12110063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10575 SAN LEANDRO AVE CONTRACTOR:CRAIG A ROGERS PERMIT NO: 12110063
OWNER'S NAME: REDDY VENUGOPAL AND GUNNA VISHAN 3914 WELLINGTON SQ DATE ISSUED:03/222013
OWNER'S PHONE: 4086035859 SAN JOSE,CA 95136 PHONE NO:(408)499-3354
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# � S` CONSTRUCT A 3962 SQFT TWO(2)STORY RESIDENCE
WITH
Contractor Date 547 SQFT ATTACHED GARAGE,AND 2,324 SQFT
I hereby affirm t t I am lic nsed under the provisions of Chapter 9 BASEMENT-6,833 SQFT TOTAL
(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:$850000
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:35705081.00 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 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 Is Date:
with all non-point source regulations perCupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature "'✓ Date �2' -3 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
I hereby affirm that I 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)
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. 1 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(x)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 Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' ns 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent i Date:' -
permit is issued.
I certify that in the performance of the work for which this permit is issued,l 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, ARCHITECTS DECLARATION
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 p e Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature4"', Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINU (408) 777-3228• FAX(408)777-3333• buildina(@cupertino.org
NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS f)l v C-11)\) F�P C P U t
L L; ,n' APN# /j ��J O� I
�,
OWNER NAME _ PHONE E-MAIL
\lFfq •, �t 1�1� �iU�-C63-
STREETADDRESS ]OoZCJ G J` /��C j��'/� CITY,STATE,ZIP L.lI j7r 7 fUC� J-� FAX t
CONTACT NAME �jLL+��I'f',c 6l'C �-r-�•—tom/ PHONE ( .-,-��L-�-.,-y?
STREET ADDRESS � CITY,STATE, ZIP r ems,,��Z r�� 6p_ -�� L FAX I �l
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT L.1a ARCHITFCT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME p ^ LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME „T �Vl t LICENSE NUMBER y .�4� 37 BUS.LIC#
COMPANY NAME ?f E-MAIL C— F
,-
14
STREET ADDRESS I' CITY,STATE,ZIP 4 C
DESCRIPTION OF WORK
�—�Cbz
EXISTING USE PROPOSED USE CONSTR.TYPE #STO S -
/I USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO V TOTAL �1
AREA AA✓ 69 � AREA ETAREA396 / ♦ �Qd
,7
BATHROOM KITCHEN OTHER y
v
REMODEL AREA REMODEL AREA /y REMODEL AREA —4;p— V;?,
;?, J
PORCH AREA DECK AREA Tn -P V QAQAQ�""Jnre GARAGE AREA: DETACH (/
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? QNO ADDITION? �d0
PRE-APPLICATION Q'ES IF YES,PRO V(DE COPY OF IS THE BLDG AN /��❑YES RECEIVED BY• TOTALVALUATION:
PLANNINGAPPL# NO PLANNING APPROVAL LETTER EICHLERHOArE? 2NO
By my signature below,I certify to each of the following: 1 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 accur, te. I agree to comply with all applicable local
ordinances and state laws relating lding constr coon. I authorize representatives of Cupertino to enter the abov -identil d property for inspection purposes.
Signature of Applicant/Agent: - �" ti�� Date:
SUPPLEMENTAL INFnR1` REQUIRED PLAN CHECK TYFE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑l OVER-TRE COUNTER l BUILDIN6 PLAN REVIEW
eXisting building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ E<PRESS LAN REVIEW, '
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ruBLtCNioRhs,
form if any Hazardous Materials are being used as part of this project.
❑- LARGE''„ .,FIRE DEPT
_Copy Of Planning Approval Letter Or Meeting Nvith Planning prior t0 _MAJOR SANITARY SERER DISTRICT
submittal of Building Permit application.
❑'ENVIRONSANTALHEALTff
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10575 San Leandro Ave DATE: 11/13/2012 REVIEWED BY: suew
APN: 357-05-081 BP#: 12110063 *VALUATION: 1$850,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? Yes • No PENTAMATION 1 R3SFD
USE: PERMIT TYPE:
WORK New 2 story house 3,962 s ft attached garage 547 s ft and 2,324 s ft basement. Total 6,833 s ft
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 6,833 $3,640.97 IR3PLNCK $4,884.42 1R3INSP
TOTALS: 6,833 $3,640.97 $4,884.42
El
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the preliminar information available and are on an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $3,640.97 Select a Misc Bldg/Structure
Suppl. PC Fee: (j) Reg. 0 OT0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $4,884.42
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
#
Construction Tax: IBCONSTAXR 1 units new $629.29
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planning Fee: IPLLONGR $888.29 Select a Non-Residential 0
Building or Structure
Strong Motion Fee: IBSEISMICR $85.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $34.001 1
SUBTOTALS: 10,161.97 $0.00 TOTAL FEE: $10,161.97
Revised: 10/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10575 San Leandro Ave DATE: 11/13/2012 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$850,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? 0 Yes •' No PENTAMATION 1 R3SFDW
USE: PERMIT TYPE:
WORK Construct a 3962 sq ft two story residence with 547 sq ft garage.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEE BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 4,509 $3,087.14 IR3PLNCK $/384.96 IR3INSP
TOTALS: 4,509 $3,087.14 $3,584.96
NOTE.This estimate does not include fees due to other Departments('e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta . Thesefees are based on the prelimina in ormation a ailable and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $3,00-14 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. C) OT0,0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $3,584.96
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 $0.00
I
PME Unit Fee: $0.00
PME Permit Fee: ' $0.00
Construction Tax: IBCONSTAXR f, #new $629.29
units
-Islet?r,ti.�traris:�le�=: Q
Work Without Permit? Yes E) No $0.00
Advanced Planning Fee: IPLLONGR $586.17 Select a Non-Residential Q
Building o Structure r
Strong Motion Fee: IBSEISMICR $85.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $34.00
SUBTOTALS: $8,006.56 $0.00 TOTAL FEE: $8,006.56
Revised: 10/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: j 0 YA f,; ! j�-t- PERMIT# �2
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: 6 BUSINESS LICENSE#
ADDRESS::3,�/�-[Afflua',*—.A. - CITY/ZIPCODE:
*Our municipal code require 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 S CONTRACTORS 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 & Millworks 1.tly6L
Cement Finishing ,24, ' C
Electrical
Excavation r �>A G) D5 �
Fencing
Flooring/ Carpeting c' Al � 3 8�
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�' % A-3
Owner/Contract r Signature Date