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10070031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10293 NOEL AVE CONTRACTOR:JAYAKRISHNA MENON PERMIT NO: 10070031 OWNER'S NAME: JAYAKRISHNA MENON 10293 NOEL AVE DATE ISSUED:09/16/2010 OWNER'S PHONE: 4084546431 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑ License Class Lic.# ADD ONE BEDROOM W/BATH INSTALLING NEW BAY WINDOW Contractor Date IN MASTER BEDROOM&NEW WINDOW IN FAMILY I hereby affirm that I am licensed under the provisions of Chapter 9 ROOM&NEW (commencing with Section 7000)of Division 3 of the Business&Professions COFFER CEILING IN FAMILY ROOM(296SQFT) 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. Sq.Ft Floor Area: Valuation:$39000 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 APN Number:32647071.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t e Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' ns 25505 X533,a 5534. Section 3700 of the Labor Code,for the performance of the work for which this 6- permit is issued. Owner or authorized agent: ate: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature110_0"aAate jvo-2vv / CITY OF CUPERTINO ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# O Date: or/ Is a 2nd unit being added? Yes Er No ❑ If yes,please fill out the permit application for 2nd unit. Building Address: l G Mailing Address (if different from building address): 57/f A-7 Owner's N e. P one Contract r: ©��, hone#: J( Fax#: Cupertino Business Licensee l State Contractor License#: c�p• Contact: A/� L®� J jt"'�,T. Fax#Phone# / 0 Landscape Ordinance Compliance: n Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Building Pe Info: Bld . L9" Elect. [ - Plumb. E-- Mech. Hillside ❑ Job Description: .� Addition-What is being added?(Be Specific): O'� ex/or dO,r� w/�j �� 1�5 � //T � !fie �1 What is being remodeled(not including addition)? / I A,r w ao 0, j:!, 4 $ A- Remodel Includes Re-Roof: Yes ❑ No [ If yes list number of squares Remodel Includes Structural: Yes [, No ❑ Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a co of your planning approval letter. Planners name: Square Footage- Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction(Usage Class): -Occupancy T 1-A, 1-B ❑ II/III/V-A ❑ II/III B,IV-HT,V-B Valuation: Please check this l5ox if the project is a Project Size: Ex ress andard ❑ Lar e ❑ Ma•or❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. Revised 05/18/10 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex OVER THE APPLICATION 1 R3SFDADD/REM USE: COUNTER. ®Yes No TYPE: as cc 3 � TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. s .ft. PC FEES PC FEE ID BP FEES P FEE ID R-3 (Custom) II-B,111-B,IV,V-B 296 $1,438.00 IADDPL CK $1,169.00 JADDINSP TOTALS: 296 $1,438.00 $1,169.00 a 4cch. Pian T-T Plumb.Phar Check Ile"'. Plan C heclk ech. Permit Fee' Plurnh.Permit P ee: Elec.Permit Fce: Other rt,lech.,Irish. Other Plumb. hap. Other Dec.Insp. NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 E . 7,11/09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,438.00 = # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. ® OT R.701 hrs $0.00 $380.00 I WINREP V1 Replacement PME Plan Check: $0.00 Permit Fee: $1,169.00 Suppl. Insp. Feer Reg. ®OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 "onslrw;iion Tox Acoustical Fee: ®Yes Q No $0.00 Work Without Permit? 0 Yes (E) No $0.00 0 Platming Fee: PLLONGRNGR $38.48 Select a Non-Residential 0 Building or Structure 0 Travel hocurnewofion P'ec�s: Strong Motion Fee: $0.00 1 # Revision Bldg Stds Commission Fee: $0.00 $633.001 IREVRESADD Addition $3,658.48 $2,645.48 $1,013.00 T�O' AI.FEE. Revised: 6/30/2010