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12120005CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 12120005 10500 MADERA DR CUPERTINO CA 95014 (326 35 052) � I I OWNER'S NAME: SESHAADRI VENKATRAMANAN AND AMR ITHA DATE ISSUED: 04/17/2013 OWNER'S PHONE: (408) 910-8721 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor Date —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: 165 SQFT BATH ADDITION I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self -insure for Worker's DEF# I - TRUSS CALC'S FOR ADDITION -ISSUED Compensation, as provided for by Section 3700 of the Labor Code, for the 5/24/2013 performance of the work for which this permit is issued. z I have and will maintain Worker's Compensation Insurance, as provided for by REV# I - ADD 3 SKYLIGHTS TO (E) SCOPE OF WORK - Section 3700 of the Labor Code, for the performance of the work for which this ISSUED 5/24/2013 permit is issued. Sq. Ft Floor Area: Valuation: $35000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above _ APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances I state laws relating to building construction, and hereby authorize 32611011 representatives of this city to enter upon the above mentioned property for ,and inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: Legac Date: 04/17/2013 OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. f, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: r. f have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, ;judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF C>< P E>E8TENO BUILDING PERMIT BUILDING ADDRESS: 10500 MADERA DR CONTRACTOR:SESHAADRI PERMIT NO: 12120005 VENKATRAMANAN AND AMRITRA OWNER'S NAME: SESHAADRI.VENKATRAMANAN AND AMRITHA 10500 MADERA DR DATE ISSUED:04/17/2013 OWNER'S PHONE: 4089108721 CUPERTINO,CA 95014 PHONE NO: 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class Lic.# 165 SQIFT BATH[ADDITION Contractor Date IIDEIF#I -TRUSS CA]LC'S FOR ADDITION-ISSUED 5/24/2013 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions REV# I -ADD 3 SKYLIGHTS TO(E)SCOPE OF WORK- Code and that my license is in full force and effect. ISSUED 5/24/2013 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:$35000 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:32635052.00 Occupancy Type: permit is issued. APPLICANT CERTIFICA'T'ION 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 ���������A��®� PERMIT ISSUANCE ®� to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 1180➢DA�Y�1,gLAST CALLED I NSPECT]ION. 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 T Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: ignature 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 Signature of Applicant: Date: he affirm that I am exempt from the Contractor's License Law for one of 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 25 (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 se equ ent 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 r Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit the Cup t o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S tions 33,a�qd 25534. / / Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 l 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 CERTIFICA'T'ION 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 expens w ich ma crue against said City in consequence of the I understand my plans shall be used as public records. granting of this unit.Addit' Ily,the applicant understands and will comply with all non-pop t souipe re iokss per thKupertino Municipal Code,Section Licensed Professional 9.18. Signature Date ✓G, ?4 [15 CITY OF SCUP EIE TINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10500 ROADERA DR DATE: 05/24/2013 REVIEWED BY: MELISSA APN: 326 35 052 ]BP#: 12120005 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1GENRES� YORK REV# 1 -ADD 3 SKYLIGHTS TOE SCOPE OF WORK SCOPE Af ch. Plan Check Phrn L Plan Check Elec,Plan Check htech. Perwil f'ee: Plumb. Permil Fee: Clec. Permit Fec:: Other llech.Insp. ED Other Plumb Insp. Other Elec.Insp. Hech. lnsp.Pee Plumb. hrsp.Fee: h'lec,Insp. Fee: NOTE;This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These Lees are based on the prelimina information available and are onl an estimate. Contact the De t Lor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 2 hours Plan Check,Hourly Suppl.PC Fee: E) Reg. (0 OT 0.0 hrs $0.00 $266.00 1STPLNCK <= 10 s.f PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-E) Reg. 0 OT p p hrs $0.00 PME Unit Fee:. $0.00 PME Permit Fee: $0.00' Construction lax: Administrative 1F eco: Q Work Without Permit? 0 Yes E) No $0.00 Advanced Plannin Fee: $0.00 Select a Non-Residential hxrrel Documentation Fees: Building or Structure. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.00 TOTAIL FEE: $266.00 Revised: 04/29/2013 CITY OF cCUP EI[ TINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 30500 RAADERA DR DATE: 05/24/2013 REVIEWED BY: MELISSA APN: 326 35 052 B?