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11030087I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10447 N BLANEY AVE OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class I ` Lic. # 9 � I'1 ( 1 \ Contractor e_ V V n R j v e QQDate 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: 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. I have and will maintain Worker's Compensation Insurance, as provided for by 1� Section 3700 of the Labor Code, for the performance of the work for which this V 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 er the Cupertino Municipal Code, Section 9.18. Signature Date 2 1 ❑ 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. 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. 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, 1 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. 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. CONTRACTOR: MORE LAND PERMIT NO: 11030087 CONSTRUCTION 5514 AMBY DR DATE ISSUED: 04/29/2011 SAN JOSE, CA 95124 PHONE NO: (408)221-0892 JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL SFDWL ADDITION(940SQFT)2 BEDROOMS, 2 BATHS,FOYER & EXTENSION OF FAMILY ROOM & REMODEL BATH(80SQFT), REMODEL KITCHEN(300SQFT),LIVING ROOMIOTHER Sq. Ft Floor Area: I Valuation: $100000 APN Number: 31633111.00 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: - 2,5—; 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 Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2550 3, and 25534. Owner or authorized agent: 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT"`'""""" BUILDING ADDRESS: 10447 N BLANEY AVE CONTRACTOR: MORE LAND T NO: 11030087 CONSTRUCTION OWNER'S NAME: SAN JOSE, CA 95124 PHONE NO: (408)221-0892 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. q It 1 Contractor ������ Date 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: 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 re ulati a Cupertino Municipal Code, Section 9.18. p 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) 1, 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, 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 MECH r RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: SFDWL ADD1TION(940SQFT)2 BEDROOMS, 2 BATHS,FOYER & EXTENSION OF FAMILY ROOM & REMODEL BATH(80SQFT), REMODEL KITCHEN(300SQFT),LrV NG ROOM/OTHER �- 3c�- ► (- el-kl� 41- �+ -a1 i 5l-• iF�c I O Sq. Ft Floor Area: I Valuation: $100000 APN Number: 31633111.00 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 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections,2550 , 2!�533, and 25534. Owner or authorized CONSTRUCTION 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 Signature Date I understand my plans shall be used as public records. Licensed Professional r-7- CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10447 n. blaney ave. DATE: 08/30/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise exisitnq kitchen joists and shear wall. SCOPE YIIv , T," -- .e':'rl ILSf>. �[?r?. imp r i ' T ,.. h::tt: NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 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 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �,rarls�Y�t�'lAUrd 1i�.� Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Plannin Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i T-uve( Strong Motion Fee: IBSEISMCR $0.50 # $0.00 Revision IREVRESADD Addition Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $130.00 TOTAL FEE: $131.50 Revised: 07/04/2011 CITY OF CUPERTINO Fm-M FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10447 n. blaney ave. DATE: 03/17/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: j$100,000 *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 2 bed and bath foyer, familyroom remodel kitchen and bath living,and dinin . SCOPE Add A/C unit and 4 skylights. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.t PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 940 $2,349.00 IR3PLNCK $1,474.00 IR3INSP TOTALS: 940 $2,349.00 $1,474.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No Mech. Plan Check 0.0 hrs $0.00 77 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs $42.00 ; ,. NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/1110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,349.00 80 s.f. $570.00 Remodel, Bath (<=300 so IREMRESBAT Suppl. PC Fee: G Reg. 0 OT 0.0 1 h. $0.00 PME Plan Check: $0.00 300 s.f. $570.00 Remodel, Kitchen (<=300 so IREMRESKIT Permit Fee: $1,474.00 Suppl. Insp. Fee.-G Reg. 0 OT 0.0 hrs $0.00 500 s.f. Remodel, Other $443.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $42.00 1 # $697.00 Skylight 1SKYL>10SF > 10 s.f. onsp-r cfit :n 70E-1 Acoustical Fee: 0 Yes (F) No $0.00 0 # $63.00 Mechanical 1BREMAIR A/C Units (<=10K cfrn) 0 E) Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: PLLONGRNGR $122.20 Select a Non -Residential Building or Structure 0 0 Travel Documentation Fee: ITRAVD0C $42.00 Strong Motion Fee: IBSEISMICR $10.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $4,043.20 $2,343.00 TOTAL FEE: $6,386.20 Revised: 01 /15/2011