12080098 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10555 ORANGE TREE LN CONTRACTOR:KRISHNAMURTI-1I PERMIT NO: 12080098
AMUDHAN AND MANICKAM
OWNER'S NAME: KRISI-INAMURTHI AMUDHAN AND MANICKAM 10555 ORANGE TREE LN DATE ISSUED: 11/06/2012
OWNER'S PHONE: 4088354268 CUPERTIN'O,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.# r--
MECH RESIDENTIAL COMMERCIAL t
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT A 883 SQFT ADDITION FRONT,MASTER
(commencing with Section 7000)of Division 3 of the Business&Professions BEDROOM/BATHROOM,FOYER,AND FRONT PORCH&REAR
Code and that my license is in full force and effect. AND INTERIOR REMODEL 820 SQFT-REROOF(E)2,141 SQ
REVISION#I-STRUCTURAL REVISION ISSUED 5/2/2013
1 hereby affirm under penalty of perjury one of the following twe declarations:
I have and will maintain a certificate of consent to sell'-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 Sq.Ft Floor Area: Valuation:$127000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
ANN Number:31634010.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
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 18� DAYS R M LAST CALLED INSPEC'T'ION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9,18. Issued by: Date:
. �3
Signature Date
1WOWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
is less&Professions Code)
s owner of the property,am exclusively contracting with licensed contractors to
c strict 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: IIAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of die work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the licalth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air
4,iy
sissucd. contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
thatthe performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
ploy 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 Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City oh 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 ARCHITECT'S DECLARATION
with all non-poi it source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature
Licensed Professional
Date �,1�)3
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10555 ORANGE TREE LN CONTRACTOR:MORE LAND PERMIT NO: 12080098
CONSTRUCTION
OWNER'S NAME: KRISHNAMURTHI AMUDHAN AND MANICKAM 1454 HUSTED AVE DATE ISSUED: 11/06/2012
OWNER'S PHONE: 4088354268 SAN JOSE,CA 95125 PHONE NO:(408)221-0892
❑ LICE SED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
License Class Lie.4 y l CONSTRUCT 883 SQFT ADDITION FRONT,MASTER .
a BEDROOM/BATHROOM,FOYER,AND FRONT PORCH&
Contractor a Date . REAR
I hereby affirm that I am licensed under the provisions of Chapter 9 AND INTERIOR REMODEL 820 SQFT-REROOF(E)2,141 SQ
(commencing with Section 7000)of Division 3 of the Business&Professions REVISION#1-STRUCTURAL REVISION
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:$127000
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:31634010.00 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 WIT UANCE 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 AYS + LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City inconsequence of the 2
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations,per the C ertino 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 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(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 25505,25 3 IRJ 25534.
Section 3700 of the Labor.Code,for the per of the work for which this v
permit is issued.
Owner or authorized agent: 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 BUILDING PERMIT
BUILDING ADDRESS: 10555 ORANGE TREE LN CONTRACTOR:MORE LAND PERMIT NO: 12080098
CONSTRUCTION
OWNER'S NAME: KRISHNAMURTHI AMUDHAN AND MANICKAM 1454 HUSTED AVE DATE ISSUED: 11/06/2012
OWNER'S PHONE: 4088354268 SAN JOSE,CA 95125 PHONE NO:(408)221-0892
❑ LICENSED CONTRACTOR'S DECLARATION
'� � f l BUILDING PERMIT INFO: BLDG r— r—ELECT PLUMB �
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
NI
I hereby affirm that am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT A 883 SQFT ADDITION FRONT,MASTER
(commencing with Section 7000)of Division 3 of the Business&Professions A D INTERIOR
D FOYER,AND FRONT PORCH&REAR
Code and that my license is in full force and effect. AND[NTERIOR REMODEL 820 SQFT-REROOF(E)2,{41 SQ
1 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.
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 Sq.Ft Floor Area: Valuation:$127000
permit is issued..
APPLICANT CERTIFICATION APN Number:31634010.00 Occupancy Type:
I certify that 1 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,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting;of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations er the Cupertino Municipal Code,Section
9.18.
Issued
Signature Date _
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that 1 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,
Business&Professions Code) Signature of Applicant: Date:
I,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:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 Heal h•&Safety Code,Sections 25505,25533,and 25534. 1 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&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
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 Cupertino 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 Code,Sections 25505,25533,and 25534.
Compensation laws of Califomia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authoriz
forthwith.comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 work's
correct.1 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and 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
DDDRESS: 10555 Orange Tree lane DATE: 08/09/2012 REVIEWED BY: Sean
PN: BP#: *VALUATION: 1$127,000
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? Yes No PENTAMATION
USE: SFD or Duplex OTC? 0 Yes No PERMIT TYPE: 1 R3SFDADD
�
WORK Construct a 845 sq ft addition and interior remodel 820 sq 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 845 $2,468.00 IR3PLNCK $1,549.00 IR3INSP
TOTALS: 845 $2,468.00 $1,549.00
MECH,HOURLY Q Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY 0 Yes Q No
Xfech. Plan Check Plumb. Mort Check Elea.Plan(;;heck
"tiu:h. Permit Fi,e. P1111m11. Permit Fee: Dec. Permit Fee:
Other :�Iech.Insp. Other Plumb Insp. F7 Other Glee.Insp. L] I
llech.Insp. e- Ph.rmb. hasp. kee: Elec.Insp.Fee:
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 preliminar information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS LF'ee Resolution I1-053 Eff.' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,468.00 = s.f. Remodel, Other
Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 $534.00 1REMRESOTA
PME Plan Check: $0.00
Permit Fee: $1,549.00
Suppl. Insp. Fee:Q Reg. ® OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constr uction Tarr: TT
Administrative Fee: 0
Work Without Permit? Yes E) No $0.00 E)
Advanced Planning,Fee: IPLLONGR $109.85 Select a Non-Residential Q
Travel Doc:•umentalion Fees: Building or Structure 0
Strong Motion Fee: IBSEISMICR $12.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $6.00
SUBTOTALS: $4,145.55 $534.00 TOTAL FEE: $4,679.55
Revised: 07/01/2012