14060004CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1448 S STELLING RD
CONTRACTOR: MUKHERJEE SHOUVIK
PERMIT NO: 14060004
AND ADITI
OWNER'S NAME:
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
CONSTRUCT ONE STORY ADDITION (434 SQ FT);
License Class Lic. N
BATHROOM
REMODEL ON SECOND FLOOR (40 SA FT); NEW ROOF
Contractor Date
STRUCTURE OVER (E) GARAGE (494 SQ FT)
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
Sq. Ft Floor Area:
Valuation: $60000
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
APN Number: 36617092.00
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,
--111Z�,
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 b Date:
Y�
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 beininstalled. if a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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)
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. 1 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 1 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 the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent:& " " "V� Date:
I rtify 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, 1
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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.
rSignature Dale
FM_71
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
1448 S STELLING RD
DATE: 06/02/2014
REVIEWED BY: MELISSA
PC FEE ID
APN: 36617 092
BP#: 7Moe2)
*VALUATION: 1$60,000
,-PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD Or Duplex
2nd Unit? Yes • No
OTC? 0 Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
ADD 434 S.F. TO 1ST FLR TO CREATE N LIVING & ENTRY AREA. REMODEL 40 S.F. OF 2ND
SCOPE
FLR DEI\J TO ADD (N) BATHROOM. RE -ROOF (E) GARAGE (60 SQ'S)
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
434
$1,579.00
IADDPLCK
$1,284.00
IADDINSP
$0.00
PME Plan Check:
$0.00
F600 s.f.
$96.00
Re -roof
IREROOFRES
El
$1,284.00
Suppl. Insp. Fee:(E) Reg.
Q OT
O.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
434
$1,579.00
$1,284.00
MECH, HOURLY
0 Yes
0
No
PLUMB# HOURLY
0
Yes
E) No
ELEC, HOURLY
® Yes
,• No
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F600 s.f.
$96.00
Re -roof
IREROOFRES
El
$1,284.00
Suppl. Insp. Fee:(E) Reg.
Q OT
O.0
hrs
$0.00
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 ha.ced on the nretiminary information available and are anly an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7;7:'13)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$1,579.00
= s. f.
$418.00
Remodel, Other
IREMRESOTH
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F600 s.f.
$96.00
Re -roof
IREROOFRES
Permit Fee:
$1,284.00
Suppl. Insp. Fee:(E) Reg.
Q OT
O.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G
Work Without Permit? ® Yes 0 No
$0.00
Advanced Planning Fee:
IPLLONGR
$60.76
Select a Non -Residential
Building or Structure
i
Strong Motion Fee:
IBSEISMICR
$6.00
Select an Administrative Item
Bldg Stds Commission Fee; IBCBSC
$3.00
SUBTOTALS:
$2,932.76
$514.00
TOTAL FEE:
1 $3,446.76
Revised: 04/01/2014