12020005CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10480 FLORA VISTA AVE
CONTRACTO .
PERMIT NO: 12020005
OWNER'S NAME:
License Class Lic. 0 V--q( C9:jL- I"(
Contractor FL-0RQ jtiDate
I 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.
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 whichthis 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 wjiich -is
permit is issued. jP
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 regulati s per the Cupertino Municipal Code, Section
9.18.
Signature - Date Z ( — G
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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)
1, as owner of die property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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 inany 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
l certify that I have read this application and state that the above information is
correct. l 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.
JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
SINGLE FAMILY BATH ADDITION(55SQFT)
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32628081.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPECTION.
Issued by: Date l bo
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. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(s) should 1 store or handle hazardous
material. Additionally, should 1 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 Health & Safety Code, 25534.
Ow eror.authorizedagent: Dater'/ - Z
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature
Date
CITY OF CUPERTINO
I / I FF.F FSTIMATOR — RITTLIDING DIVISION
ADDRESS: 10480 flora vista ave.
DATE: 02/02/2012
REVIEWED BY: bobs.
APNim: 30�,1�
BP#:
"VALUATION: 1$20,000
"PERMITTYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex
USE: P
2nd Unit? Yes • No
OTC? Yes No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK I
sfd bath addition .
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,NN-B
0
$0.00
$0.00
TOTALS,
0
$O.OU
:':':
$0.00
MECN, NOUkLY .::.
0• •Yes'..'4:1�IA:.'
::Fl; >.'g �:Y..:.
•. --.0::: eS.:':
"� 4t::..
'. i �:: J i'' ::::
Yl s
(!)No
Li
Li
NULL: phis estimate does not include fees due to other Departments (ie. Planning, Public Works, tire, J'anilaryJ'ewer Uislrici, School
DiviriM- ofr-1_ Thoto foot Oro hntod nn odimnfo- Cnnfnct 1ho Don> for nddn'/ info_
FEE ITEMS (Fee Resolution 11-053 E . 7/l,/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes C) No
$0.00
2 7 hours
$260.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes 0 No
$0.00
Suppl. Insp. FeeQ Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? ® Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Strom; Motion Fee: IBSEISMICR
$2.00
8.0 hrs
$1,040.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
$3.00?T?">[
$1,303.00
Revised: 1 /19/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10480 FLORA VISTA AVE
CONTRACTOR: HOSAKOTE SRIKANTH
PERMIT NO: 12020005
AND SRIKANTH SU
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
f— F F
MECH RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: SINGLE FAMILY BATH ADDITION(55SQFT)
(commencing with Section 7000) of Division 3 of the Business &Professions
and that my license is in full force and effect.
SANITARY PROPERTY LINECode
1 hereby affirm under penalty of perjury onethe following two
declarations— [ have and will maintain a certificate of consent to 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
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: 32628081.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
(certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
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 the Cupertino Municipal Code, Section
�J
12
per
Issued by: Date: L
9.18.
Signature Date
RE :
OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material berg installed. if a roof is
offing m
installed without first obtaining an inspection, 1 agree to remove all new materials for
hereby affirm that I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain a Certificate of Consent to self -insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health &
�b2
become subject to the Worker's Compensation provisions of the Labor Code, I must
�, r
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vwrk's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
1, certify that I have read this application and state that the above information is
Lender's Name
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
Lender's Address
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
ARCHITECT'S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
1 understand my plans shall be used as public records.
with all non -point
tWZ