13080193 CITY OF CUPIERTINO BUILDING PERMIT
BUILDING ADDRESS: 10032 SCENIC BLVD CONTRACTOR.VENKATESHA IYENGAR PERMIT NO: 13080193
OWNER'S NAME: VENKATESHA IYENGAR 10032 SCENIC BLVD DATE ISSUED:09/16/2013
OWNER'S PHONE: 3107044604 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL
License Class Lic.i✓ ADDITION OF 115 S.F.TO CREATE(N)KITCHEN NOOK.
RAISE CEILING FROM 8'TO 10' (550 S.F.AREA).
Contractor Date REPLACE 6 WINDOWS, LIKE FOR LIKE&ADD 1 (N)BAY
1 hereby affirm that 1 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:
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:$20000
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:35709047.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PEST EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITI�IN 180 DAYS OF PERMIT ISSUANCE ®R
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 DAYS FROM 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: �
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 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)
,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
1 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255_05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: pate;
permit is issued.
1 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,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
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 l�Q 3
CITY OF CU P1Ell TINO
FEE ESTIMATOR- BUILDING DIVISION
J. ADDRESS: 10032 SCENIC BLVD DATE: 08/26/2013 REVIEWED BY: MELISSA
PN: 357 09 047 BP#: 3O&a/ _5 'VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? °Yes No PENTAMATION
USE: SFD or Duplex OTC? O Yes o No PERMIT TYPE: 1 R3SFDADD
�
WORK ADDITION OF 115 S.F. TO CREATE N KITCHEN NOOK. RAISE CEILING FROM 8' TO 10' 550
SCOPE S.F. AREA). REPLACE 6 WINDOWS, LIKE FOR LIKE &ADD 1 (N) BAY WINDOW TO AN (E)
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.E
R-3 (Custom) II-B,111-B,IV,V-B 115 $1,059.00 IADDPLCK $1,026.00 IADDINSP
TOTALS: 115 $1,059.00 $1,026.00
MECH,HOURLY O Yes E) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
Wec:h. Plan Check FT Plronh. Plum Check Elect. Plan Check
IN ch. Perrrri!Fee: Plumb. Permii ree. Iileu. Permit l=ee:
Oilrer Afech. Insp. (hoer Plumb Insp. Usher Elee. Insp.
A?ech. Insp.Fee: Plumb. Insp. ree: Elec. Insp.Flee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These Lees are based on the relimina information available and are on ly an estimate. Contact the De t for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E1T 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,059.00 F 550-1 s.f. Remodel, Other
Suppl. PC Fee: C) Reg. Q OT 0.0 1 hrs $0.00 $488.00 IREMRESOTH
PME Plan Check: $0.00 = # Window/Sliding Glass Door
Permit Fee: $1,026.00 $418.00 1 1WINREP Replacement
Suppl. Insp. Fee.0 Reg. Q OT Q Q hrs $0.00 = # Window/Sliding Glass Door
PME Unit Fee: $0.00 $834.00 IWINBAYSTR Bay Window
PME Permit Fee: $0.00
Const uctton Tax:
Administrative Fee: Q
Work Without Permit? O Yes (E) No $0.00 G
Advanced Planning Fee: IPLLONGR $16.10 Select a Non-Residential
Truce l Documentation Fees: Building or Structure to
Stronp-Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2,104.101$1,740.001 TOTALFEE: 1 $3,844.10
Revised: 07/01/2013