12040069CITY OF CUPERTINO BUILDING PERMIT
Blit LDING ADDRESS: 10430CHERRYTRITI-N
CON'1'ItACfOR: IiRI(il I'fON DUILUI(RSd:fU
PER]IITNO:12040069
O\VN ER'S NAME: PI IANINDRA YARLAGADDA
PO BOX 3104
DA'I'F: ISSUED: 05/150012
OWN'ER'S PHONE: 4087575251
LOSALI'OS,CA 94024
PIIONENO: 16501787.6255
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMITINFO: BLDG ELECT PLUMB
License Class Lie. q
r r r
N1ECI1 RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD 330 Sp 171 '1O NI SUI'lli, Rl'MODIA. 13AAI'11 76 Sp 1-1', 3
(commencing with Section 7000) or Division 3 of the Business & Professions
BEDROOMS 552 SQ I''1', RH.00A'I I- FURNACI?'I'O Al-I'IC &
Code and that my license is in full force and effect.
R19.0CA'IlS/UPDA'I'17 I'-I,bC'I'll ICA I. Mli'I'FR & SUB PANEI.
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate ofconsenl to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance oflhe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, u provided for by
Sq. Ft Floor Area:
Valuation: 566000
Section 3700 of the Lahor Code, for the performance of the work for which this
pcmtil is issued.
APPLICANTCERTIFICVfION
APN Number: 3163304700
Occupancy'Iype:
I cenify Him I have read this application and state that the above information is
correct_ I agree m comply With all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this cit) to enter
upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
and keep harmless lite City ol'Cuperlino against liabilities, judgments,
costs. and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regalia ions per the Cupertino Municipal Code, Section
9.18,
Signature [)site
Issued by: Dale:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RF -ROOFS:
A0 roof's shall be inspected prior to :any rouling material being installed. If a roof k
the following hro rrasonso
installed wimmn Iirst obtaining an inspection. I agree to remove au new materials liar
1, as owner ofthe property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signmaue of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project(Sec.7044, Business & Professions Code).
:\1.1. ROOF CO\'P:RINGS'f0 BE CLASS ",\" OR Ii F: I-I'ISR
I hereby affirm under penally of perjury one mf the following three
declarations:
I have and will maintain it Certificate of Consent to self -insure for Worker's
HAZARDOUS NIA'I ERIALS DISCLOSURE.
Compensation, as provided for by Section 3700 of the Labor Code. for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance oflhe work for which (his permit is issued.
California I le:dth & Safety Code, Sections 25505. 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the labor Code, for the performance of the work lot which this
Safety Code, Section 25532(x) should I store or handle hazardous material.
permit is issued.
Additionall)', should I use equipment or devices w'hirh emit hazardous air
I certify that in the perl'ormnnce of lite work for which this permit is issued, I shall
contaminants its defined by lite Bay Area Air Qualify Management District I w"ill
not employ any person in any maturer so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safely Code, Sections 25505, 25533, and 25534.
Compensation laws of Calilmnia_ Il, after making this certificate of exemption. I
become subject to the Worker's Compensation provisions of the labor Code, I must
Owner nr authorized agent:
fimhwith comply with such provisions or this permit shall be deemed revoked
Dole:
APPLICANT CERTIFICVI-ION
CONS 'IRUC HON LENDING AGE%]\'
I certify that I have read (his application and state that the above information is
I hereby alfrm thin there is a construction lending agcncs tsar the pertinnuulcc of work's
correct I agree to comply with all city and county ordinances and state Imus relating
or which this permit is issued (Sec. 3097, Civ C I
to building construction, and hereby authorize representatives of this city to enter
Lender's .Vane
upon the above mentioned properly for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities. judgments,
Lender's Address
costs, and expenses %hull may accrue against said City In consequence of the
granting of this permit Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCIII'FEC 'I'S DI':(:I.ARA IRON
9" 18.
1 understand my plans shall be used it, public records.
Signature Dale
Licensed Professional
CITY OF CUPERTINO
�l/JI FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10430 cherry tree In.
DATE: 04/12/2012
REVIEWED BY: bobs.
'VALUATION: 1$66,000
APN:
BP#: o�j
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes • No
OTC? 0Yes ® No
PENTAMATION
PERMIT TYPE: 1R3SFDADD
WORK
sfd add master suite 330 s.f., remodel bath 76 s.f. 3 bedrooms 552 s.f., relocate furnace to attic
SCOPE
relocate electric meter and panel.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.L
PI ZEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,1VN-B
330$1,482.00.
Other Plumb Insp.Ej
IADDPLCK
$1,205.00
IADDINSP
PME Plan Check:
$0.00
552 s.f.
$457.00
Remodel, Other
1 1REMRESOTH
Permit Fee:
$1,205.00
Suppl. Insp. Fee Q Reg. 0 OThrs
"00
$0.00
100 amps Electrical
$44.00 IERT<200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
0 #
$130.00
Mechanical
IMFR=<100 Furnace, Forced -Air
,n Tax:
TOTALS:
330
$1,482.00
Adininistrative .Fee:
$1,205.00
NIECH, HOURLY O l es 0 No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
Mech. Plan Check"00 $0.00
Plumb. Plan C'hec+
Elec. Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
Plo/-
Elec. Permit Fee: IEPERMIT
Other Mech. Insp.0.0 hrs $44.00
Other Plumb Insp.Ej
--L
Other Elec. Insp. 0.0 hrs $44.00
,.
Plumb. hasp. Fe"'
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution I1-053 E . 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,482.00
76 s.f.
$588.00
Remodel, Bath (<=300 sf)
IREMRESBAT
i
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
552 s.f.
$457.00
Remodel, Other
1 1REMRESOTH
Permit Fee:
$1,205.00
Suppl. Insp. Fee Q Reg. 0 OThrs
"00
$0.00
100 amps Electrical
$44.00 IERT<200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
0 #
$130.00
Mechanical
IMFR=<100 Furnace, Forced -Air
,n Tax:
Adininistrative .Fee:
O
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee: PLLONGRNGR
$42.90
Select a Non -Residential
Building or Structure
O
O
A
Travel Documentation Fee: ITRA VDOC
$44.00
Strong; Motion Fee: IBSEISMICR
$6.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$2,871.501$1,219.00
TOTAL FEE:
$4,090.50
Revised: 04/01/2012
Ae-
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 CHERRYTREE LN
CONTRACTOR: BRIGHTON BUILDERS
PERMIT NO: 12040069
OWNER'S NAME: PHANINDRA YARLAGADDA
PQ 460Y,310171DATE
ISSUED: 05/15/2012
OWNER'S PHONE: 4087575251
y U S 7 4 q
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class Lic. # ; T 13
ADD 330 SQ FT TO M.SUITE, REMODEL BATH 76 SQ Fr, 3
LT o
BEDROOMS 552 SQ FT, RELOCATE FURNACE TO ATTIC &
64/6H�v�-
Contractor Q (>l L D 6(Pb Date S//S�/ '2 _
RELOCATE/UPDATE ELECTRICAL METER & SUB PANEL
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Profession.
Code and that my license is in full force and effect.
1 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: $66000
performance of the work for whichthis 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
,CPN Number: 31633047.00
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,
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 by Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
C
RE -ROOFS:
Signature Date S/�s/r2.
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
(tie 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
1 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 Area Air Quality Management District I
performance of the work for whichthis 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
/t.,� Date: Z
permit is issued.
or authorized agent:
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 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
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