11070062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10295 N BLANEY AVE CONTRACTOR:PARRA BUILDERS INC PERMIT NO: 11070062
OWNER'S NAME: KRISHNAMURTHY VENKATABALAKRISHNAN A 5704 COLDWATER DR DATE ISSUED:08/23/2011
O y R'S PHONE: 4088594695 CASTRO VALLEY,CA 94552 PHONE NO:(510)889-0102
❑ LICENSED CON TOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class c.#
MECH" RESIDENTIAL COMMERCIAL
Contractor ,Date 20
[hereby a rm that I' m 1' ensed under the provision of Ch ter 9 JOB DESCRIPTION:APD LIVING,DEN,EXTEND KITCHEN(200SQFT),EXTEND
(comme ing with Section 7000)of Division 3 of the usiness&Profession GARAGE,ADD TWO STORY,BEDROOMS,BATH&MASTER BEDROOM
Code and that my license is in full force and effect. &BATH,BUILT ROOF(650SQFT);NEW FLOOR
I hereby affirm under penalty of perjury one of the following two declar tions:
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.
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 Sq.Ft Floor Area: Valuation:$280000
permit is issued.
APPLICANT CERTIFICATION APN Number:31633009.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,th pplicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point sourc egulations er a Cupertino Municipal Code,Section
9.18. 1 _-
J�l�-�'L/ Issued by:r,����—�"`'--� Date:
Signature Date_J
G OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cuperpno Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety de,Section 55 ,25533,and 25534.
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 Owner o ori d ag zj
forthwith comply with such provisions or this permit shall be deemed revoked. Date:Lell .�
`f CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Aork's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
it -tify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c nd expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
_............... ...... .
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10295 n. blaney ave. DATE: 07/11/2011 REVIEWED BY:
i
APN: BP#: "VALUATION: 1$280,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? 0 Yes No PENTAMATION 1 R3SFDW
USE: PERMIT TYPE-
WORKRebuild sfd add living, den kitchen arae add 2nd storyaddition master suite remodel kitchen
SCOPE bath,family room, garage. Rebuild new roof.
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 2,896 $2,777.16 IR3PLNCK $2,702.68 IR3INSP
TOTALS: 2,896 $2,777.16 $2,702.68
Lj
. ;,C:• Fal t,Ull?f t'('t'; -..,-. ..,.
NOTE.These TF are based on the prelindnary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef} "r.;"11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,777.16 Select a Misc Bldg/Structure
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $2,702.68
Suppl.Insp.Fee @ Reg. 0 OT Fo.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constr.Tax: 1BCONSTAXR 1 � $579.61
uniAcoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00 G
Planning Fee: PLLONGRNGR $376.48 Select a Non-Residential E)
Building or Structure 0
Strong;Motion Fee: IBSEISMICR $28.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $12.00
SUBTOTALS: $6,475.93 $0.00 TOTAL FEE: 1 $6,475.93
Revised: 07/04/2011