13010124 BUILDING ADDRESS: 10642 RANDY LN CONTRACTOR:ALVARADO PERMIT NO: 13010124
CONSTRUCTION
OWNER'S NAME: VIVEK DEO 1001 JACKSON ST DATE ISSUED:04/10/2013
OWNER'S PHONE: 4086490412 SAN JOSE,CA 95112 PHONE NO:(408)799-9918
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL
License Class L_ Lic.# CONSTRUCT A 423 SQ FT ADDITION AT REAR OF
A�]
RESIDENCE;REMOVE AND REPLACE FURNACE;
Contractor Ap V ) tira Date4�''-- 3 DEMOLISH
➢hereby affirm that I am licensed.under the provisions of Chapter 9 NON-PERMITTED 231 SQ]FT]PATIO AND INTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions WALLS
Code and that my license is in full force and effect. "V#12AgDgD(1)DESIGNATED GAS LINE&2(N)PLUMBING
➢hereby affirm under penalty of perjury one of the following two declarations: FIXTURES FOR(N)LAUNDRY AREA IN DETACHED GARAGE-
ISSUEDI have and will maintain a certificate of consent to self-insure for Worker's 10/7/20fl3
Compensation,as provided for by Section 3700 of the Labor Code,for the
erformance of the work for which this permit is issued. Sq.Ft Floor Are Valuation:Valuation:$65000
have and will maintain Worker's Compensation Insurance,as provided for by u
Section 3700 of the Labor Code,for the performance of the work for "
IM" N Number:31602066.00 Occupancy Type:
permit is issued. ,
APPLICANT CERTIFICATION Q
I certify that I have read this application and state that the abovFinformation is PERMIT EXPIRES IF WORK IS NOT STARTED
EIlD
correct.I agree to comply with all city and county ordinances and state laws relating �II� Ili®����OF PERMIT ISSUANCE®�
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 Y� ROM LAST CALLED�R1$ll']E � ON*
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the G c�
granting of this permit. Tonally,thea understands and will comply Issued by- Date: 7
with all non-point so a re lations e C rtino unicipal 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
➢hereby affirm that➢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)
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 9.12 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 Ara Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the C e?921
ti Muni ' al ode, liter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 2550 ,255 an 3 /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen D a toh, -0
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,l 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.l 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.
Signature Date
(CII'I'ZY OF cCNIIDER'I<'NG
FEE IES'I<'MATOR— BUILDING DIVISION
ADDRESS:. 10642 RANDY LANE (DATE: 10/07/2013 REVIEWED BY: MELISSA
APIA: 316.02 066 BP#: 13010124 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPGA i
WORK REV# 1 -ADD N DESIGNATED GAS LINE & 2 N PLUMBING FIXTURES FOR N LAUNDRY
SCOPE AREA IN DETACHED GARAGE
.tech. Alan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan ck
F"1711,. I'ertuit Fee: Plumb.Permit Fee: 1PP MIT Elec. Permit Fee;
Other;11ech.Insp. TEDT-t
Other Plumb Insp. 0.0 hrs $47.00Ll,, l
.Insp.
He& Insp. Fe(.. Ahunb. Insp. Fee: .Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,e(a . TheseLees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l in o.
IEEE ITEMS (Fee Resolution 11-053 E . 7/1/13) IEEE QTY/FEE MISC I'T'EMS
Plan Check Fee: $0.00 0 # Plumbing
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $70.00 1PGASRES Piping,Gas<=4 Outlets
PME Plan Check: $0.00 = # Plumbing
Permit Fee: $0.00 $20.00 1BPFIXTURE Fixture set on One Trap
Suppl. Insp.Fee,0 Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes E) No 00
Advanced Planning Fee: Select a Non-Residential I)
Travel Documentation Fee: 1TRAVDOC $47.00 __L= Building or Structure 0
i
StronjZ Motion Fee: $0.00 Select an Administrative Item or
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $138.00 1 $90.00 'TOTAL FEE: $228.00
Revised: 10/01/2913
CTY OF CU PIEI[8TffNO Buff LDIING PERMIT
BUILDING ADDRESS: 10642 RANDY LN CONTRACTOR- -T&BE- PERMIT NO: 13010124.
