10090190CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10546 MANZANITA CT
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
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 regulations per the Cupertino Municipal Code, Section
9.18.
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:
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)
1, as owner of the property, am exclusively contracting with licensel to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following Ye
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 rev k
APPLICANT CERTIFICATION 1V
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 wil I comply
with all non -Point source regulations per the Cupertino Municipal Code, Section
9.18.- ` hh
Sienature � Date I I /) I I V
CONTRACTOR: VISVAMOHAN PERMIT NO: 10090190
BHAGAVATHY YEGNASHANKARA
10546 MANZANITA CT DATE ISSUED: 11/17/2010
CUPERTINO, CA 95014 PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: ADD ENTERTAINMENT ROOM & DECK OFF MASTER
BEDROOM
160 SQ FT; NO RE -ROOF & NO STRUCTURAL
Sq. Ft Floor Area: I Valuation: $16000
APN Number: 34261024.00 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// G�
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(x) 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 & Sat ty :a9_e
, Sections 25505, 25533, and 25534.
Owner ora o nt:
Date•I( / 0
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
CITYOF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10 S4r b MAN 2 Ary ITA
DATE: 6f 16 ao 10
REVIEWED BY:
PC FEE ID
APN:
BP#:
'VALUATION: 1$16,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / A ition / Repair
PRIMARY SFD or Du lex
USE: p
OVER THE
COUNTER? 0 Yes E)No
APPL ATION 1 R3SFDW
TY
WORK
$0.00
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
160
$965.
ADDPLCK
$934.00
IADDINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$934.00
Suppl. Insp. Fee.0 Reg.
0 OT
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
160
$965.00
1
1 $934.00
&MMIS
MECHANICAL O Yes 0 No
PLUMBING Q Ye`s Q No
ELEC I—CAL 0 Yes 0 No
_, ', l'�.,, [..hc..ck
1'l onb. Plan ChccF
L �.' Pl,w Chinch
P/,,//,. Per. -,;f ree.
Flec. Pt:: ., Fee.
llr•rh, In.SPF-1 I
Li I
0//IL,
omp, Fcte:
Ph!ul:',. bl.sp. CC,
$0.00
NOTE. These fees are based on the preliminary info4tion available and are only an estimate. Contact the Pt for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$965.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
s
$0.00
PME Plan Check:
$0.00
Permit Fee:
$934.00
Suppl. Insp. Fee.0 Reg.
0 OT
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consirw-Lion 7tTv
Acoustical Fee:
0 Yes Q No
$0.00
Q
0
Work Without Permit? Q Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$20.80
Select a Non -Residential
Building or Structure
0
0
I
TI-oi'r4 Doc runentcidon Fcrcs:
Strong Motion Fee:
IBSEISMICR
$1.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1,922.40
$0.00
TOTAL FEE:
1 $1,922.40
Revised: 8/12/2010
CITY OF CUPERTINO
F -M-7 FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS:
DATE:
REVIEWED BY:
PC FEE ID
APN:
BP#:
`VALUATION: 1$16,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
OVER THE
COUNTER. 0 Yes 0 No
PENTAMATION �Z3SFDAD�
PERMIT TYPE:
WORK
Elec. zsy. f'.:c:
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP EES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
160
$965.00
IADDPLCK
$934.00
IADDINSP
Elec. zsy. f'.:c:
$0.00
PME Plan Check:
$0.00
Permit Fee:
$934.00
Suppl. Insp. Feer Reg.
0 OT
0.0
hrs
$0.0
PME Unit Fee:
$0 0
TOTALS:
F 160
1 $965.00
$934.00
N ECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes. � No
LEC, HOURLYQ Yes, Q No
�1i°cat. tcrn t'heck
11tw1 +. Plcm
Hec; Plan Che(,k
Per...mi[ Fee:
irnh. Permit Fee,
EZ, r. Pe i�zi/ I cue:
Ocher ,liech. Insp.
CINx-r Plumb lav)
Li
O er Uec. Insp.
Li
14c(h. Imp. Pee:
Plumb. Gasp. Fee:
Elec. zsy. f'.:c:
NOTE: These fees are based on the nrelindnary information available and are'on1v an estimate. Cdtetact the Devt for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 7/1/10)
FEE
QTY/F E
M C ITEMS
Plan Check Fee:
$965.00
Select a Misc Bg/Structure
or El ent of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$934.00
Suppl. Insp. Feer Reg.
0 OT
0.0
hrs
$0.0
PME Unit Fee:
$0 0
PME Permit Fee:
$ .00
Consir7wtion Tal
Acoustical Fee:
0 Yes 0 No
$0.00
0
Work Without Permit? Q Yes 0 No
Planning Fee:
PLLONGRNGR
$20.80
Select a Non -Residential
Building or Structure
0
0
Truvel Docuinentulion Fees:
Strong Motion Fee:
IBSEISMICR
$1.60
Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 11
$11922.40
$0.00
TOTAL, FEE: 1 $1,922.40
Revised: 9/14/2010