Loading...
11070122CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20379 BOLLINGER RD CONTRACTOR: Northern California PERMIT NO: 11070122 Construction Services OWNER'S NAME: 1 . I PHONE NO: 'U LICENSED CONTRACTOR'S DECLARATION License Class Lic. N '?,57 OR CICe►(16 Contractor — Date I hereby affi that am license der the provisions of apter 9 (commencing ith ection 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 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. 0 I hereby affirm that 1 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: 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, 1 become subject to the Worker's Compensation provisions of the Labor Code, l 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. Date BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SFDWL (420SQFr)-BEDROOM, BATHROOM & LAUNDRY,EXTEND GARAGE(CONVRT TO LIVING 329SQFr)& REMODEL EXISTING BATHROOM(50SQFr),REPLACE 1 Sq. Ft Floor Area: I Valuation: $80000 APN Number: 36936005.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b • Date:�� j 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner thorized agent: Q � 'Z ©rr Date: \J CONSTRUCTION LEND G 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. Licensed J -Am FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 20379 bollinger rd. DATE: 07/19/2011 REVIEWED BY: bobs. PC FEE ID APN: BP#: "VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE• P 2nd Unit? % Yes `; No . OTC? 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK sfd add to ciarage, add bedroom bath laundry, remodel existing bedroom re -roof, replace 1 window, SCOPE relocate furnace, lighting at dining adn exterior, install 2 new sun tunnels. 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,IVY-B 420 $1,482.00 IADDPLCK $1,205.00 IADDINSP $0.00 PME Plan Check: $0.00 50 s.f. Remodel, Bath (<=300 so $588.001REARESBAT Permit Fee: $1,205.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 0 # Window / Sliding Glass Door $392.00 1WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $44.001,500 s.f. $210.00 TOTALS: 420 $1,482.00 $1,205.00 MECH, )HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes Q No Mech. Plan Check"00 $0.00 Plan Check Fee: Mech. Permit Fee: IMPERMITr,rt; $1,482.00 306 s.f. $457.00 Other Mech. Insp.0.0 hrs 1 $44.00 �,,, E3 160 hrs $0.00 NOTE. These fees are based on the nreliminarv, information available and are onlv an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,482.00 306 s.f. $457.00 Remodel, Other IREARESOTH Suppl. PC Fee: 0 Reg. 0 OT 160 hrs $0.00 PME Plan Check: $0.00 50 s.f. Remodel, Bath (<=300 so $588.001REARESBAT Permit Fee: $1,205.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 0 # Window / Sliding Glass Door $392.00 1WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $44.001,500 s.f. $210.00 Re -roof IREROOFRES _T7 L'rat,�.r4g'r"a2 '(rF,1 7i�.x Acoustical Fee: 0 Yes 0 No $0.00 # $130.00 Mechanical ]MFR=<100 Furnace, Forced -Air 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $54.60 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $44.00 Stronp- Motion Fee: IBSEISMICR $8.00 Select an Administrative Item t q Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $2,841.60 $1,777.00 TOTAL FEE: 1 $4,618.60 Revised: 07/04/2011 ."e . --.& CITY OF CUPERTINO ww FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: DATE. REVIEWED BY: UNITS APN: BP#: *VALUATION: I$o *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Dup USE: # PENTAMATION 1 REAP1 1 PERMIT TYPE:lex WORK Recep/Switch/Outiets SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Permit Fee: IEPERT AE Fixtures, Lighting 1BREMFIXT Other Elec. Insp. LLO J hrs 1 $44.00 8 # $65 Recep/Switch/Outiets 1BREMRECEP 6 # $44 PME Unit Fee: $109.00 PME Permit Fee: $44.00 7_1 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $109.00 Strom- Motion Fee: NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addnl into. FEE ITEMS (Fee Resolution 11-053 E_ff 7/1111) FEE QTY/FEE Elec. Plan Check 1 0.0 1 hrs $0.00 FElec. F­7� Permit Fee: IEPERT AE rPiwiLi ki�,Jl. I - Other Elec. Insp. LLO J hrs 1 $44.00 PME Plan Check: $0.00 NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addnl into. FEE ITEMS (Fee Resolution 11-053 E_ff 7/1111) FEE QTY/FEE MISC ITEMS Plan PME Plan Check: $0.00 PME Unit Fee: $109.00 PME Permit Fee: $44.00 7_1 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC Strom- Motion Fee: $0.00 Select an Administrative Item Ll Bldg Stds Commission Fee: $0.001 SUBTOTALS: $197.001 $o.+ - TOTAL FEE: 00 $197.00 Revised: 07/04/2011