13100184 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6756 JOHN DR CONTRACTOR:ALL WEATHER PERMIT NO: 13100184
CONSTRUCTION
OWNER'S NAME: VIJAYAKUMAR KULKARNI&ROOPA RAO 615 DUNHOLME WAY DATE ISSUED: 11/26/2013
OWNER'S PHONE: 4086803299 SUNNYVALE,CA 94087 PHONE NO:(408)708-8603
61 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
License Class 13 Lic.# EXTEND GARAGE TO ENLARGE(E)BEDROOMS(149 S.F.),
REMODEL 2 BATHS(120 S.F.),REMODEL KITCHEN(144
Contractor Z0,26 7"-A r? Date ZI 6/2-ai 3 S.F.)&UPGRADE EL PANEL TO 200 AMPS
I hereby affirm that I am licensed under the provisio of Ch pter 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$85000
1have 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:36923003.00 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. 1 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 DAY R M 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 //�G
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature r Date 13 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
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(x)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,Sections 25507"
550 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
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,l 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
1 certify that I have read this application and state that the above information is
correct.1 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.I8.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 6156 JOHN DR DATE: 10/28/2013 REVIEWED BY: MELISSA
APN: 369 23 003 BP#: 3 *VALUATION: 1$85,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Uijit? Yes No PENTAMATION 1R3SFDADD
USE: OTC. ®Yes 0N PERMIT TYPE:
WORK EXTEND GARAGE TO ENLARGE E BEDROOMS 149 S.F. REMODEL 2 BATHS 120 S.F.
SCOPE REMODEL KITCHEN (144 S.F.) & UPGRADE EL PANEL TO 200 AMPS
OCCUPANCY TYPE: TYPE OF F1 R AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 149 $1,059.00 IADDPLCK $1,026.00 IADDINSP
TOTALS: 149 $1,059.00 $1,026.00
MECH,.HOURLY O Yes E) No PLUMB,H URLY Yes Q No ELPC,HOURLY Q Yes Q No
Elec.Plan Check 0.0 firs $0.00
Elec.Permit Fee: IEPERMIT
��<«, �1..k a.,r<.�� );,{.t ;irr-?r� E3_L_
OtherElec.Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments(Le.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 Ef 7/1,113) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $1,059.00 F 2-6 47 s.£ Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $626.00 IREMRESKIT
PME Plan Check: $0.00 200 amps Electrical i C-0-r c 2.,00
Permit Fee: $1,626.00 $47.00 IBELEC200 Services
Suppl. Insp. Fee.0 Reg. Q OT Q.0 hr $0.00
PME Unit Fee:
PME Permit Fee: $47.00
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee. IPLLONGR 20.86 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR ,$8.50 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $4.00
SUBTOTALS: 1 $2,212.36 $673.00 TOTAL FEE; $2,885.36
Revised: 10/01/2013