15040150 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23028 CRICKET HILL RD CONTRACTOR:PLANET PERMIT NO: 15040150
CONSTRUCTION
OWNER'S NAME: MENON PRAKASH AND KUMAR REND E RAM 1347 MAIN AVE DATE ISSUED:04/21/2015
OWNER'S PHONE: 6508680507 SACRAMENTO,CA 95838 PHONE NO:(916)275-4171
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL E]
License Class Lic.#
9�q6 KITCHEN REMODEL(194 SQ FT)
Contractor aL to
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. Sq.Ft Floor Area: Valuation:$15500
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:34240030 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 Issued by: �FI/�< �rG� Date: ����'
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re ul_ation - er the pertino Municipal Code,Section
918.
RE-ROOFS:
Signature c Date 7'Z��� 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 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 which this permit is issued. will maintain compliance with the Cupertino unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 — 5 and 25534.
Section 3700 of the Labor Code,for theerformance of the work for which this 7�Zj
p Owner or authorized agent: Date:
permit is issued.
Ir—
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 CONSTRUCTION LENDING AGENCY
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 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 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
r10a
N
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingacupertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS , Jo 2 q /_ J, /f�/ 7,. %I APN#
OWNER NAME r �� i (i��I �( PHONE
V' 05-0 7 E-MAIL
STREET ADDRESS 9 l�!! CITY,STATE,ZIP FAX
CONTACT NAME �J [J /7 PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
OWNER ❑ OWNER-BUILDER ❑ONTIERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME)/ /r LTC EN�& ER LICEN TYPE BUS.LIC#
�/
COMPANY NAME p ` U /� E-MAIL FAX ' 7
STREET ADDRESS C STATE,ZIP P
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
7�1-
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA ._
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: ISASECOND UNrr E]YES SECONDSTORY []YES
BEING ADDED? ❑NO ADDITION? [-]NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES `RECEIVE Y s �i, ;y TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO
By my signature below,I certify to each 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 correct. 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.build' ns i I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED ��I�aNczz
� �ROUTING;SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forMEx 4
VER TH000UNTER , BUII DING PLANREVTEW -
eXisting building(s). Demolition permit is required prior to issuance of building { mak
permit for new building. ® ExPxs � � pPIAI,fiIz c�pLArr xEyl>w
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure g STANDARD �� UBlcwo�Rlcs� � _:
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to
I) z ATTT� DISTRI
submittal of Building Permit application. YSERER
fl4ElaLViRONMENTriI HEALTH
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 23028 Cricket Hill Road DATE: 04/21/2015 REVIEWED BY: Sean
APN: BP#: `VALUATION: 1$15,500
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE: i
WORK Kitchen remodel 194 s ft
SCOPE
MIN
.VIech. Plan Check � Ptrrrrrb.Plan Check lilec.Plan Check
Feclr. Perrrril Feer Plumb. Permit Iee: I lilec. Permir Fee:
Ozher We ch. IrIT Otho Plumb Insp. Other 137ec.Inap. Li
bRech. Irish. Fee: Plumb. fish. fee: /ler.Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(i.c Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are onl an estimate Contact the Dept for addn7 info.
FEE ITEMS Lee Resolution 11-053 E . 7f( 11113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 194 1 s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: (F) Reg. ® OT 0.0 1 hrs $0.00 $645.00 IREMRESKIT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: F-71
Adr'rnip2istrative Fee:
Work Without Permit? ® Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
/ia gel l c�c°a�rnentatrnr�Fees:
Strong_Motion.Fee: IBSEISMICR $2.02 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
�O ATS FEE ' $648.02
$3.02 $645.00 r
N.
Revised: 04/01/2015
Mask pathway to working area. Includes masking walls and flooring as needed for dust control.
Haul away construction debris.
Protect and mask off existing floor. Some floor may need to be patched upon
installation of the cabinets. Price to be determined after cabinet installation.
Tenon Final Sektion - Plan View All measurement in inches Remove existing counter tops, cabinets and appliances at kitchen location.
� k 0000-8233-0311 Remove existing tile backsplash.
Remove existing baseboard.
i
2143/4 — - 1 Remove existing laundry shelves as needed.
BO 5116 1 f 4 3M 1 403116 4 18 i 7913116 Remove washer and dryer. Save to reset.
6B 1116 t 25 118 f 5(1 6 1 24 5Add switch for under cabinet lights at(1) location.
6 Add outlet right of sink left of range location for microwave.
Add(2) GFCI outlets at counter top height location.
n Replace(4) existing outlets to GFCI tamper resistant outlets at kitchen location.
Run 110 volt dedicated electrical line for refrigerator. Additional drywall work may to be done which is not
included in this line item. - -
Hard-wire for under cabinet light/s at(4) locations.
10
Remove and reset outlet at peninsula location.
Relocate water supply line/s to new refrigerator in-box location.
Relocating duct to new hood location to be determined after demo.
t Repair drywall at kitchen location. Any texturing work that will be done will be matched as close as
possible 100% match no guaranteed.
Repair drywall at removed backsplash area kitchen location.
Paint 2 tone walls only at kitchen location. Labor only Patch laminate floor at kitchen location per new
` plan. Customer will provide flooring.
1 Transition strip to be determined. Price to be determined.
Install new baseboard MDF paint grade. No prep or paint included. Customer will supply baseboard.
141 Prep, paint, caulk and finish baseboard as needed.
Install under cabinet lights at 4 locations. Customer will provide lighting.
Install tile over mesh backsplash at kitchen location. Customer will provide tile and grout.
Install dishwasher. Labor only. After counter tops and backsplash are installed.
Install refrigerator. Labor only.After counter tops and backsplash are installed.
1:14 114 89 U2
�- install free standing range. Labor only. After counter tops and backsplash are installed. If old range is
1263/4 Be being reset new brackets
Install peciali y hood Labor only.required
counter ops and backsplash are installed.
Install washer and dryer at laundry location. Labor only.
Install free standing microwave. Labor only. -Complementary
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