14050071 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10310 PLUM TREE LN CONTRACTOR:BRIGHTON BUILDERS PERMIT NO: 14050071
LTD
OWNER'S NAME: RAO MANJUNATH S AND RAMACHANDRA SHI PO BOX 3104 DATE ISSUED:06/18/2014
OWNER'S PHONE: 4088738224 LOS ALTOS,CA 94024 PHONE NO:(650)787-6255
01 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
nn �p CONSTRUCT ONE STORY ADDITION(381 SQ FT);
License Class Lie.# 6 13 So� INTERIOR
Contractor N�i/�f7w• K✓i Date REMODEL(621 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:
1 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
0rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100500
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:31633015.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 P SUANCE 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 FR STC 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 y: Date: l
with all non-point source regulations per the Cupertino Municipal Code,Se
9.18.
6 l/�� any
r 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
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)
1,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.I2 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 the Cupertino Municipal Code,Chapter 9.12 and
1 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
Owner or authorized agent: Date:
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 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
1 certify that I 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 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.
Signature Date
CONSTRUCTION PERMIT APPLICATION
[a COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V
CUPERTI;NO (408)777-3228 • FAX(408)777-3333 • buildina(a,cupertino.orq I
❑NEW CONSTRUCTION ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
10 3 10 ��;,� Tie� L v►
OWNER NAME � PHONE �+ c�L ,-MAIL
STREET ADDRESS „ CITY, STATE,ZIP FAX
S%.Nrrz
CONTACT NAME ( ,^ ` . PHONE (/�� -+�/ E-MAIL '541c
STREET ADDRESS CITY,STATE,_ZIP 7FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME Gj n LICENSE NUMBER ! >r BUS.LIC d
I l
COMPANY NAME E-MAIL `- (� FAX
�5 YN eC L' ll� f is l
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STREET ADDRESS CITY,STATE,ZIP PHONE
40 ,-- I -o it
DESCRIPTION OF WORK
ba-fn
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
/2 I USE TYPE OCC. SQ FT. VALUATION(S)
EXISTG NEW FLOOR DEMO V C-21TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA 1.a v REMODEL AREA s'"-P REMODEL.AREA
PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
k DWELLING UNITS. IS A SECOND UNIT ❑YES SECOND STORY []YESBEINGADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE(tEltEDIBY TOTAL VALUAON:
PLANNING APDL N F1 NO PLANTING APPROVAL LETTER EICHLER HOME? ❑NO I +o 0 C)
By my signature below,I certify to each of the following: I am the property owner or author d a ent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work an verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating touil g construction. I autho7ize representatives of Cupertino to enter the above-identi ed pro rty for inspection purposes.
1
Signature of Applicant/Agent: Date: Z
S -2,01
SUPPLEMENTAL INFORMATItNREQUIRED rL�ycHECK�mE RouT>IacsilP. , :,,
New SFD or Multifamily dwellings: Apply for demolition permit for )] ovER CHE coUIVTER BIJIiDIIvcPLAxREfEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EAPRESS ,rLAxriINCPLAxREvtEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. Q LARGE fl FIRE DEPT r
Copy of Planning Approval Letter or Meeting with Planning prior to
ALIJOR n SAxITARX,EKv RDISTRICT
submittal of Building Permit application. .qw
❑ `ENVIRONMENTAL
"HEALTH
BIdgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
Q �'E ESTIMATOR- BUILDING DIVISION
ADDRESS. DATE: 05/12/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $100,500
RPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes .' No PENTAMATION 1 R3SFDADD
USE: FOTC? 0 Yes E)No PERMIT TYPE:
WORK 381 sq ft addition to side of sfdwl remodel 621 of existing to include m e 's
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.f.
R-3 (Custom) II-B,111-B,IV,V-B 381 $1,579.00 IADDPLCK $1,284.00 IADDINSP
TOTALS: 381 $1,579.00 $1,284.00
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ® Yes (DNo_
ET El
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,579.00 = s.f. Remodel,Other
Suppl.PC Fee: (F) Reg. 0 OT f 0.0 hrs $0.00 $558.00 IREMRESOTH
PME Plan Check: $0.00
Permit Fee: $1,284.00
Suppl. Insp. Feer Reg. Q OT ro.flhrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning Fee: 1PLLONGR $53.34 Select a Non-Residential 0
Building or Structure
Strong Motion Fee: IBSEISMICR $10.05 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $5.001 1
SUBTOTALS: $2,931.39 $558.00 TOTAL FEE: $3,489.39
Revised: 04/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical 57 ifX L C[?R+ e-
Excavation
Fencing
Flooring / Carpeting
1/ Linoleum/Wood R E l/D U S 1 c2 73 Zal7z
Glass/ Glazing
V Heating AIA P j--sj
V- Insulation q CC UkA?C Flk CS;roP 3
Landscaping
Lathing
Masonry
✓ Painting/Wallpaper 'F'v Te 'S ftq(yi T I G 3
Paving
Plastering
I� Plumbing L A PL LAM 10/,v
Roofing GoL-Dkn• p0�1� G o2 at
Septic Tank
Sheet Metal
Sheet Rock A M P R y w A L
V Tile L' 1�► (� & A (3 5/'1/
Owner/Contractor Signature Date