#: 12120005 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: 1GENRES� woRK DEFERRED SUBMITTAL FOR TRUSS CALC'S FOR BATHROOM ADDITION SCOPE ltecA Plan Check. Phmtb, Plum Check Dei:.Plan Check llech.Permit I ee: Plumb. Permit Fee: L+'lec. Permit Fee: Other Llech,Insp. Other Plumb Insp. Other Elee.Insp. El Hech.Insp.Fee: Plumb. his). Fee: Elec.Insp.I,cc: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). TheseLees are based on the prelimina information available and are onl an estimate. Contact the De t or addn'l in o. FELE ITEMS (Fee Resolution 11-053 L•f 711112) FEE QTY/]FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes E No $0.00 1 hours Plan Check,Hourly Suppl. PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $133.00 1STPLNCx PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. OTp,p �hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Feer: Building or Structure 0 Stroniz Motion Fee: $0.00 Select an Administrative Item Bids Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $133.00 TOTAL FEE: $133.00 Revised: 04/29/2013 ;F .4 OF CU PlERTM HUIDLWNG IPIERMffT BUILDING ADDRESS: 10500 MADERA DR CONTRACTOR:SESHAADRI PERMIT NO:.12120005 VENKATRAMANAN AND AMRITHA OWNER'$NAME:.,SESHAADRI VENKATRAMANAN AND AMRITHA 10500 MADERA DR DATE ISSUED:04/17/2013, I' . OWNER'S PHONEi;'4089108721 CUPERTINO,CA 95014 PHONE'NO: ❑ LICENSED CONTRACTOR'S IItACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS SQ FT IFT BATH ADDITION Class ,�•I � '.Lac.# 16 ' Contractor Date A hereby affirm that'fl 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. Sq.Ft Floor Area: Valuation:$35000 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:32635052.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify Oat,Ihave read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STERT7E>(D ' correctA agree,to comply with all city andcounty ordinances and state laws relating ����� ®����®� PERMIT �������� ®� 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 DA IF M LAST CA>(.11.,IED INSPECTION.:. . indemnify'ani 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 perriiit; .?additionally,the applicant understands and will comply Issued by: Date:I �3• withal non-point souice!regulations per the Cupertino Municipal Code,Section 9.18.' 1 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 L Signature of Applicant: Date e I herby affirm thaf.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 I,as.owner of the property,of my employees with wages as their sole compensation, will do th'e'wor'k,,and the(structure isnot intended or offered for sale(Sec.7044, he's ! „ Business&Professions Code) I,as owner of the,propert'Irn 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 I'i i'',' 1 1. I'; i' .! II I ' 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:i;I;.''i;��I , .I.I' " 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 1 use equipment or devices which emit hazardous n•::. :: i 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 perfor"mance 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 thetAbor Code for the performance of the work for which this pa Owner or authorized agent: Date: t tP7P permitis issued I certify that in the perlfor•mance of the work for which this permit is issued,I shall not employ,any person im any manner so as to become subject to the Worker's Compensation;lawsio f 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 ' work's for which this permit is issued Sec.3097,Civ C. forthwith comply,with-such provisions or this permit shall be deemed revoked. P ( ) !;•; ' . • L Lender's Name APPLICANT CERTIFICATION Lender's Address ! I certify,that I have read this application and state that the above information is correct.'llagree;to cort!ply;'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 6ty of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION . costs,and expenses w'icb may!accrue against said City in consequence of the I understand my plans shall be used as public records. grantingof this pi nm Additionally,.the applicant understands and will comply i ! •I � with Ali Irron porn[source ire ulations per the Cupertino Municipal Code,Section Licensed Professional 9.18 �i ill I �II IIIc �� SignatureDate I 4 cCUTY OF cCUP ER'I NO FEEIES'I'II\YIIA'I'®lL�—BUU LDffNG DIVISION A DDRESS: 90500 Madera Dr. DATE: 12/03/2012 REVIEWED BY: RDW PN: BP#: �� �_ *VALUATION: ION: $35,000 *PERMIT TYPE: Building Permit ELAN CHECK TYPE: Addition PRIMARY 2nd Unit? Xes No PENTAMATION USE: SFD or Duplex OTC? 0 Yes 1 R3SFDADD t�No PERMIT TYPE: WORK 165 sq/ft bath addition. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE IID BP FEES BP FEE IID CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 165 $1,014.00 IADDPLCK $983.00 IADDINSP TOTALS: 165 $1,014.00 $983.00 M.ECH,HOURLY Yes No PLUMB,HOURLY ® Yes Q No ELEC,HOURLY ® Yes Q No Mech. Plan(heck Plumb, Plan Check Elec.Plan Check 1 fech. Permit Fee: Plumb.Permit Fee: L'fec.Permit Fee: Other Alech.Insp. . Other Plumb Insp. Other Elec.Insp. Aleck.Insp. Fee: Plumb. hasp. Fee: I:lee.Insp.Fee: 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 relimina information available and are onl an estimate. Contact the De t for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,014.00 Select a Misc Bldg/Structure Suppl.PC Fee: E) Reg. () OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $983.00 Suppl. Insp.Feer Reg. 0 OT 0,0 hrs $0.00 ^� �Y PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswuction.Tar: -A din inistrative.Fee: Work Without Permit? 0 Yes E) No $0.00 0 Advanced Planning Fee: IPLLONGR $21.45 Select a Non-Residential Q T rcn-el Documentation Fees: Building or Structure 0 Strong Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $2,023.95 $0.00 TOTAL FEE: 1 $2,023.95 Revised: 10/01/2012