eETER1Gi1NLD
OWNER'S NAME: VIVEK DEO ��(2 DATE ISSUED:04/10/2013
OWNER'S PHONE: 4086490412 PHONE NO:
❑ LICENSED CONTRACTOR DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class_ Lic.# t 1,�RJ � CONSTRUCT A 423 SQ FT ADDITION AT REAR O1F
Q RESIDENCE; REMOVE AND REPLACE FURNACE;
Contractor�`tlf?tr�iYJID CQ JAZ . Date — 3 DEMOLISH
I hereby affirm that I am licensed under the provisions of Chapter 9 NON-PERMITTED 231 SQ FT PATIO AND INTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions WALLS
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:$65000
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:31602066.00 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 relatingWp p HIN ® AYS O]F 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 DAY OM]LASS'CALLED 1(Rl�lP C 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 pe ditionally,the p cant understands and will comply Issued by: IDate: .
with all non-poi sot ou ce/egulations r the upe unicipal Code,Section
9.18.
RE-ROOFS:
Signatu 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:
I hereby 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 25532(a)should I store or handle hazardous
I have and will maintain aCertificate 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 Awa Air Qu#y Management District I
performance of the work for which this permit is issued. will maintain compliance with the99 e 'r o Muni i I Codi, hapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 255 ,2553 ,a 25534 /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: -�Q-(
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
I certify that 1 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...
Signature Date
(CI«'1Y ®IF cCUP EI[BTIIN®
FEE IESTMATOR—BUff .DffNG DWISI O N
ADDRESS: 10642 RANDY LN DATE: 0112312013 REVIEWED BY: MELISSA
APN: 31.6 02 066 BP#: 3� *VALUATION: 1$65,000
*PERMRT TYPE: Building Permit PLAN CHECK TYPE: Addition
PREMA Y 2nd Unit? Yes ° No PENTAMATIION
USE: SFD or Duplex OTC? C)Yes C)No PERMIT TYPE: 1 R3SFDADD
WORKREAR ADDITION OF 423SQ FT TO ENLARGE E BEDROOM & FAMILY ROOM $ADD 1 N FULL
SCOPE BATH
OCCUPANCY TYPE: TYPE OF FIL][Z AREA PC]FEES PC]FEE IID BP FEES BP]FEE YID
CONSTR. s.>f
R-3 (Custom) II-B,III-B,MV-B 423 $1,512.00 IADDPLCK $1,230.00 IADDINSP
TOTALS: 423 1 $1,512.00 $1,230.00
MECH,HOURLY 0 Yes (E) No PLUMB,HOURLY () Yes E) No ELEC,HOURLY () Yes No
Mech. Non Clieek Plumb.Plarn Check Elec. Plan Check
.�Lf ll.h. Permil'Fe'e: [Plumh. Permil Fee: Elec. Permit Fee:
Other Afech.Insp. 01her Plumb Insp. Olber F.,lec.Insp.
Alech.Imp.Fee: Plumb. lisp. Fee: Elec.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. . TheseLees are based on the prelimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Tee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,512.00 = s.f. Re-roof
Suppl. PC Fee: 0 Reg. 0 OT 0,0 �±r_s $0.00 $45.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $1,230.00
Suppl. Insp.Feer Reg. 0 OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: 0
Work Without Permit? C) Yes E) No $0.00
Advanced Planning Fee: IPLLONGR $54.99 Select a Non-Residential 0
Travel Doccrinentution Fees:
Building or Structure 0
Strong Motion Fee: IBSEISAffCR $6.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $3.00
SUBTOTALS: $2,806.49 $45.00 TOTAL FEE: $2,851.49
Revised: 10/01/2012