12050147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22224 VIA CAMINO CT CONTRACTOR:S&B CONSTRUCTION PERMIT NO:12050147
OWNER'S NAME: SRIKUMAR CHARI 1294 CALDWELL CT DATE ISSUED:11/05/2012
OWNER'S PHONE: 4088874262 SUNNYVALE,CA 94087 PHONE NO:(408)529-1818
LICENSED CONTRACTOR'S DECLARATION
,,�. BUILDING PERMIT INFO: BLDG ELECT' PLUMB
License Class '-3 Lie.# U 19
-i—:) MECH`r r
RESIDENTIAL' COMMERCIAL
Contractor �"�' `� r'` Date -7y
I hereby affirm that I arq-licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD 421 SQ FT TO SINGLE STORY SFDWL,REMODEL
(commencing with Section 7000)of Division 3 of the Business&Professions 1,042
SQ FT THROUGHOUT.RE-ROOF ENTIRE(E)ROOF 22
Code and that my license is in full force and effect.
SQUARES.
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.
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
permit is issued. , Sq.Ft Floor Area: Valuation:$214450
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:32646006.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FRO LAST CALLED INSPECTION.
9.18. _ n
Signature C DateC
Issued by: Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
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(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections,25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must f
forthwith comply with such provisions or this permit shall be deemed revoked. Owner�r au �or�zed agent
Date: !f" 05. j2
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of Mrk's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO 99//
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22224 Via Camino Ct DATE: 06/12/2012 REVIEWED BY: suew
APN: 326-46-006 BP#: 12050147 *VALUATION: 1$214,450
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD
USE: !0 OTC? 0 Yes 0 No PERMIT TYPE:
WORK /17M/ ' oz SG� — z
47-f
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,IiI-B,IV,V-B 421 $1,482.00 IADDPLCK $1,205.00 IADDINSP
TOTALS: 421 $1,482.00 $1,205.00
MECH,HOURLY O Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0 No
7—
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 relimina. information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,482.00 1,042 s.f. Remodel,Other
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $4,196.00 IREMRES2
PME Plan Check: $0.00 2,175 s.f. Re-roof
Permit Fee: $1,205.00 $308.00 IREROOFRESl�/ G�7
Suppl. Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
F-1
0
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planning Fee: PLLONGRNGR $54.73 Select a Non-Residential 0
Building or Structure 0
Strong Motion Fee: IBSEISMICR $21.45 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $9.00
SUBTOTALS: $2,772.18 $4,504.00 TOTAL FEE-. F $7,276.18
Revised: 06/05/2012
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
WADDRESS: 22224 Via Camino Ct DATE: 05/21/2012 REVIEWED BY: Sean
PN: BP#: O/ "VALUATION: $214,450
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD
USE: pOTC? 0 Yes •
No PERMIT TYPE:
WORK Construct a 421 sq ft single story addition with 1042 sq ft remodel.
SCOPE
lS.
OCCUPANCY TYPE: TYPE OF FL AREA PC FES PC FEE ID BP FEES BP FEE
CONSTR. s.L
R-3 (Custom) II-B,111-B,IV,V-B 421 $1,482.00 IADDPLCK $1,205.00 1 INSP
TOTALS: 421 $1,482.00 $1,205.00
MECH,HOURLY 0 Yes (j) No PLUMB,HOURLY Q Yes '(j) No EC,HOURLY Q Yes Q No
-. r< <ck �"�rrrF, Plrm�C�.cl, ale.:.rfu Chick
1:Ie..
? - �l 7 >. ��. r„
� G�`��e� f u,.znl;as� v;herL;��c.L�zsr�.
:I E3
El
^,`cCf7. plzlwl J:. j';tp. �.�C'C.1r��.�.
NOTE:This estimate does not include fees due to other Departments(i.e.Panning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelinddha in ormaiion available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff" 7/1,11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
$1,48200 1,042 s.f. Remodel, Other
f
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs /$0.00 $4,196.00 IREMRES2
PME Plan Check: , ` $0.00
Permit Fee:
//$1,205.00
Suppl. Insp.Fee:Q Reg. Q OT0.0 hd $0.00
PME Unit Fee: . $0.00
PME Permit Fee: f $0.00
Work Without Permit? 0 Yes () No $0.00 0
Advanced Planning Fee: PLLONGRIVGR $54.73 Select a Non-Residential E)
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $21.45 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $9.00
SUBTOTALS: $2,772.18,$4,196.00 TOTAL FEE: $6 .18
ised: 04/01/2012