15030189 (3) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10640 GLENVIEW AVE CONTRACTOR:LEI WEN PERMIT NO: 15030189
CONSTRUCTION
OWNER'S NAME: BHAGWAT YOGESH A AND BHAGYASHREE Y 432 HONOLULU CIR DATE ISSUED:05/04/2015
OWNER'S PHONE: 5103661833 UNION CITY,CA 94587 PHONE NO:(408)509-9700
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
CONSTRUCT ONE STORY ADDITIONS(317 SQ FT);
License Class_ Lic.# F /S BATHROOM REMODEL(60 SQ FT); OTHER REMODEL(338
7 �� SQ FT); ELEC PANEL UPGRADE(200 AMP).
Contractor /f?/` Gt/e%J7� Date IREV#2-ELIMINATE 2 CEILING BEAMS OVER FAMILY
I hereby affirm that I am licensed under the provisionso Chapter 9 RM&ADD A 2 X 10 OVER MASTER BDRM&INCREASE
(commencing with Section 7000)of Division 3 of the Business&Professions MASTER BDRM WINDOW HEADER TO 4 X 12-ISSUED
Code and that my license is in full force and effect.
6/9/15
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:$150000
d ave 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 W OT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D T ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA 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 comply ate:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature at.,c� � --vo a 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.
13 ER-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
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
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. I 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 1 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 I
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,Sections 25505,25/533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 6Q W ,+ `/
permit is issued. Owner or authorized agent: DateP_
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I 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 I 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 eb
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3226 FAX(408)777-3333•building(cDcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION//TI REVISI DEFERRED ORIGINAL PERMIT R lJ 03 Cl /
PROJECT ADDRESSa APN R 7 Z O 0/
O ✓/ /le-
OWNER NAME�O PHONE 6 /833 E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL /
7.0 u s ✓
STREET ADDRESS CITY,STATE,ZIP FAX
El OWNER ❑ OWNER-BUDDER ❑ ORTIERAGENr CONTRACTOR ❑CONTRACTOR AGENT - ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME LICENSENUMBER LICENSETYPE BUS.LIC
CO�ANY NAME E-MAIL FAX
Gam'%rtil•Piyl vaST/arc ,oh
ST ADDRESSCITY,STATE,ZIP r PHONE
L � 7D 41Z'1 C-/y- lith,nti
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC
COMPANY NATE E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK rf
w.:Ne � -t I'),, ej¢�{w y aVF .' Gtww4 Y'04 Q Z x to 49 VPr\/
Ma.'Olcw bekYe"w\ cx o 91RV t, *- Z fZ
EXISTING USE PROPOSED USE CONSTR TYPE I -'STORIES -
USE TYPE OCC. SQ.FT. VALUATION(S)
EX'I.STG NEW FLOOR- DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM. KITCHEN.. OTHER.
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA . DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
O ATTACH
R D\\'ELLINGUNITS: IS A SECOND UNIT ❑YES SECOND STORY OYES
BEING ADDED? 0 N ADDITION? ONO .
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN �- - —"'
❑YES D BY - TOTAL VALUATION:
PLA,N7dING APPL,- ❑NO PLANNII.'G APPROVAL LErrER EiCHLER HOME? ❑
By my signature below,I certify to each of the follo\ving: I am the property owner or autho act on the property ov ner s behalf. I have read this
application and the information I have provided is correc I have read the Description of\ ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTA 4ATION REQUIRED '
�;;PxAI\�C]�CKTrYPlaru'_ _�.0 `�=ROUSI3GSLIP.F��,_,-.
New SFD or Multifamily d ellings: Apply for demolition permit for r t
�� 04�R�TH.1iCOUI�TER flkBUII;DInGPLAI�REVIES?,T _ s^�'
existing building(s). Demolition permit is required prior to issuance of building
permit for new buildingt 0 gr Ar<n�c7'LnnrvzE1,0
w_ 4
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure =p ter, PusLzc
fovFORxss
_rm if any Hazardous Materials are being used as part of this project. �� f
LARGE i n h E DggIItEDEPT �MME
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. rnz4fiaox ` fl sATVT AR sE\i R �s�RIC
B1dgApp_2011.doc revised 06/11/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10640 GLEANVIEW AVE DATE: 06/09/2015 REVIEWED BY: MELISSA
APN: 369 25 001 BP#: 15030189 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 GENRE
WORK REV#2- ELIMINATE 2 CEILING BEAMS OVER FAMILY RM &ADD A 2 X 10 OVER MASTER
SCOPE BDRM & INCREASE MASTER BDRM WINDOW HEADER TO 4 X 12- ISSUED 6/9/15
;leech. Plan Check Plumb,Plan Check Elec.Plan Check
;Meeh. Permil Fee: Plumb. Permit Fee: lslec. Permit Fee:
Other AIech.Ins). Other Plumb trap. EI-L- Other Ve c.Insp.
EL j
11ech.Insp.f=ee: Plumb. Ins). Fee: I Llec.Insp.fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prefintina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly
Suppl. PC Fee: (j) Reg. Q OT 0.0 1 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
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: 0
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
Travel Doc°urnentaturr Fees: i
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.00 $143.00 ISTINSP Inspection,Hourly
SUBTOTALS: $0.00 $286.00 `TOTAL FEE:•,1 $286.00
Revised: 05/07/2015