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10100102CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22530 RICARDO RD CONTRACTOR- f�17 ("trCPERMIT NO: 10100102 G�d27 S' 41- CtUO OWNER'S NAME: YAEL & NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALXENLARGI­NG COMMERCIAL ❑ �� ^� ADD 2 BEDROOM & I NEW DEC O THEQ);NOI License Class Lic. N LJ., � ROOM(97SQ)8c ADD NEW DECK & TRELLIS(642SQ); NO / p1120111 J RE -ROOF & NO STRUCTURAL- REVIEWED BY PLANNfNG(GS) U Contractor IQ� llb 1. Date 1l 2Q/ / 1 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: 1. 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. 2. 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 rtino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 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: 1. 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. 2. 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. 3. 1 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. Sq. Ft Floor Area: I Valuation: $72000 APN Number: 35601008.00 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 1 have read the hazardous materials requiremcnts 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sec�ns..25505, 25533, and 25534. Owner or : CONSTRUCTION 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 _ /-/_ 60 -- `l 1 BUILDING ADDRESS: 22530 RICARDO RD CONTRACTOR: GREEN CIRCLE PERMIT NO: 10 100 102 CONSTRUCTION INC OWNER'S NAME: PALO ALTO, CA 94306 PHONE NO: (650) 703-4934 ❑ LICENSED CONTRACTOR'S DECLARATION r License Class Lic.# 9�� �� � BUILDING PERMIT INFO: BLDG ELECT PLUMB pp IV'� ` �/ MECH F RESIDENTIAL COMMERCIAL � Contractor 6 � %I (— I Date (p Thereby 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.effeet. 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 perdfe Cupertino Municipal Code, Section 9.18. SignatureDate ❑ OWNER -BUILDER DECLARATION 1 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). 1 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, 1 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. JOB DESCRIPTION: ADD 2 BEDROOM & I BATHROOM(402SQ) & ENLARGING I ROOM(97SQ)&. ADD NEW DECK & TRELLIS(642SQ); NO RE -ROOF & NO STRUCTURAL- REVIEWED BY PLANNING(GS) 4/6/11-REV#I REVISE DECK REPAIR-ISS'D OVR COUNTER 4/6/11 Sq. Ft Floor Area: I Valuation: $72000 APN Number: 35601008.00 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: / ' %Ql 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 al I new materials for inspection. Signature of Appl 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 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 Cuper ' unicipal Code, Chapter 9.I2 and the Health & Safety Code, Sectio 05, 25533, and 25534. Owner or authorize ent: � Date: ( CONSTRUCTION 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 ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FM-7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: ''VALUATION: 1$75,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: OVER THE COUNTER. 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK 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,IV,V-B 938 $2,349.00 IR3PLNCK $1,474.00 IR3INSP TOTALS: 938 $2,349.00 $1,474.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No IELEC, HOURLY 0 Ves Q No tilc0l. Ilia, (', � ' ­, i I Ihftc:. Mein s ;, " tee: , I" --I- �, .. EIF-L-Flrl Otllet� AkLh. Insp. , , CHIC"- F.kr ImpLl k. h2slz I�e>c: /'s„r:; ,.:.�,. r`:;. i.'k-c. Insp. Tee' NOTE. These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 F . 7/00) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,474.00 Suppl. Insp. Fee10 Reg. 0 OT I O.OT hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conwritction Kry Acoustical Fee: 0 Yes (E) No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $121.94 Select a Non -Residential Building or Structure 0 0 i Trovel Docrtnnewwiori Fees: Strong Motion Fee: IBSEISMICR $7.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SL'IVI'OTALS: $3,955.44 $0.00 TOTAL FEE: 1 $3,955.44 Revised: 9/29/2010 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 22530 ricardo rd. DATE: 04/06/2011 REVIEWED BY: bobs. IWIADDRESS: APN: BP#: "VALUATION: 1$4,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION PERMIT TYPE: WORK revise deck repair SCOPE 1 ee:+ 1ian f"1rci; t?.^r"tr r11e� sr. Li I-- Fee: NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee{') Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 {,'(rn5lP71iJ11(Jn TOO Acoustical Fee: 0 Yes (F) No $0.00 Q 0 Work Without Permit? O Yes 0 No $0.00 Planning_Fee: $0.00 Select a Non -Residential Building or Structure Q 0 i la~�i��11?=:�r;rrtnrr�tet czff.T t�s; Strong- Motion Fee: IBSEISMICR $0.50 1 # $633.00 Revision IREVRESADD Addition Bldy, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $633.00 TOTAL FEE: $634.50 Revised: 01 /15/2011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22530 RICARDO RD CONTRACTOR- 6-/W,,7 (,,,r PERMIT NO: 10100102 OWNER'S NAME: YAEL&NIMROD BEN NATAN DATE ISSUED:01/20/2011 ' ER'S PHONE: 4087778983 PHONE NO: LICENSED CONTRACT^QR'S DECLARATION JOB DESCRIPTION: RESIDENTIALKENLARGING COMMERCIAL ❑ ADD 2 BEDROOM&1 BATHROOM(402S 1 License Class Lic.# 4 (� ROOM(97SQ)&ADD NEW DECK&TRELLIS(642SQ);NO RL--ROOF&NO STRUCTURAL-REVIEWED BY PLANNING(GS) Contractor (�r U (i!�/t Date 1120111 / 1 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. 1 hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Arca: Valuation:$72000 t. 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. APN Number:35601008.00 Occupancy Type: 2. 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 —5r L PERMIT EXPIRES IF WORK IS NOT STARTED 1 certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSPECTION. 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, Issued by: Date: 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 rtino Municipal Code,Spdon 9.18. RE-ROOFS: Signature Date 020 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. OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 ht.eby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE: sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should 1 store or handle hazardous material. t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should 1 use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District 1 will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sect 5505,25533,and 25534. 2 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 Owner or auth agent: permit is issued. Date: l 3. 1 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,1 f 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.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. 1 agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the of this permit.Additionally,the applicant understands and will comply with d., point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date