12010164CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10769 W ESTATES DR
CONTRACTOR: HJ INVESTMENT &
PERMIT NO: 12010164
DEVELOPMENT LLC
OWNER'S NAME: HJ INVESTMENT & DEVELOPMENT LLC
4049 MEZZAMONTE PL
DATE ISSUED: 03/09/2012
OWNER'S PHONE: 4089660087
SAN JOSE, CA 95148 .
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
1, . r
BUILDING PERMIT INFO: BLDG � ELECT PLUMB '
License Class Lie. N
F 1—
MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADDITION OF 1058SQFT TO LIVING,MASTER
(commencing with Section 7000) of Division 3 of the Business & Professions
SUITE,DINING,FOYER HALLWAYS AND FAMILY
Code and that my license is in full force and effect.
ROOM;REMODEL 222SQFT TO BATK200SQFT TO
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
Sq. Ft Floor Area:
Valuation: $250000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36923029.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.I8.
Issued by: Date:
Signature Date
OWNER -BUILDER DECLARATION
f1h,reby
RE -ROOFS:
affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
be deemed
Owner or authorized agent:
Date:—,��//Z
forthwith comply with such provisions or this permit shall revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature ' Date y
Licensed Professional
t-
CITY OF CUPERTINO
Fm--� FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
10769 W. Estates Dr
DATE: 05/14/2012
REVIEWED BY: Sean
APN:
I BP#:
*VALUATION: j$1,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP2
PERMIT TYPE:
WORK
Upgrade main electrical panel
to 200 amps.
SCOPE
APPLIANCE EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Services
1 ERT<20.0
200
Amps
$44
TOTALS:
$44,0(
'.4
4
C)i
Elec. Plan Check 0.0 hrs $0.00
F71-11
Elec. Permit Fee: IEPERAHT
E3
Other Elec. Insp. hrs
-0j L
L
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the Dreliminarv, information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E-ff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Ch"!)", 1"ec.-
SNOPLPC T-1
PME Plan Check:
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Administrative Fee: IADMN
$
Work Without Permit? 0 Yes 0 No
Feels-:
Travel Documentation Fee: ITRAVDOC
00
Strong Motion Fee: IBSEISMCR
$0.501
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00,
............ . .....
$174.501
$0.001
Revised: 04/01/2012
CITY OF CUPERTINO
ICI FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10769 W. Estates Dr
DATE: 01/27/2012
REVIEWED BY: Sylvia
APN:,3 A 3 L9
BP#:
VALUATION:
$250,000
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
god Unit? Yes No
OTC. 0 Yes ®No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
Addition of 1,058 sq ft to Living, M.Suite Dininq, Foyer, Hallway and Family room Remodel 222 sq ft to
SCOPE I
bath, 200 sq ft to kitchen, through out 390 sq ft add A/C, replace Furnace lighting and recep at garage
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
1,058
$2,438.81
IR3PLNCK
$1,586.38
IR3INSP
TOTALS:
1,058
$2,438.81
>:'::
$1,586.38
:'N.
# '?�C; �1'' '.� Y$$ ®l�Ia
Mech. Plan Check 0.0 hrs $0.00
< ...
Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: 1MPERMIT
_
Elec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs "00
Other Elec. Insp. 0.0 hrs $44.00
NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the nrelininary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (P'ee Resolution 11-053 Lf. 711,111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,438.81
222 s.f.
$588.00
Remodel, Bath (<=300 so
IREMRESBAT
Suppl. PC Fee: 0 Reg. ® OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
20 ss.f.
$588.00
Remodel, Kitchen (<=300 so
(REAP ESKIT
Permit Fee:
$1,586.38
Suppl. Insp. Fee-.0 Reg.
Q OT
0,0
hrs
$0.00
F-3907 ss.f. Remodel, Other
$457.00 IREMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee.:
$88.00
#
$260.00
Mechanical
IWR=<100 Furnace, Forced -Air
4 1#
$65.00
Electrical
1BREMFLKT Fixtures, Lighting
0
G
Work Without Permit? C) YesA No
$0.00
Advanced Planning Fee:
PLLONGRNGR
$137.54
Select a Non -Residential
Building or Structure
G
0
Travel Documentation Fee: ITRAVDOC
$44.00
Strong .Motion. Fee:
1BSEISMICR
$25.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$10.00
......... .... .
:..U..::.:
4
$ 329.73
1 958.00
E
1I,fi .
6,287.73
,
Revised: 1 /19/2012
���-�,,� CITY OF CUPERTINO
I NI FEE ESTIMATOR — BUILDING DIVISION
iaADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
'VALUATION:
Iso
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP10
PERMIT TYPE:
WORK
SCOPE
FTElec. Plan Check 0.0 hrs
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs -$4'M
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District; School
District. e n ). These feet are haled an the nrelininam infarmatian availahle and are nnly an estimate C onlact the Dent fnr addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E . Z/1/11)
FEE
QTY/F.EE
MISC ITEMS
Plan Check Fee:
$0.00
F-67 #
$44.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: Q Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
-gip
Administrative Fee: IADMIN
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC
�$#@@�
Strong, Motion Fee:
$0.00
Select an Administrative Item
6 0
Bldg Stds Commission Fee:
$0.00
$44.00
::: `:::::..::::::::. T..' TA ; 9-V.
Revised: 1 /19/2012