12020054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 202t0 PATRIC CT CONTRACTOR: HARRELL REMODELING PERMIT NO: 12020054
INC
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S �D%ECCLA�jRATION
License Class Lie 7//G ` L )
Contractor ce ` Z
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 hr full force and effect.
MOUNTAIN VIE, W, CA 94043 ! PHONE NO: (650)230-2900
BUILDING PERNLIT INFO: BLDG € - ELECT i PLUMB 1
MECH l RESIDENTIAL I s COMMERCIAL
JOB DESCRIPTION: SINGLE FAMILY DWELLING REMODEL-
IUTCHEN(221 SQFT)
BATHROOM(136SQ17T), HALLWAY/LIWNG & DINING
(442SQFT)UPGRADE ELECTRICAL PANEL AND ELECTRICAL
I hereby affirm tinder 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 tine
performance of the work for which (tris permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued. Sq. Ft Floor Area:
APPLICANT CERTIFICATION
€ certify that I have read this application and state that the above information is
correct. t agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby a€ttiorize 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 no s rrce regulatiars per the Cu t ipal Code, Section
9.18. rr I
Signature
❑ ONVNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or illy employees with wages as their sole compensation,
will do (lie work, and (he structure is not intended or offered for sale (See.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sce.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 (tie
performance of the wort: for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of (lie Labor Code, for the perfonnance 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 shalt 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 liarnitess 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
APN Number: 36935012.00
Valuation: $150000
Occupancy Type:
WITHIN 180 DAYS OF PERMIT ISSUANCE 0 11
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 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. 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 I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Managenicnt District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health R Safety Code, Sections 25505, 25533, and 25534.
. (b2-
Date:
NSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Neork'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 Professional
CITY OF CUPERTINO BUILDING PERMIT+
BUILDING ADDRESS: 20210 PATRIC CT CONTRACTOR: HARRELL REMODELING PERMIT NO: 12020054
INC
OWNER'S NAME:
MOUNTAIN VIEW, CA 94043 PHONE NO: (650)230-2900
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic, #
Contractor e.
I hereby affirm that I am licensed under the provisions of apter 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
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
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I 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).
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 Cupertnno Municipal Code, Section
9.18,
Signature Date
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: SINGLE FAMILY DWELLING REMODEL-KITCHEN(221SQFT)
BATHROOM(136SQFT), HALLWAY/LIVING & DINING
(442SQFT)UPGRADE ELECTRICAL PANEL AND ELECTRICAL 4/12/2012-REV#1 - REVISE
KITCHEN,MASTER BATH,HALL BATH,UPGRADE ELECTRICAL,RELOCATE GAS METER, NEW
HVAC, WATER HEATER, REVISE WINDOWS AND DOORS -4/23/2012 REV#1 ISS'D
Sq. Ft Floor Area: I Valuation: $150000
APN Number: 36935012.00 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 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.
Own r.,authorized agent:
Die:
NSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of «ork'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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
Y
ADDRESS: 10813 northoak square
DATE: 04/16/2012
REVIEWED BY: bobs.
, 11"ch. Permit Fe("
APN:
BP#:
*VALUATION: 1$6,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
Plruub. lay, Fec.
PENTAMATION
PERMIT TYPE: 1SFDWLR00
WORK
tear -off existing cal -shake roofing s s tem install comp shingles Color and type to match exisitin .
SCOPE
Suppl. Insp. Fee:4 Reg. 0 OT
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nrelintinarv, information available and are only an estin:ate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef' 7/1/11)
Afi',:11, Playa C'hcck
Plamb, Plmr Check
Elect Mon Church
, 11"ch. Permit Fe("
1111x1, PCOWI Fae:
B(cc. Permit Fee:
Other AieLA Insh,
Chher Pbimb liup.E1__L_
01her Elec. lits°p.
-Tech. lavpc
Plruub. lay, Fec.
Dec. hisp. Fze:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nrelintinarv, information available and are only an estin:ate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef' 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
13 s.f. Re -roof
$14.00 IREROOFRES
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:4 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C.'onswilction Tax:
TT
rI dinil LCtI wive Fee:
0
0
Work Without Permit? 0 Yes j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Travel Docione ztotion
Strong Motion Fee: IBSEISMICR
$0.65
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$1.65
$14.00 TOTAL FEE:
$15.65
Revised: 04/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
Y
ADDRESS: 20210 Patric ct.
DATE: 04/16/2012
REVIEWED BY: bobs.
1 -tech, PcrmllI o"
APN:
BP#:
*VALUATION: Iso
,-PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
__TPERMIT
Ppl_ ATION
TYPE: 1GENRE
WORK
revise kitchen master bath hall bath upqrade electrical relocate gas meter, N Hvac water heater,
SCOPE
revise windows and doors.
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information availahle and are only an estimate. Contact the Dent far addn'I infra_
FEE ITEMS (Fee Resolzition 11-053 E . 711111)
Lic�clt, Phos Check
Numb, Owl Chec1,
Oct-, Plan Owl/,
1 -tech, PcrmllI o"
phI3Rl7, N'17T1771'c'c:
Flec. Pcoull l`ee:
0hho, I'lec h. Insp.
