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12040001CITY OF CUPERTINO BUILDING PERMIT - - - :­ BUILDING ADDRESS: 19503 STEVENS CREEK BLVD I CONTRACTOR: PALISADE BUILDERS 1NC1 PIRMTI' NO: 120W0001 OWNER'S NAME: I PALO ALTO, CA 94301 I PHONE NO: (650)470-4700 I ❑ LICENSED CONTRACTOR'S DECLARATION Clas 6 Lic. # (. /46 ContractorAI-lJADC.,00�-PQ2SO IA(Cat. ! / 2 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 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 ac ie against said City in consequence of the granting of this permit. ition 1 the applicant understands and will comply with all non -point sourc r ulat' u per the Cupertino Municipal Code, Section 9.18. Signature77�� ❑ OWNER -BUILDER DECLARATION 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 (See.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 ELECT f PLUMB MECH RESIDENTIAL r COMMERCIAL F JOB DESCRIPTION: UNIT 237 - STRUCTURAL REPAIRS DUE TO WATER DAMAGE TO INCLUDE: REPLACE I O'X9' EXTERIOR WALL FRAME, REP ACE (3)TJI FLOOR JOISTS, REPLACE SUB -FLOOR, yr t r Sq. Ft Floor Area: I Valuation: $25000 APN Number: 31649068.00 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 �s de ed by the Bay Area Air Quality Management District I will maintain co p ian a vith the Area Municipal Code, Chapter 9.12 and the de Sections 25505, 25533, and 25534. wner : "7` (p CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Nuork's for which this permit is issued (See. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19503 STEVENS CREEK BLVD CONTRACTOR: PALISADE BUILDERS INC PERMIT NO: 12040001 OWNER'S NAME: PALO ALTO, CA 94301 PHONE NO: (650)470-4700 ❑ LICENSED CONTRACTOR'S DECLARATION r. BUILDING PERMIT INFO: BLDG ELECT PLUMB' License Class Lic.# ECH ' MRESIDENTIAL COMMERCIAL Contractor h �l a 1 G �r (spate 6 '� % I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UNIT 237 - STRUCTURAL REPAIRS DUE TO WATER (commencing with Section 7000) of Division 3 of the Business & Professions DAMAGE Code and that my license is in full force and effect. TO INCLUDE: REPLACE 10'X9' EXTERIOR WALL FRAME, REPLACE (3)TJI FLOOR JOISTS, REPLACE SUB -FLOOR, 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 M,6- 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 w Jlich ay accrue against said City in consequence of the granting of this pernjnt. �Adiiionally, the applicant understands and will comply with all non -point s6irc r{cgu ations per the Cupertino Municipal Code, Section 9.18. Signature F� 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 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 harness 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: $25000 APN Number: 31649068.00 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:p / ""p 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 I will maintain complian}'e4wflh,the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety C�odef,Sec(ions 25505, 25533, and 25534. Owne"rsauElrurt LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Nwrk'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 CITY OF CUPERTINO W—W FEE ESTIMATOR — BUILDING DIVISION imADDRESS: , 19503 Stevens Creek Blvd #137 DATE: 04/06/2012 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$17,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildina is 3 Stories 0 Yes (F) No PENTAMATION PERMIT TYPE: WORK Revision #1: Repair water damage in master bathroom in unit #137 145 SQ FT). SCOPE Xh!cht Plon C'hcck Plnmb. Phm Check Elea. PI(m (hec% hXfech. Permit Feu: Phmib. N1770 Fe'e: r F/ce. Pemit PC": Ocher Atech. h7s/ Ocher Plumb layl), other El(,(. Insp. �i'Iccb. hup, Fae: Numb. hap. Fern: Elec, hup. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictriN. atr. L Thoco faa.v aro ha.vod nn tho nreliminary infarmotinn availahle and are only an estimate. Contact the Dent for addtt'I info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building i Suppl. PC Fee: Q Reg. 0 OT 0.0 17 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes ) No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0 0 lus $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onsirliclioll Tax: Adinillistrotive Fee: 0 G Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: $0.00 hours Inspections $260.00 ISTINSP Inspection, Hourly 0 Trure�l Docrur�Errtcrtii,lt rc�s': Strong Motion Fee: IBSEISMICR $1.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.70 $260.00 TOTAL FEE: $262.70 Revised: 04/01 /2012 Fm_ft CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 19503 Stevens Creek Blvd DATE: 04/02/2012 REVIEWED BY: Sean APN:, �- BP#: *VALUATION: $25,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-FamilyDwellin USE: g Buildina is >3 Stories 0 Yes Q No PENTAMATION 1 R2REM PERMIT TYPE: A WORK Structural repairs due to water damage to include: Replace 10'x9' exterior wall frame replace 3 TJI SCOPE floor joists, replace sub -floor, install finishes (draywall, tub, shower, fixtures, tile, flooring, stucco, etc.) A,lcch. Plaii c•hf ck P/1111,/5, Mori Checfi E/w, Pl(,r Ch�c�:/c A'fec/l. Perruit Fc>e: Ph(mb, Permit 1,e.e: Gtec, Permi7 Fc"e: Other Alech, hasp,E1__L_ Other Phmrh hasp. Otter Elec, 11?sp. A1ccch, Insp. Fcc: I Phrmh. hrsp. Fec: Elec. Jay, Fee: 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 available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-143-1 s.f. $588.00 Remodel, Bath (<=300 sf) IREAfl?ESBAT i Suppl. PC Fee: Q Reg. 0 OT T0,01 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg, 0 OT F0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cwl, rllclion Tax: rl(lnYilllstraill-v 1 4'; 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G) Building or Structure � TPC' vc/ Docilinc7ilotion Fees: Strong Motion Fee: IBSEISMICR $2.50 = hrs $41.00 Admin./Clerical Fee IADMIN Bldg Stds Commission Fee: 1BCBSC $1.001 SUBTOTALS: $3.50 $629.00 TOTAL FEE: 1 $632.50 Revised: 1/19/2012