15030189 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10640 GLENVIEW AVE CONTRACTOR:T115---e BE PERMIT NO: 15030189
946}� 6/,,Q v T
OWNER'S NAME: BHAGWAT YOGESH A AND BHAGYASHREE Y � #0-2749161b-0DATE ISSUED:05/04/2015
�.
OWNER'S PHONE: 5103661833 lv 4�; e7y,5-671PHONE NO: 9
-,-LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL
CONSTRUCT ONE STORY ADDITIONS(317 SQ FT);
License Class Lie. ,r0o BATHROOM REMODEL(60 SQ FT); OTHER REMODEL(338
- SQ FT); ELEC PANEL UPGRADE(200 AMP).
Contractor !�/�11>°1/I Date REV# 1-REVISE SLAB/FOUNDATION TO ACCOMODATE
I hereby affirm that I am licensed under the provisions of Chapter 9 ROOF LOAD-ISSUED 6/1/15
(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:
1 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 Valuation:$150000
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:36925001.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I 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 WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter D INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save OM
indemnify and keep harmless the City of Cupertino against liabilities,judgments, _41A/%`f
costs,and expenses which may accrue against said City in consequence of the Date: J
granting of this permit. Additionally,the applicant understands and will comply <1��; y'
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date �( 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
I,as owner of the roe y g HAZARDOUS MATERIALS DISCLOSURE
property,rty,am exclusive) contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I 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 I 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Date:
Owner or authorized agent:
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 CO CTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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 which 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.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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE^CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingQcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION 1 DEFERRED ORIGINAL PERMIT 4
PROJECT DRESS APN#
lrleo✓ier✓ Ave
OWNER NAME ,I� V� PHGNErrO E-MAIL
STREET ADDRESS 41' ` CITY, STATE,ZIP FAX
CONTACT NAME ./-U p4 9;100pQ E-MAIL,
Lei' Ale PHONE 4 // I
STREET ADDRESS //O _/ /U ei CITY,h"e.'e z �r ^ FAX
OWNER ❑ OWNER-BIJILDER ❑ 0!kWERAIGENT d CONTRACTOR ❑CONTRACTOR AGENT • ❑ ARCHITECT /❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMESE NUMB ,c�3ER LICENS TYPE BUS.LIC k
de
�
i , LICENTTs
COMPANY NAME C �OLr E-MAIL1180 Cwt l r t `C FAX
age
ST DRESS / A CITY,STATE,ZIP �'/ O PHONE
eev
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
1 1 �cf 19n 491K1&'
GL7 G� j6--e d A1,0 D0 o V Tv p - - l2cx� Logo
EXISTING USE PROPOSED USE CONSTR.TYPE 4 STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR, DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN. OTHER.
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DEC, ORCH AREA I GARAGE AREA: LJDETACH
[]ATTACH
A!D WELLINGUNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? []NO ADDITTON? []NO
PRE-APPLICATION ❑ITS IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES �"tix. .;`^r OTAL VALUATION:
PLANNING APPL V ❑NO' PLANNING APPROVAL LETTER EICHLER HOME?
-By my signature below,I certify to each of the following: I am the property owner or auth o act owner
w er'11
be have read this
application and the information I have provided is correct. I have rea Description ork an rt Tt is accurate. I agree to comply with a icable local
ordinances and state laws relating to building construct'on. I o e representatives of Cupertino to enter the above��-identified property for inspection p ses.
S i gnature of Appl icant/Agent: Date: ✓GL(/I ��� �J'
3� 'iv' �e'_Y%rL"�fa , '`•�iwxt,' ".s 3 �&'. -3'�rfw'<rits a.�a e
SUPPLEMENTAL INFO REQUIREDyw�t�.o._ �,sL�.�:�
T r v '"N '�'R'-"2-' •�,` �� v..+'yx ,•k Lr'--r teF..`'E'x`�3." .,,�aw
`• �•.rsf'm''tA a``S
New SFD or Multifamily d«ellings: Apply for demolition permit for
❑ OVERT1 E OUATSR fi t��l`i„B�UILDENGPL°�REVIE1Vk .
existing building(s). Demolition permit is required prior to issuance of building r wq'. N M
permit for new bui]ding. 3ExP � � F 17>r rLayN SSI gNg�
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ;q�sTaIDAIRD 0-' r
g P �` ,�Vin.-•���h�+c Je"t=u'.`�cr' '`��•a s"'o--��-£fid D �'�rSFt'i�w.'+`t�`
form if any Hazardous Materials are being used as part of this project.
Copy ofPlanning Approval Letter or Meeting with Planning Prior to
ub_mittal
of Building Permit application.
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
IFFEE ESTIMATOR-BUILDING DIVISION
ATADDRESS: 10640 GLENVIEW AVE DATE: 06/01/2015 REVIEWED BY: MELISSA
N: 369 25 001 BP#. 15030189 `VALUATION: Iso 771
-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PENTAMATION
PRIMARY 1GENRES
USE: 5FD or Duplex PERMIT TYPE:
WORK I REV# 1 - REVISE SLAB/FOUNDATION TO ACCOMODATE ROOF LOAD - ISSUED 6/1/15
SCOPE
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a..oi. g.--... �r �:_ry-s` off. .a,�G ✓ sry;;i. r f yti::. 1 a.:_.,a �,E
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„e� yfi�„0° AIMA i
_1
.Vec'A. Ple ('heck• 1'lrur;h P/a"I('frc cb E1ec. 11/wl Check
:41'11",/7. Pe,n,il Fee: Plaunb. Pc:rmil I,cc1'c<c.Perrrrir Pee:
r);hrr:Ilech. /n. 01her•Plrrrnh Jnsa 01her]:.,I I'rsp.
I is e`h. irulr. Fee: Mrnrh. hrsp. Fee: Fee:
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 preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Yes 0 No $0.00 1 hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. 0 OT 0,0 T hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
( onstraction 1 ux:
1 rlr;lini,l irr:rti i cc Fee,: 0
Work Without Permit? 0 Yes No $0.00 1 0
Advanced Plannin&Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
7iwvel Dtx•r,llnenlalinrl Fees: I- 114
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
r r� lw 7 a ?tJii �t sY .k° tiv
SUBTOTALS $0.00 $143.00 „ 4'tSTOTAI.tiF,EE $143.00
Revised: 05/07/2015