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