C 1ho. plumb h7sp.E1__L_
Outer Elec. Jay,
Alack. My, Fcc.
plim1b. tits(, I'cc
Elec. Insp, Fce:
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information availahle and are only an estimate. Contact the Dent far addn'I infra_
FEE ITEMS (Fee Resolzition 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
00
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Coiulnictlon Tax.,
T_T_
�'Idlniniso-love Fee:
0
G
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
�
Tl r7s'e' / Z10Cl1117Z'771Ut7(177
"1"'k,E.',9�:
Strong Motion Fee:
$0.00
0 #
$652.00
Revision
IREVRESREM Remodel
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$652.00
TOTAL FEE
$652.00
Revised: 04/01/2012
Elec. Plan Check 1 0.0 1 hrs $0.00
Elec. Permit Fee: IEPERAffT
Other Elec. Insp. 1 0,0 1 hrs 1 $44.00
L1
A10TE: This estimate does not hicludeftes due to other Departments (i.e. Planning, Public Works, Fire, Sanitur
y Sewer District, School
Dit,trirt pet,. �. Thovo fppv firo havad nit yh" 11roU3thlarl) h1mr1iIfifin" nuidlahlo and aro nnhV aij aeflng"t" rAidapf ih" Done f1w fiddlill 1,02fn
FEE ITEMS (Fee 1,esohnqon 11-0-53 L,ff 7,11,111)
FEE
CITY OF CIT PERTIN
MISC ITEMS
R{�" `O
FEE ESTIMATOR — BUILDING DIVISION
$0,00
ADDRESS: 20210 patric ct.
14
DATE: 02/13/2012
REVIEWED BY: bobs.
L Tf
hrs $0.00
APN:3667-,:j�:-61-4
BP#.
VALUATION: F$�2�'00
PERMIT TYPE: Building Permit
Permit Fee: $0.00
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
$0.00
F-442 s.f. Remodel, Other
$457.001 ]REAIRESOTH
PENTAMATION IR3SFDREM
I
USE:
PME Permit Fee:
$44.00
F-200 amps Electrical
$44.001 IERT<200 /services
PERMIT TYPE:
'VVOR17�-s�fd
remodel kitchen, livinq and dininq, hallwav and master bath, upqrade electrical panel, electrical
SCOPE I
throughout.
$41.00
F-9-4-1 #,/' Electrical
$266.00 IBREAIRECEP I Recep/Switcli/Outtets
Elec. Plan Check 1 0.0 1 hrs $0.00
Elec. Permit Fee: IEPERAffT
Other Elec. Insp. 1 0,0 1 hrs 1 $44.00
L1
A10TE: This estimate does not hicludeftes due to other Departments (i.e. Planning, Public Works, Fire, Sanitur
y Sewer District, School
Dit,trirt pet,. �. Thovo fppv firo havad nit yh" 11roU3thlarl) h1mr1iIfifin" nuidlahlo and aro nnhV aij aeflng"t" rAidapf ih" Done f1w fiddlill 1,02fn
FEE ITEMS (Fee 1,esohnqon 11-0-53 L,ff 7,11,111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0,00
F-221 s.f. Remodel, Kitchen (<=300 so
$588.001 IREMRESKIT
14
Suppt. PC Fee: (D Reg. OT
Q.Q
hrs $0.00
PME Plan Check:
$0.00
136 s.f. Remodel, Bath (<=300 sf)
$588.00 1 1 R =EAR? -'SBA T
Permit Fee: $0.00
Suppt. Insp. FeerReg. 0 OT
Q,Q
$0.00
F-442 s.f. Remodel, Other
$457.001 ]REAIRESOTH
—hr's
PME Unit Fee: $0.00
PME Permit Fee:
$44.00
F-200 amps Electrical
$44.001 IERT<200 /services
Administrative Fee: IADWN
$41.00
F-9-4-1 #,/' Electrical
$266.00 IBREAIRECEP I Recep/Switcli/Outtets
0
(D
Work Without Permit? 0 Yes (D No $0.00
Advanced Planiiim, Fee:
$0.00
Select a Non-Residentiat
" Building or Structure
L5
0
0
A
Travel Documentation Fee: iTpArlwc $44.00
Strom, Tylotion Fee: IBSEISAffCR
Select an Administrative Item
Bldg Stds (-'ouimissiwi Fee: IBCBSC
SUBTOTALS:
$1,943.00TOTAL FEE: I $2,CO.00,
13-0, IV Revised: 1/19/201
1,5
V
CITY OF ATE TIN
- MR FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: &VY0DATE: VIEWED BY:
APN:&5�-C3�-0/"-Z,1BP#: /4a�00_5�1 "VALUATION:
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY SFD or Duplex PENT TION I REAPI I
USE: PERMIT TYPE:
IVORITJ��
SCOPE I
Etec, Plait Check 10.0 1 lirs
Etec, Permit Fee:
Other Elec. Insp. El hrs
$0.
NOTE. This esdinate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
FEE ITEMS jL1,_',?e AlesolyfioTr 11-053 LA 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0,00
43 # Electrical V/
$157.001 1BREA11FIXT Fixtures, Lighting
Suppl, PC Fee: 0 Reg. OT
0,0
hrs
$0.00
PME Plan Check;
$0.00
Permit Fee:
$0.00
Suppt. Insp. Feer Reg. 0 OT
[H] hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
W
IgI I
El
Administrative Fee: 1ADA17k
f V
1
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
/),L I A
Travel Documentation Fee: 1 TP -4 rlp(oc
$0�0,jge
I � vi c� t i on F e e:
trcwiFee:
$0.00
- f U
Select an Administrative Item
Wg"ntds Commissiog Fee:
$0.00
SUBTOTALS:
I V29-00
$157.00
TOTAL FEE:
Revised: 1/19/2012