12040124CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10424 WESTACRES DR CONTRACTOR: MANA GENERAL PERMIT NO: 12040124
CONTRACTOR
OWNER'S NAME: TYAGI RITESH AND RITU 1839 TAMPA WAY DATE ISSUED: 08/13/2012
OWNER'S PHONE: 4086214323 SAN JOSE, CA 95122 PHONE NO: (408)375-4288
'0_ LICENSED CONTRACTOR'S DECLARATION
License Class
,�^ Lic. # C
ContractoVW(�V�k 0�06C. Date &/f3 2—
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.
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.
APPLICANT CERTIFICATION
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
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
with all non -p rce regulations per the Cupertino Municipal Code, Section
9.18,
Signature Date r ��
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18,
BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB f—
MECH r RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: ONE STORY 870 SQ FT ADDITION AND 999 SQ FT
REMODEL, REROOF 2132 SQ FT, 200 AMP SERVICE
UPGRADE, INSTALL NEW FURNACE AND WATER HEATER.
Sq. Ft Floor Area: I Valuation: $150000
APN Number: 35914012.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: / �" Date:i
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
r 2
�✓�Dater
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of nvork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
igADDRESS:
10424 Westacres Dr.
DATE: 04/23/2012
REVIEWED BY: RDW
PC FEE ID
APN:
BP#: a 01/0
'EVALUATION:
1$150,000
,PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? -. Yes • No
OTC? 0 Yes E)No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
1 story 870 sq/ft addition w/2 bedroom bath and living room. Remodel 999 sq/ft including kit & ba.
SCOPE
Reroof 31 sq. 200 A service upgrade, new furnace.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
870
$2,420.00
IR3PLNCK
$1,519.00
IR3INSP
Efec. li7s 1=. 1't',t?:
$1,519.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
0 # Mechanical
$130.00 IMFR=<I00 Furnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
200 amps Electrical
1ERT<2oo ServicesrH:�OH1
. r>rFl-��
Fec:
0
G
Work Without Permit? C) Yes (F) No
$0.00
TOTALS:
F 870
$2,420.00
Travel Documentation Fee: ITRAI DOC
$1,519.00
Strong Motion Fee: IBSEISMICR
MECH, HOURLY 0 Yes G No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY ® Yes Q No
Mech. Plan Check 0.0 hrs $0.00
I r.�.mbr 11100" (_ he,
Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERb1IT
('hors b. 1'rv, ;ri l ers:
Elec. Permit Fee: IEPERDIIT
Other Mech. Insp. 0.0
06, s I't,rl,rb < gip,
Other Elec. Insp.0.0 hrs $44.00
$0.00
r
z'`Es':
Efec. li7s 1=. 1't',t?:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addit'1 into.
FEE ITEMS (Fee Resolution 11-053 E,{f. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,420.00
F9997 s.f. Remodel, Other
$587.00 IREMRESOTH
Suppl. PC Fee: F) Reg. 0 OT
0.0
1 lu's
$0.00
PME Plan Check:
$0.00
37045 s.f. Re -roof
$434.00 IREROOFRES
Permit Fee:
$1,519.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
0 # Mechanical
$130.00 IMFR=<I00 Furnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
200 amps Electrical
1ERT<2oo ServicesrH:�OH1
. r>rFl-��
Fec:
0
G
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning Fee: PLLONGRNGR
$113.10
Select a Non -Residential G
Building or Structure 0
�
Travel Documentation Fee: ITRAI DOC
$44.00
Strong Motion Fee: IBSEISMICR
$15.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $6.00
SUBTOTALS:'
$4,205.101$1,195.001
TOTAL FEE:
1 $5,400.10
Revised: 04/01/2012