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11070099CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10471 WESTACRES DR OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 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. l certify that in the performance of die 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 l 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. CONTRACTOR:PURLUPADY GANGARATHNA 10471 N BLANEY AVE CUPERTINO, CA 95014 PERMIT NO: 11070099 DATE ISSUED: 10/03/2011 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH F_ RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: SFDWL RE -BUILD -DEMOLISH 600'-ADD 812SQ,FRONT LIVING ROOM,OFFICE, NEW GUEST BEDROOM & BATHROOM. REMODEL KITCHEN 200',rNTERIOR BATHROOM, MASTER Sq. Ft Floor Area: I Valuation: $150000 APN Number: 35914032.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued ly} _ Datao;_, � 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or autl rized agent: Date: JO CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of vwrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature �`��/�� ! ` Date Licensed Professional CITY OF CUPERTINO BUILDING PERN'E BUILDING ADDRESS: 10471 WESTACRES DR OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 1 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Date Chi OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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) 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. Signature_ Date CONTRACTOR: GEORGE RAJESH AND PURLUPADY GANGARA 10471 WESTACRES DR CUPERTINO, CA 95014 PERMIT NO: 11070099 DATE ISSUED: 10/03/2011 PHONE NO: BULLDING PERMIT INFO: BLDG F ELECT F PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SFDWL RE -BUILD -DEMOLISH 600'-ADD 812SQ,FRONT LIVING ROOM,OFFICE, NEW GUEST BEDROOM & BATHROOM. REMODEL KITCHEN 200',INTERIOR BATHROOM, MASTER 10/19/1 l REVISION # I CHANGE ROOF TO CONCRETE TILE- REV# I ISS'D 11/22/2011 Sq. Ft Floor Area: I Valuation: $150000 APN Number: 35914032.00 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: 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 1 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(s) 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mork'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 CITY OF CUPERTINO FM_ l FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10471 west acres dr. DATE: 10/19/2011 REVIEWED BY: bobs. APN: I BP#: 11070099 *VALUATION: 1$1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise roof to concrete tile. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District_ etc )_ Thece fev_c are hacod nn the nrelininary inlarniminn availahlo and aro nnly an ovdinnty_ Cnntart tho Dont far addn'1 infn_ FEE ITEMS (Yee Resolution II-053 L•'ff. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feel@ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7_1 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Strong- Motion Fee: IBSEISMICR $ 1 # $783.00 Revision 1REVSFDWL SFDWL Bldg_Stds Commission Fee: IBCBSC 0 „+.. $1.50 $783.00 . ' . = $ 784.50 /01 / Revised: 10 W��,,--�� CITY OF CUPERTINO -W FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10471 westacres dr. DATE: 07/15/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? % Yes No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK sfd re -build add living, office master suite remodel fa m ily, kitchen d in i ng, bedrooms bathrooms hallway. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.L PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 2,257 $2,664.53 IR3PLNCK $2,394.94 IRMNSP TOTALS: 2,257 $2,664.53 .. $2,394.94 NOTFt These fees aro hacod nn /ho nroliminnry infnrmnJinn nvni/nhlo and Oro nn/v nn octimnJa CnnJnrt Jho 1)onJ fnr nddn'1 infn- FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,664.53 470 s.f. $2,744.00 Roof Structure Replacement IROFSTRREP Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,394.94 Suppl. Insp. Fee G Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: IBCONSTAXR J # new units $579.61 Acoustical Fee: 0 Yes G No $0.00 Q 0 Work Without Permit? 0 Yes (E) No $0.00 PlanningFee: PLLONGRNGR $293.41 Select a Non -Residential Building or Structure E) 0 i Strong; Motion Fee: IBSEISAfICR $15.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 4• `:1t7 l 5 $ 953.4 9• 2744. 40 � •`•� •• �••��>E�l •$8,697.49 Revised: 07/04/2011