HomeMy WebLinkAbout11120073BUILDING ADDRESS4
a 10815 BROOKWELL DR C
M
OWNER'S NAN)IE4
C
LICENSED CONTRACTOR'S DECLARATION
B
License Class Lic. #
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(CORHOCROlig With Section 7000) of Division 3 of the Business & Professions B
Code and that my license is in full force and effect,
I have and will maintain a certificate of consent to self4nsure for Worker's
Compensation, as provided for by Section 3700 of die Labor Code, for the
perforniance of the Work for which this pemiit 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,
A PDT TO A Nrr Jr11rDrrY17Ff�ArrYnV
L certity that 1 have read this application anU SLate 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 tionwpoint source regulations per (fie Cupertino Municipal Code, Section
t hereby affirm that I am exempt from the Contractor's I
[,as owner of the property, or my employees with wages as their sole compensation, in
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Business &r Professions Code) S
1, as owner of the property, ani 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
I have and will maintain a Ccr(mcate or Consent to seltminsure for Worker s
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the Work for which th is permit is issued. C
t have and will maintain Worker's Compensation insurance, as provided for by c
Section 3700 of (fie Labor Code, for (fie performance of the work for which this S
permit is issued. c
I certify diat in the performance of die work for which this permit is issued, I shalt it
not employ any person in any manner so as to become subject t ' o 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 0
forthwith comply with such provisions or this permit shall be deemed revoked.
MIL
nd hereby authorize representatives o
upon the above mentioned property for inspection purposes. (We) agree to save
indemnit�l and keep harmless the City of Cupertino against liabilities, judgments, L
costs� and expenses which may accrue against said City in consequence of the
granting of (his permit, Additionally, the applicant understands and will comply
with all rion�point source regulations per the Cupertino Ntunicipal Code, Section
9,18,
Signature Date L
TRACTOR: KRISHNAN
SARAVAKKANI S
IFT N04 11120073
133UUM Vz1Vt1zV1z
I I I I
ILDING PERMIT INFO: BLDG ELECT PLUMB
MECH' F, RE, SIDENTIAL COMMERCIAL
HROONI(I 00SQFT), NO ELECTRICAL OR LIGHTING
alled without first obtaining an inspection, I agree to remove all new materials for
ection.
nature of Date:
fety Code� Sections 25505� 25533, and 25534. 1 w
P ance W e upet no un c pa o " iap i a an e ea
ety Code, Section 25532(a) should I store or handle hazardous material.
ditionally, should I use equipment or devices which cinit hazardous air
tanduants as defined by the Bay Area Air Quality MaRageRICRit District I will
intain coin pliance With the Cupertino Municipal Code, Chapter 9.12 and the
alth & Safety Code, Sections 25505,25533, and 25534S
/ Date:
CONSTRUCTION LENDING AGENCY
I At'� P� i
\ �V, P
der's Address
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10815 brookwell dr.
DATE: 12/08/2011
REVIEWED BY: bobs.
Ila APN: f2b 2 ,
B P #: -Z
*VALUATION: 1$6,000
*PERMIT TYPE: Building Permit
s.f.
$588.001
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
I-0-.0-1
hrs
PENTAMATION 1R3SFDRE
I PERMIT TYPE:
WORK
and replace patio cover, remodel bathroom= no electrical or lighting.
SCOPE
[��e
Permit Fee:
$0.00
NOTE: This estimate does not includefees due to offier Departments (i. a Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the Preliminary information available and are on/v an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohition 11-053 Aff Z��l
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee:
$0.00
s.f.
$588.001
Remodel, Bath (<=300 sf)
IREAMESBAT
Suppl. PC Fee: (j) Reg. 0 OT
I-0-.0-1
hrs
$0.00
PME Plan Check:
$0.00
= # Covered Porch
$914.0011COVPORCH
Permit Fee:
$0.00
_F
SuppI.Insp.Fee-.(j)Reg. OOT
_T_
070
hrs
$0.00
PME Unit Fee:
$0.00-
PME Permit Fee:
$0.00
Con's1ructio"? 7`a'�_'
T
0
Work Without Permit? 0 Yes (D No
$0.00
Advanced PI qnniD_g_f ec.-
$0.00
Select a Non -Residential
Building or Structure
T7 I
0
0
A
Trav�d f_)o(,,mneP., icaion /'r:'�.W.'
Strong Motion Fee: IBSEISAffCR
$0.60
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SIUBTOTAILS:
$1.60.$1,502.001
TOTAIL FEE:
1 $1,503.60
Revised: 12/04/2011