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13020157 CITE'OF CUPIERTINO BUILDING PERMIT BUILDING ADDRESS: 20309 SILVERADO AVE CONTRACTOR:C AND D FREITAS PERMIT NO: 13020157 CONSTRUCTION OWNER'S NAME: SHARMA SURENDRA P AND DURGAPAL 23610 MORREL CUT-OFF RD DATE ISSUED:05/09/2013 OWNER'S PHONE: 4083531900 LOS GATOS,CA 95033 PHONE NO:(408)353-1900 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ffI License Cla��Ijwemce Lic. ��� �( 7 CONSTRUCT A 532 SQ FT ONE STORY ADDITION; INTERIOR Contractor je REMODEL(1840 SQ FT). I hereby affirm that I am licensed under the provisions Ch ter 9 (commencing with Section 7000)of Division 3 of the Bu iness&Professions REVISION#1- REVISE MINOR STRUCTURAL INTERIOR Code and that my license is in full force and effect. ONLY-ISSD OTC 6/4/2013 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. Sq.Ft Floor Area: Valuation:$175000 l 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:36939006.00 Occupancy Type: permit is issued. o ' APPLICANT ERTIFICATION I certify that i have read this application and state that the abo PERMIT E IBES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances s relating WITHIN O DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives o t is city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA 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: l with o of ations per the Cupertino Municipa Code, ection 9. RE-ROOFS: Si ire 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 1 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). 1 have read the hazardous materials requirements under Chapter 5.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. t 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 1 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 1 performance of the work for which this permit is issued, will maintain compliance wit t e ti o Municipal Code,Chapter 4. and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cod4e ns ,2 533,and 25534. r Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized ag Date: I certify that in the performance of the work for which this permit is issued,1 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCLUTECTIS DECLARATION 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 CU PIERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20309 SILVERADO AVE DXTE: 06/0412013 REVIEWED BY: MENDEZ APN: BP#: 3 b `VALUATION: iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK REVISION#1- REVISE MINOR STRUCTURAL INTERIOR ONLY SCOPE 'tech. Plan Chuck Plruuh. Plun Cheek Dec. Plan Check Afech. Perniit Fee Plumb. Permit Fee: Dec. Permit Fee: Other Afech.Insp. Other Plumh Insp. ELI Oilier Elec. hzsp. hlec•h.lnsp. Fee: Plinth. Insp. Fre: Elec.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). TheseLees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes C) No $0.00 1 hours Plan Check,Hourly Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $133.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Trcnvel Doemnentation Fees: Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item.- Bldg Stds Commission Fee: $0.001 1 SUBTOTALS: $0.001 $133.00 TOTAL FEE: $133.00 Revised: 04/29/2013 l ' CITY OF CUPERTiNO BUILDING PERMIT BUILDING ADDRESS: 20309 SILVERADO AVE CONTRACTOR:C AND D FREITAS PERMIT NO: 13020157 CONSTRUCTION OWNER'S NAME: SHARMA SURENDRA P AND DURGAPAL 23610 MORREL CUT-OFF RD DATE ISSUED:05/09/2013 OWN R'S PHONE: 4083531900 LOS GATOS,CA 95033 PHONE NO:(408)353-1900 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class L' # 9-76513 CONSTRUCT A 532 SQ FT ONE STORY ADDITION; Cantractopd` yPeW �l tHt INTERIOR Date REMODEL(1840 SQ FT). 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:$175000' 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:36939006.00 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 WITI�IlV 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 N1 ST 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 h-3 granting of this permit. Additionally,the applicant understands and will comply Iss by: Date: with all non-point source gu ions per the Cupertino Municip 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 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) 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. 1 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 1 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,Se ti 12556 7, 33, ad 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: bi 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 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 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 CUP ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20309 Silverado Ave DATE: 02/28/2013 REVIEWED BY: Sean APN: OLZ 0 11 'VALUATION: $175,000 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD USE: OTC. ©Yes Q No PERMIT TYPE: WORK Construct a 532 sq ft one story addition; interior remodel '1840 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,1V,v-B 532 $2,468.00 IR3PLNCK $1,549.00 IR3INSP TOTALS: 532 $2,468.00 1 $1,549.00 MECH,HOURLY Q Yes E) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes .fl No Mech, Flan Cheek Plumb. Plan ChecA F_lec..Piari Check hr'ch. Perwil Fra': Plumb.Permi!Feet: Dec.Permit Fee: Orher,tlec•h. Insp. Li Other Plumb Insp. L] Odrer filer.Insp. Ll —L— . Adech. hup,Fee: Plumb. hasp.ree: Flee.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. . These ees are based on the prelimina information available and are onlan estimate Contact the De t or addn'l in o. FEE ITEMS(Fee Resolution 11-053 Efj'.• 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,468.00 EiO s.f. Remodel,Other Suppl. PC Fee: Q Reg, Q OT 0.0 hrs $0.00 $4,809.00 IREMRES2 PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee:Q Reg. Q OT 0 0 firs $0.00 PME Unit Fee: $0,00 PME Permit Fee: $0.00 Consiruction Tax: Administrative Fee: Q Work Without Permit? Q Yes E) No $0.00 E) Advanced Planning Fee: IPLLONGR $69.16 Select a Non-Residential .Q Travel Doct.anentalion Fees: Building or Structure . .Q Strong Motion Fee: IBSEISMICR $17.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $7.00 SUBTOTALS: $4,110.661$4,809.00 TOTAL FEE: 1 $8,919.66 Revised: 01/01/2013