13030114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:'10526 LONNA LN CONTRACTOR:ANINDITA BANERJEE PERMIT NO: 13030114
OWNER'S NAME: ANINDITA BANERJEE 10526 LONNA DR DATE ISSUED:03121/2013
OWNER'S PHONE: 4083662029 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# ADD 85 SQ FT TO ENLARGE KITCHEN & BATH&
REMODEL
Contractor' Date BOTH AREAS, INCLUDING (N) LIGHTING FIXTURES.
I hereby affirm that I am licensed under the provisions of Chapter 9 REMOVE HALL WALLS& PANTRY NEAR DINING RM.
(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:$65000
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 APN Number:35919019.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 WITHIN 180 DAYSIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspeetion purposes. (We)agree to save 180 DAYS F 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 compl I by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Secti
9.18.
RE-ROOFS-
Signature Date All roofs shall be inspected prior to any roofing material being installed: [f 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
1,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
constrict the project(Sec.7044,Business&Professions Code). 1 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 1 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 1
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,Sectio s 25505,2553i a97—vate:4. r
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent&_
P
emit is issued.
I certify that in the performance of the work for which this permit is issued,l 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 whieh 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.1 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 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 ' LA--Date )C�} ��
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10526 LONNA B# 4V DATE: 0312112013 REVIEWED BY: MELISSA
APN: 359 19 019 BP#: �Q VALUATION: 1$65,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Oves No PENTAMATION 1 R3SFDADD
:
USE: OTC. O Yes �No PERMIT TYPE:
WORK ADD 85 SO FT TO ENLARGE KITCHEN & BATH & REMODEL BOTH AREAS INCLUDING N
SCOPE LIGHTING FIXTURES. REMOVE HALL WALLS & PANTRY NEAR DINING RM.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. S.I.
R-3 (Custom) II-B,111-B,IV,V-B 85 $1,014.00 IADDPLCK $983.00 IADDINSP
TOTALS: 85 $1,014.00 $983.00
MECH,HOURLY O Yes 0 No PLUMB,HOURLY Q Yes 0 No ELEC,HOURLY Q Yes Q No
Alech. Plan Check Plumb, Plun Check Elcc. Plan Check
�Lfcch. Per-il Fete:- Plumb. Pci7nil Fere: Elec. Permit Fee.'
Orher Aleck. ln.rp. Other Plumb Insp. Other Efec.Insp. Li
_Hoch. Insp. Fere: Plumb, Insp. Fee: Elee.Imp. Fee:
NOTE. This estimate does not include fees due to other Departments(Le. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 f . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,014.00 300 s.f. Remodel,Other
Suppl. PC Fee: Q Reg. () OT 0,fl hrs $0.00 $400.00 IREMRESOTH
PME Plan Check: $0.00
Permit Fee: $983.00
Suppl. Insp. Fee:Q Reg. Q OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.
Administrative Fee:
Work Without Permit? Yes No $0.00
Advanced PlanninL Fee: 1PLLONGR $11.05 Select a Non-Residential
Travel Docrunentation Fees: Building or Structure
Strone Motion Fee: IBSEISMICR $6.50 Select an Administrative Item
Bldg,Stds Commission Fee: IBCBSC $3.00
SUBTOTALS: $2,017.55 $400.00 TOTAL FEE: $2,417.55
Revised: 01/01/2013
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