 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.
hereby alum 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 perm' r Ily plicant understands and will comply
with all non-po' rce r ulat s per i Cupertino Municipal Code, Section
9.18.
Signature Date AAA 10
❑ 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)
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
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 F, ELECT r PLUMB r
MECH I— RESIDENTIAL r COMMERCIAL r
4y7
JOB DESCRIPTION: ADDA3'sSQ FT WORKSHOP, FRONT PORCH & ENTRY.
REMODEL KITCHEN 151 SQ, BATHROOM 41 SQ FT
Sq. Ft Floor Area: I Valuation: $116000
APN Number: 31632055.00 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: 1-/
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
1 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 1 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 w'th the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safe e, StctionsV5505, 25533, and 25534.
Owner
iD�iy1�4 ,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Date I Licensed Professional
lJ✓
n (�
FM_7
CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 'Sv
ADDRESS: 10641 n. portal ave.
DATE: 09/21/2011
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: 116,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE: P
god Unit? Yes ' No
OTC? O Yes ONo
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK I
sfd bath and kitchen remodel 204 s.f., kitchen entry, gallery addition 204 s.f.porch 43 s.f.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTIL
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
247
$994.00
IADDPLCK
$963.00
1ADDINSP
TOTALS:
247
$994.00
$963.00
MECH, HOURLY O Yes O No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
,:
NOTE. This estimate does not include fees due to other Depts (Le Public Works, Sanitary Sewer District, School District, etc).
These fees are based on the nreliminary infornmdon available and are onlv an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohition 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
= s.f-
$588.00
Remodel, Kitchen (<=300 sf)
IREA9tESKIT
Suppl. PC Fee: 0 Reg. ® OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
41 s.f Remodel, Bath (<=300 sf)
$588.00 IREARESBAT
Permit Fee:
$963.00
Suppl. Insp. Fee fl Reg.
O OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
O
Work Without Permit? Q Yes Q No
$0.00
Advanced Planning Fee:
PLLONGRNGR
$32.11
Select a Non -Residential
Building or Structure
Q
0
Strong Motion Fee:
1BSE1SMCR
$11.60
Select an Administrative Item
Bldg Stds Cormnission Fee: IBCBSC
$5.00
SUBTOTALS:
$2,005.71
$1,176.00
TOTAL FEE:
1 $3,181.71
Revised: 09/02/2011
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10641 n. portal ave.
DATE: 09/21/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION.: 116,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE• P
2nd Unit? • Yes • No
OTC? Q Yes QNo
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK I
sfd bath and kitchen remodel 204 s.f., kitchen entry, gallery addition 204 s.f.porch 43 s.f.
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,IVN-B
247
$994.00
IADDPLCK
$963.00
IADDINSP
TOTALS:
247
$994.00
$963.00
MECH, HOURLY Q Yes O No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No
NOTE. This estimate does not include fees due to other Depts (Le. Public Works, Sanitary Sewer District, School District, etc.).
These fees are bated on the nreliminary informadnn availahle and are nnly an estimate. Cnntact the Dent far addn'1 info_
FEE ITEMS (I ee Resolution 11-053 Elf 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
= s.f.
$588.00
Remodel, Kitchen (<=300 so
1REMRESKIT
Suppl. PC Fee: 0 Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
41 s.f. Remodel, Bath (<=300 so
$588.00 IREARESBAT
Permit Fee:
$963.00
Suppl. Insp. Feefl Reg.
Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? Q Yes Q No
$0.00
.Advanced Planniw, Fee:
PLLONGRNGR
$32.11
Select a Non -Residential
Building or Structure
E)
Q
Stronp, Motion Fee:
IBSEISMICR
$11.60
Select an Administrative Item
Bldg Stds Corrunission Fee: IBCBSC
$5.00
SUBTOTALS:
$2,005.71
$1,176.00
TOTAL FEE:
1 $3,181.71
Revised: 09/02/2011