12060159CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10388 LANSDALE AVE
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class_ Lie.# p
ContractorDatin
eDateR_
I hereby am 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.
CONTRACTOR: PETER CONSTRUCTION PERMIT NO: 12060159
5925 TOMPKINS DR DATE ISSUED: 08/09/2012
SAN JOSE, CA 95129 PHONE NO: (408) 529-6412
BUILDING PERMIT INFO: BLDG T_ ELECT r PLUMB r
MECH r RESIDENTIAL r- COMMERCIAL I -
JOB DESCRIPTION: SINGLE FAMILY ADD WALK IN CLOSET, MASTER
BEDROOM(260 SQFT);REMODEL BATHROOM (66
SQFT)REMODEL LIVING AND KITCHEN AREAS (446 SQFT)
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.
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 Sq. Ft Floor Area:
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 regula ions per the Cupertino Municipal Code, Section
9.18.
Signature Date D
❑ 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 1 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.
APN Number: 36912007.00
Valuation: $50000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM L 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
Signare Q£�cant � 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner a
�/O�l//2.
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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
a
CITY OF CUPERTINO
FM-,7 FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
10388 LANSDALE AVE
DATE: 07/30/2012
REVIEWED BY: BOBS
APN: 369-12-007
BP#: 12060159
*VALUATION: $50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
SFD or Duplex
USE:
2nd Unit? Yes No
OTC.? 0 Yes GNo
PENTAMATION
1R3SFDADD
PERMIT TYPE: �
WORK
ADD WALK IN CLOSET MASTER BEDROOM 260 SF REMODEL BATHROOM 66 SF REMODEL
SCOPE
LIVING AND KITCHEN AREAS 446 SF
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
260
$1,482.00
IADDPLCK
$1,205.00
IADDINSP
TOTALS:
260
$1,482.00
$1,205.00
MECH, HOURLY 0 Yes O No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No
Ll
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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7111112
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,482.00
FETTI s.f.
$457.00
Remodel, Other
1REMRESOTH
Suppl. PC Fee: E) Reg. Q OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,205.00
Suppl. Insp. Fee-G) Reg.
Q OT
F0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G
Work Without Permit? Yes (j) No
$0.00
Advanced Planning Fee.
PLLONGRNGR
$33.80
Select a Non -Residential
Building or Structure
G
0
A
Strong Motion Fee:
1BSEISMICR
$5.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$2,727.80
$457.00
TOTAL FEE:
1 $3,184.80
Revised: 06130/2012
FM_7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10388 Lansdale Ave
DATE: 06/27/2012
REVIEWED BY: Sean
APN:
BP#:
*VALUATION: 1$75,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? , Yes •) No
OTC? 0 Yes GNo
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
of a master bedroom addition 181.69 s ft stud addition 22.5 s ft),livingroom
SCOPE
0onstruction
dition (30 sq ft), bedroom addition (75.75 sq ft). Remodel 850 sq ft of existing residence.
OCCUPANCY TYPE:
TYPE OF
FLR AREA
PC FEES
PC FEE ID
BP FEES
BP FEE ID
CONSTR.
s.f.
R-3 (Custom)
II-B,III-B,IV,V-B
310
$1,482.00
1ADDPLCK
$1,205.00
1ADDINSP
f
f
TOTALS:
310
$1, 2.00
$1,205.00
MECH, HOURLY O Yes (j) No
PLUMB, HOURLY Q es Q No
ELEC, HOURLY Q Yes Q No
�.. Flan
1,01 i114e.
hlec
(i,; r,� �,�ch. In.+r�.
U:•.•�;a f'/u rth lnrl�-
Oo'Ir:; ) % . Ins,r,.Li
flrsp' f^, c
Phrlfrtr. hrxp. [ell-
Elegy:. l w� ' Fcc.
NOTE: This estimate does not include fees due to other Depa nts (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary inforniation available and are onlv an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 711111)
EE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,482.00F
850 1 s.f.
$522.00
Remodel, Other
IREMRESOTH
Suppl. PC Fee: Q Reg. Q OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,205.00
Suppl. Insp. Fee-0 Reg. Q OT
0,0 ;
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
L r,ir,•tryrchon Tirv.
f
.!Chni.rrisfr•urive f ec'.
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
PLLONGRNGR
$40.30
Select a Non -Residential
Building or Structure
0
0
i
Tioii f Oocrrrrrr. ntelfin)o 11"' 8.
Strong Motion Fee:
1BSEISMICR
$7.50
Select an Administrative Item
Bldg; Stds Commission Fee: 1BCBSC
1 $3.00
r
SUBTOTALS:
1 $2,737.80
$522.00
TOTAL FEE:
1 $3,259.80
Revised: 06/30/2012