13020112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10471 LANSDALE AVE CONTRACTOR:MANA GENERAL PERMIT NO: 13020112
CONTRACTOR
OWNER'S NAME: DILEEP TIKU 1839 TAMPA WAY DATE ISSUED:06/20/2013
OWNER'S PHONE: 4086943515 SAN JOSE,CA 95122 PHONE NO:(408)375-4288
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# CONSTRUCT(678 SQ FT)SECOND STORY ADDITION;
REMOVE AND REBUILD GARAGE(438 SQ FT); KITCHEN
Contractor_ Date REMODEL(100 SQ FT);DINING AND FAMILY ROOM
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions REVISION 41 ADD AN ENTRY ROOF ON THE PORCH-ISSD OTC
Code and that my license is in full force and effect. 9/4/2013
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:$90000
I have and will maintain Worker's Compensation Insurance,as y
Section 3700 of the Labor Code,for the performance of th A�ch this APN Number:36911011.00 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 WITHI 80 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 DA ROM 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
q3
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
I he:eby 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. 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(x)should I store or handle hazardous
I have and will maintain aCertificate 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 p 1
Owner or authorized agent: Date:
permit is issued.
J..eertify 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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must l 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 l understand my pians 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. q
Signatures Date f 1 Of 3
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10471 LANSDALE AVE CONTRACTOR:MANA GENERAL PERMIT NO: 13020112
CONTRACTOR
OWNER'S NAME: DILEEP TIKU 1839 TAMPA WAY DATE ISSUED:06/20/2013
OWNER'S PHONE: 4086943515 SAN JOSE,CA 95122 PHONE NO:(408)375-4288
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# �1 - b CONSTRUCT(678 SQ FT)SECOND STORY ADDITION;
i � � 13 REMOVE AND REBUILD GARAGE(438 SQ FT); KITCHEN
Contracto,((Y�G(V uk cyy fci \ REMODEL(100 SQ FT); DINING AND FAMILY ROOM
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:$90000
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:36911011.00 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 80 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 DA F OM 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 U/2�.��
granting of this it. Additionally,the applicant understands and will comply Issued by: Date:
with all non- int rce r g tions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date f 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)
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(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, W,255331, 534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agen : Date:
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 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 per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10471 LANSDALE AVE DATE: 02/20/2013 REVIEWED BY: SEAN
APN: BP#: 06L-11 *VALUATION: 1$90,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD
USE: OTC. 0Yes ®No PERMIT TYPE:
WORK CONSTRUCT 678 SQ FT SECOND STORY ADDITION; KITCHEN REMODEL 100 SQ FT • DINING
SCOPE AND FAMILY ROOM REMODEL(500 SQ FT).
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 678 $2,468.00 1R3PLNCK $1,549.00 lR31NSP
TOTALS: 678 $2,468.00 $1,549.00
MEGH .Yes(
Afcch. i'fart
CJth<r,'1t•r�r.Ir,h ? �°r- ' E3
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . These ees are based on the prelimina information available and are
onl an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 Eff 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,468.00 1002-1 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $600.00 IREMRESKIT
PME Plan Check: $0.00 F-5007 s.f. Remodel, Other
Permit Fee: $1,549.00 $467.00 IREMRESOTH
Suppl. Insp. Fee:Q Reg. OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(.'ons(ruction Tax:
Work Without Permit? 0 Yes (F) No $0.00 0
Advanced Planning Fee: 1PLLONGR $88.14 Select a Non-Residential 0
Building or Structure 0
'lru�el l�oc:rt�;�i�n.trztiorr 1�'�es: �
Stroniz Motion Fee: 1BSEISMICR $9.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $4.00
SUBTOTALS: $4,118.141$1,067.00TOTAL FEE: $5,185.14
Revised: 01/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10471 landsdale ave DATE: 09/04/2013 REVIEWED BY: Mendez
APN: BP#: 13020112 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK �revision #1 add an entry roof on the porch.
SCOPE
Aft,(Ir F ir�r' 'dry c n "un%. '` :r i 7rrc l ". 'i tf'(•'>: r
Prrn ,%'c'l'
El El Li I
lcch i7i—, "'C" I
V,
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees 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& L11112 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $139.00 1STPLNCx
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
1-{'F_' Building or Structure
[l'rfic' l�nC'N1%1Nd(LdltY17! ,1:
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS. $0.001 $139.001 TOTALFEE:` $139.00
Revised: 07/01/2013