13090056I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10676 AMULET PL I CONTRACTOR- '"^BQ—TD RE I PERMIT NO: 13090056 I
r]FTFA 1;iirTTFTL
OWNER'S NAME: RAO PADAKANDLA K AND YADGIRKAR HEMA A0k4C'?erne%r S DATE ISSUED: 09/10/2013
OWNER'S PHONE: 4087338870 51 n r x l PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # Q-7410(19
Contractor lel J e 16rft) j4 Date q 0
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.
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.
fecave and will maintain Worker's Compensation Insurance, as provided for by
tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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,
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.
Signature Date�3
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I 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 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
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
REMODEL KITCHEN TO INCLUDE ISLAND, REPLACE
PATIO
DOOR WITH WINDOW M,E,P'S, ADD (10) LIGHTS IN
FAMILY ROOM, 5 SWITHCES
Sq. Ft Floor Area: I Valuation: $35000
APN Number: 32643060.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPECTION.
Issued by: Date• �/O 'S
RE -ROOFS:
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.
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. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date
:1�3
CONSTRUCTION LENDING AGENCY
A., f rformance of
become subject to the Worker's Compensation provisions of the Labor Code, I must I I hereby affirm that there is a construction len mg agency o.11
r a pe
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
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,
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.
Signature Date
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION ,gip
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION v lv
im 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �" L
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECTADDRESS /0(07/Aynt)ld i/►/
APN# 2Z�j
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OWNER NAME
PHONEM-733 `W 0
E-MAIL(
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STREET ADDRESS/ /��VId CITY, STATE, ZII'� Q��"' A /I 1/I QCOI �J
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FAX
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CONTACT NAME
PHONE
STREET ADDRESS
CITY, STATE, ZIP 7
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ;K CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ✓ 1 ��t
LICENSE NUMBER% 7 O
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LICENSE
BUS. LIC #
COMPANY NAME
IIID • •
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ARCHTPECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
1
DESCRIPTION OF WO • • 1 1
etA
f �p J1
1 \ \ 1 p ti
• 1
EXISTING USE
PROPOSED USE CONAR TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EMSTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
,1 //
i( kkit1�--
II ��--LLLLLL ,,,,,, '''"'------'"'''
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCHAREA
GARAGE AREA: ODETACH
I
❑ ATTACH
I
#DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECONDSTORY []YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED Y- -
TOTAL VALUATI
PLANNING APPL# NO PLANNINGAPPROVALLETTER
EICHLER HOME? 0 N
. �`G
'551 U
By my signature below, I certify to eaeh.of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is conect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildingction I authorize represen ives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: 2:.Date: 7 ` Z O `,
SUPPLE INFO . TION REQUIRED
PLAN CEWkX TYM
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buIl '
OVER -Tiff -COUNTER
B nvc PLAN REVIEW
permit for new building.p
EXPRESS
PLAxxnvG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
El rustle woxxs
form if any Hazardous Materials are being used as part of this project.111,
LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
� IKAaox
El sANrraRv sEwERDIsrRler
submittal of Building Permit application.
❑ ENvmoIVlMrrraLMal,Tg-
BldgApp 2011.doe revised 06/21/11
CITY OF CUPERTINO
No FEE ESTIMATOR - BUILDING DIVISION
S x i P-
tx w
il'foch. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00
FW_-, . l'errarit Pee: Plumb. Permit fee: Elec. Permit Fee: IEPERMIT
Other Afecrh. Insp. Other Plumb Insp.Ll Other Elec. Insp. El
hrs 1 $47.00
Hech. Inspz Fee: Plumb. hasp. Fee: Is'lec. Insp. tete:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctriet otr_ L Thoco fooc aro hacod an tho nreliminary informatian availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
ADDRESS: 10676 amulet pl
DATE: 09/10/2013
REVIEWED BY: Mendez
APN:
BP#:
'EVALUATION:
1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
REMODEL KITCHEN TO INCLUDE ISLAND REPLACE PATIO DOOR WITH WINDOW M E P'S ADD
SCOPE 1
(10) LIGHTS IN FAMILY ROOM, 5 SWITHCES
S x i P-
tx w
il'foch. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00
FW_-, . l'errarit Pee: Plumb. Permit fee: Elec. Permit Fee: IEPERMIT
Other Afecrh. Insp. Other Plumb Insp.Ll Other Elec. Insp. El
hrs 1 $47.00
Hech. Inspz Fee: Plumb. hasp. Fee: Is'lec. Insp. tete:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctriet otr_ L Thoco fooc aro hacod an tho nreliminary informatian availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.0025
ss.£
$626.00
Remodel, Kitchen (<=300 sf)
IRE;; SKIT
Suppl. PC Fee: (F) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
5
$47.00
Electrical
1 1BREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0,0
hrs
$0.00
10 Electrical
$70.00 IBREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Construction Tax: J-1
Administrative Fee: IADMIN
$44.00
E)
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion. Fee: 1BSEISMICR
$3.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
$143.50
$743.00
$886.50
Revised: 07/01/2013
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COMBUILDNGDIITY ESIONECUPERTNO DEPARTMENT
APPROVE®
This set of plans and specifications MUST be kept at the
job sKe during construction. It is unlawful to make any
chsr.gos or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or Sfate Law.
r
BY we, —
DATE 3
PERMIT NO.
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