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11010066CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21700 ALCAZAR AVE CONTRACTOR: T PERMIT NO: 11010066 OWNER'S NAME: License Class Lic.# Q Contracto ��•'�/���• Date 2 L(' I hereby affirm that 4 i-tfcensed de hPe 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. 1 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 1 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 Jon;point source regulations per the Cupertino Municipal Code, Section 9.18. 1 --- 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, wil I 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 1 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 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: RESTORE GARAGE, ADD FAMILY ROOM & BEDROOM AND REMODEL(226SQ) Y OF SIDE WALL OF BACK ROOM TO MEET SET BACK RULES, BRACE BEDROOM FLOORING, AND Sq. Ft Floor Area: I Valuation: $35000 APN Number: 35719109.00 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:_�C2— �% 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wrk'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. Signature Date Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21700 ALCAZAR AVE 1CONCRETE CONTRACTOR: RCAMIREZ I PERMIT NO: 11010066 I OWNER'S 1 SAN JOSE, CA 95157 I PHONE NO: (408) 661-2696 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. N 0 v Contractor I hereby affirm that I am licensed under the provisio s 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 consentto 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 1 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 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 oint source regulations per the Cupertino Municipal Code, coon 9,18. Signature I hereby affirm that I 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: 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 inany 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 r ELECT r PLUMB r i" r I MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: m� cC4--. 6T Sq. Ft Floor Area: I Valuation: $35000 I APN Number: 35719109.00 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, 1 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 ' h the Cupertino Municipal Code, Chapter 9.12 d the Health & Safety Code, boos 25505, 25533, and 25534. Owner or authorized agent: Date: LENDING 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT 1 ` U BUILDING ADDRESS: 21700 ALCAZAR AVE CONTRACTOR: RAM IREZ CONCRETEEC' PERMIT NO: 11010066 OWNER'S NAME: Class_ _� Lic. N Contractor_ Q� Date 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. 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 n - -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 Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r MECH F_ RESIDENTIAL r COMMERCIAL r— JOB DESCRIPTION: RESTORE GARAGE, ADD FAMILY ROOM & BEDROOM AND REMODEL(226SQ) 3' OF SIDE WALL OF BACK ROOM TO MEET SET BACK RULES, BRACE BEDROOM FLOORING, AND 6/6/11 -REV# I -ADD NEW FOOTING TO EXISTING BACKROOM-6/14/2011 REV#I ISS'D Sq. Ft Floor Area: I Valuation: $35000 APN Number: 35719109.00 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: C' �17— �> 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. I 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 with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. O : l CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION Signature Date 1 understand my plans shall be used as public records. Licensed Professional �� CITY OF CUPERTINO Ill FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 21700 alcazar ave. DATE: 07/28/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise roof framong, clarifV roof diaphragm SCOPE NOTE- These fees are hated an the nrelimina" infarmatinn availahle and are nniv an estimale- Canlaet the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes E) No $0.00 0 hours $130.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.. r;r'; 't'lfi'Ir<m T-"t Acoustical Fee: 0 Yes 0 No $0.00 Q G Work Without Permit? 0 Yes G No $0.00 Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i Strong; Motion Fee: IBSEISMICR $0.50 0.5 hrs $41.00 Admin./Clerical Fee IADMIN Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $171.00 TOTAL FEE: $172.50 Revised: 07/04/2011 CITY OF CUPERTINO Ili FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 21700 alcazar ave. DATE: 06/06/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$7,500 ` PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise add new footing to existing back room. SCOPE NnTF.- These foot Oro haced on tho nreliminary information availahle and are only an estimate. Contact the Dent for addh7 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 hours Plan Check, Hourly $252.00 ISTPLNCK Suppl, PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee{O Reg. 0 OT 0.0 1 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 77 Acoustical Fee: 0 Yes (F) No $0.00 0 (F) Work Without Permit? 0 Yes (D No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Strong Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.75 $252.00 TOTAL FEE: $253.75 Revised: 04/29/2011 CITY OF CUPERTINO IM-1 FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 21700 alcazar ave. DATE: 01/11/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$35,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes . No OTC. 0 Yes ® No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK Clear Code Enforcement Case: sfd addition of ara a famil room bedroom remodel bedroom SCOPE �and bath. 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 835 $2,349.00 IR3PLNCK $1,474.00 IR3INSP TOTALS: 835 1 $2,349.00 1 $1,474.00 MECH, HOURLY C) 'Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No ,Wech. Plan ('Pwrk pilemh. Plan Check Eke" I'lon Chc<ck .L9e1h. Perntil "A'e. Phrr;th. P(,;;;":( Fc t : Elec Permit Fee: Otho Al-ch. Insp, Olhvr Pl.,fjw� knsp. lkherElec. Insp. Li lee{r. Imp. Fce: Plumb. lav), Fee: Flea. ln.sp. Fce. NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the DeDt for addn7 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 30 s.f. $570.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 226 s.f. $380.00 Remodel, Other IREMRESOTH Permit Fee: $1,474.00 Suppl. Insp. Fee10 Reg. 0 OT 0.0 hrs $0.00 = s.f. Re -roof $65.00 1REROOFRES PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consowctiun Tor- Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $4,946.55 Planning Fee: PLLONGRNGR $108.55 0 A Travel Doctrtnentation Fees: Stroniz Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $8,883.60 $1,015.00 TOTAL FEE: 1 $9,898.60 Revised: 12/07/2010