14040058 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21523 CONRADIA CT CONTRACTOR:VENKATESH GANTI PERMIT NO: 14040058
OWNER'S NAME: VENKATESH GANTI 21523 CONRADIA CT DATE ISSUED:04/14/2014
OWNER'S PHONE: 6503888823 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REMODEL& RECONFIGURE AREAS,INCLUDING
License Class Lia# KITCHEN
165 SQFT,BATHROOM 72 SQFT,LAUNDRY,HALLWAY&
Contractor Date FOYER TOTAL OTHER REMODEL AREA 161 SQFT.
I hereby affirm that I am licensed under the provisions of Chapter 9 REV#t-REMOVE SKYLIGHTS(2)FROM(E)SCOPE OF WORK-ISSUED
(commencing with Section 7000)of Division 3 of the Business&Professions 9/29/14
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:$37000
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:35623050.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 theA�k
granting of this permit. Additionally,the applicant understands and will comply ed Date:
with all non-point source regulations per the Cupertino Municipal Code,Sectio
9.18.
RE-ROOFS:
Signature Date 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
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
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
1 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
1 have and will maintain Worker's Compensation Insurance.as provided for by the Health&Safety Code,Sections255 255 25534.
Section 3700 of the Labor Code,for the performance of the work for which this n . O �q
Owner or authorized ageDate:
permit is issued.
1 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 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
1 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 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 DateB� oZG f
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21523 CONRADIA CT DATE: 09/29/2014 REVIEWED BY: MELISSA
APN: 356 23 050 BP#: 14040058 `VALUATION: Iso
PERMIT TYPE: Building PermitPLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES�
USE: PERMIT TYPE:
WORK REV# 1 - REMOVE SKYLIGHTS 2 FROM E SCOPE OF WORK- ISSUED 9/29/14
SCOPE
Li
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee 1?esolution 11-033 Eff 71,13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. Q OT0,0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
4
Work Without Permit? ® Yes (2) No $0.00 G
Advanced Plannin-,Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Strom Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.001 __F_
SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00
Revised: 0812012014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21523 CONRADIA CT CONTRACTOR:VENKATESH GANTI PERMIT NO: 14040058
OWNER'S NAME: VENKATESH GANTI 21523 CONRADIA CT DATE ISSUED:04/14./2014
OWNER'S PHONE: 6503888823 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
REMODEL&RECONFIGURE AREAS,INCLUDING
License Class Lie.# KITCHEN
(165 S.F.),BATHROOM(72 S.F.),LAUNDRY, HALLWAY&
Contractor Date FOYER(TOTAL OTHER REMODEL AREA 161 S.F.).
I hereby affirm that 1 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:
1 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:$37000
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:35623050.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
t 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 Taws relating WITHIN Igo DAYS OF P ANCE 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 Igo DAYS FRO SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 4
granting of this permit. Additionally,the applicant understands and will comply Is Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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:
('1hereby 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(See,7044,
smess&Professions Code)
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 Municipal Code,Chapter 9.12 and
I 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 Q
Owner or authorized agent_� � Date:
ermit is issued. f
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 Taws 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 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 pAr the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature"� Date 6 t4 �O
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21523 CONRADIA CT DATE: 04/10/2014 REVIEWED BY: MELISSA
APN: 356 23 050 BP#: 0 `VALUATION: 1$37,000
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK REMODEL & RECONFIGURE AREAS INCLUDING KITCHEN 165 S.F.), BATHROOM 72 S.F.
SCOPE LAUNDRY, HALLWAY & FOYER (TOTAL OTHER REMODEL AREA 161 S.F.).
NOTE: This estimate sloes not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 EfL* 7 1!131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 72 s.£ Remodel,Bath(<=300 sfJ
Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $626.00 1REMRESBAT
PME Plan Check: $0.00 165 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $626.00 IREMRESKIT
Suppl. Insp. Fee-.E) Reg. 0 OT 0,0 hrs $0.00 =1s.f. Remodel, Other
PME Unit Fee: $0.00 $418.00 IREMRESOTH
PME Permit Fee: $0.00
T7
0
Work Without Permit? 0 Yes ) No $0.00
Advanced Planninu l'ee. $0.00 Select a Non-Residential 0
Building or Structure 0
i
Stronp, Motion Fee: IBSEISMICR $3.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $5.701$1,670.001 TOTALFEE: 1 $1,675.70
Revised: 04/01/2014