11110012I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10401 PLUM TREE LN I CONS CONTRACTOR:
MENLO OAKS I PERNHT NO: 11 110012
OWNER'S NAAIE:
j MENLO PARK, CA 94025 I PHONE NO: (650)329-0245
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #/�` 7 �� 7
Contractor t' I42 n /p o g �- 6j [D
pate • 3 Zv t 3
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 ��:k 11 this
permit is issued. t
APPLICANT CERTIFICATION lY
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 thi enni Additiot ally, the applicant understands and will comply
with all non point
J 2 v
❑ 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 (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 count)' 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.
I- F I_..
BUILDING PEWMIT INFO: BLDG ELECT PLUMB
I__ (__ 1_..
MECII RESIDENTIAL CO\4MERCLkL
JOB DESCRIPTION: SFDWL ADDITION MASTER SUITE,OFFICE,ENTRY,2
BEDROOMS,PANTRY=1113SQFT; REMODEL 2
BEDROOMS,BATH(30SQFT),KITCHEN(196SQF"f), REPLACE 5
Sq. Ft Floor Area: I Valuation: $300000
I APN Number: 31633022.00 1 Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ,- Cf Date-t„„-%!
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. Il'a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appl
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 IIealth & 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 i\lunicipal Code, Chapter 9.12 and
the Health & Safety Code, Sections
, ION 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 A
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
Signature
Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19 ADDRESS: 10401 plum tree In.
DATE: 11/02/2011
REVIEWED BY: bobs.
APN: �'3& �,3
BP#: / C% / ,;�
`VALUATION: 1$300,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE SFD or Duplex
2nd Unit? Yes '' No
OTC? 0 Yes 0 No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
add master suite office entry,2 bedrooms ant 1113 s.f, remodel 2 bedrooms bath kitchen
SCOPE
�sfd
443 s.f., replace 5 windows, add A/C unit, replace light fixtures, outlets, switches.
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
1,113
$2,457.62
IR3PLNCK
$1,653.76
IR3INSP
TOTALS:
1,113
$2,457.62
$1,653,76
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
Mech. Permit Fee: IMPERMIT
Lr Mech. Insp. 0.0 hrs $44.00
Odle), 'irow" t,, p.
f^£;'£'
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 nrelininary information available and are ondv an estimate. Contact the 1) t far addn'l info.
FEE ITEMS (Fee Resohrtion 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,457.62
F-301 s.f.
$588.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
196 s.f. Remodel, Kitchen (<=300 sf)
$588.001REMRESKIT
Permit Fee:
$1,653.76
Suppl. Insp. Fee:E) Reg. 0 OT
0,0
hrs
$0.00
217 sf Remodel, Other
$392.00 IREMZESOTx
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
0 #
$65.00
Mechanical
IBREMAIR A/C Units (<=10K elm)
t;"<rrt. r za:fi : 1;sr3;
#
$392.00
Window / Sliding Glass Door
IWINREP Replacement
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee: PLLONGRNGR
$144.69
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee: IBSEISMICR
$30.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$12.00
SUBTOTALS: 1
$4,386.07
$2,025.00
TOTAL FEE:
1 $6,411.07
Revised: 10/01/2011
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10401 plum tree In.
DATE: 11/02/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: $0
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 RMAP8
PERMIT TYPE:
WORK
sfd add master suite office entry,
2 bedroomspantry 1113 s.f. remodel 2 bedrooms bath kitchen
SCOPE
443 s.f., replace 5 windows, add A/C unit, replace light fixtures, outlets, switches.
Mech. Plan Check 0.0 hrs 0.00
.`'i<iJju;. 1c-; C'Irr r 1,
Elea Plan Check 0.0 hrs $0.00
Mech Perms-t-Fe . E T
ti Ffr�z=<fr, ;'cr,r; F�r:<>:
Elec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs $44 00
r}}�i;r ,' F>i; :1=;; 1J : ;:.
Other Elec. Insp. 0.0 hrs $44.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. Thesefees are based on the preffidna information available and are only an estimate. Contact the Dew for addn'l into.
FEE ITEMS (lee IZesohaion 11-053 Eff. ZjU
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$110. 0 Oj
Mechanical
IBREMVENF Ventilation Fan
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
110 Electrical
$314.00 IBREMRECEP I Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0 0
hrs
$0.00
55 Electrical
$205.00 IBREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
Administrative Fee: IADMIN
$41.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fee: 1TRAVDOC
$44.00
Strom Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$173.00
$629.00
TOTAL FEE:
$802.00
Revised: 10/01 /2011