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11040068CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10800 MAXINE AVE CONTRACTOR: AVA CONSTRUCTION PERMIT NO: 11040068 OWNER'S NAME: SAS[ K ATLLURI & SRI L SURAPANENI 20689 FORGE WAX UNIT 202 DATE ISSUED: 05/16/2011 OWNER'S PHONE: 4083147932 CUPERTINO, CA 95014 PHONE NO: (408) 387-0999 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 5 � � Lic. # ! Contractor �/T / &ZPIn��✓�rU-- fie` (v Vaffirm that I am licensed under the provisions of hapter 9 ncing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect eby 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of dre work for which this permit is issued. APPLICANT CERTIFICATION 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 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 non -point sour re lations per the Cupertino Municipal Code, Section 9.18. / Signature Date 6 ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 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. I certify that in the performance of the work for which this permit is issued, I shal I 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH F RESIDENTIAL F COMMERCIAL r— JOB DESCRIPTION: ADD(358) SFD FAMILY,DINING,FOYER & REMODEL KITCHEN(88SQFT) Sq. Ft Floor Area: Valuation: $77000 APN Number: 32602060.10800 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date/d"// RE -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner. ' d ager /fi / Date: `T CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUBE T1NO (408) 777-3228 • FAX (408) 777-3333 • buildin4(a.cuoertino.or4 [:1 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION / DE�FE/RRID ORIGINAL PERMIT # PROJECT ADDRESS j nya i j/(� "' APN # OWNER NAME r PHONE O 3L STREET ADDRESS v' v - ! CITY, STATE ZIP FAX CONTACT NAME ))) PHO /%6 Q/lq ?�du E-MATT /J �y STREET ADDRESS /LY0 Crf� CITY, STATE, `CZIP O'[ (�L %�� J �Y F Z �. O ❑ OWNER ❑ lo/WNER( ��-ffB((((�,UE.DEP ❑ OWNERRAMINT ❑ CONTRACroR ❑ CONTRACrORAGINT ❑ ARCHITECT 11 IENGNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' ' LICENSE NUMBER _q-?�-_/LICENSE TYPE BUS. LIC COMPANYNAME E MAII FAX �9 / ry STREET ADDRESS 2-6 6 ,j"J CITY, STATE, ZIP /�� /�r'�� PHONE /J Lk (F' ARCHTTECMENGJNEERNAME 6 / / e LICENSE NUMBER ('J (/ BUS. LIC �Yj/ COMPANY NAME d/ E-MAIL� e, a F Uf�1 . % In + 5 /1�wg STREET ADDRESS 3' v v V Iii/ CITY, STATE, ZIP PHO V �j�f l� DESCRIPTION OF WORK Afnvl f Bldg4pp_2011.doc revised 03/16/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Q w C— PERMIT # d OWNER'S NAME: eA-- V, cou,/� PHONE # GENERAL CONTRACTOR: ,��C�a� BUSINESS LICENSE # ADDRESS: • CITY/ZIPCODE: O� *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 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10800 fffaRflii ave. DATE: 04/11/2011 REVIEWED BY: bobs. PC FEE ID APN: ! Bf Q g "VALUATION: 1$77,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? Yes No OTC? © Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK sfd add family,dining, foyer, remodel kitchen. SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 358 $1,438.00 IADDPLCK $1,169.00 IADDINSP hs $0.00 PME Plan Check: $0.00 Permit Fee: $1,169.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: 358 $1,438.00 $0.00 $1,169.00 MECH, HOURLY O Yes (E) No PLUMB, HOURLY Q Yes Q No ` ELEC, HOURLY Q 'Yes Q No MISC ITEMS Plan Check Fee: $1,438.00 88 s.f. $570.00 Remodel, Kitchen (<=300 sfl IREMRESKIT El Suppl. PC Fee: 0 Reg. 0 OT 0.0 hs NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (!ee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,438.00 88 s.f. $570.00 Remodel, Kitchen (<=300 sfl IREMRESKIT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hs $0.00 PME Plan Check: $0.00 Permit Fee: $1,169.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CCtrl r, ac'fT tri 'I o.% Acoustical Fee: 0 Yes (F) No $0.00 Q 0 Work Without Permit? 0 Yes (E) No $0.00 Planning Fee: PLLONGRNGR $46.54 Select a Non -Residential Building or Structure 0 0 Strony, Motion Fee: IBSEISMICR $7.70 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: 1 $2,665.241 $570.00 TOTAL FEE: $3,235.24 Revised: 01115/2011