15060107-expiredCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22772 ALCALDE RD
CONTRACTOR: ROCHA'S COMPANY
PERMIT NO: 15060107
OWNER'S NAME: NEEL DHAMDHERE
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DATE ISSUED: 6/23/15
OWNER'S PHONE: (408) 221-3918
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PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class (C.. Z Lic. # S) V 12—
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RESIDENTIAL COMMERCIAL
Contractor r Date � ��� /�
MECH
I hereby affirm that I am license mde a provisions of Chapter 9
_
JOB DESCRIPTION: 7-A1
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(commencing with Section 7000) of Division 3 of the Business & Professions
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Code and that my license is in full force and effect.
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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
Sq. Ft Floor Area:
N aluafion:
permit is issued.
APPLICANT CERTIFICATION
APN Number:
Occnpanc> I ypc:
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
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to building construction, and hereby authorize representatives of this city to enter
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upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF SNOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant u stands and will comply
WITHIN 1 S OF IT ISSUANCE OR
with all non-point sour regul ns per th Cu m unicipal Code, Section
18 S FRO LLED INSPECTION.
9.18.
Signature
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE-ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
1 certify that in the performance of the work for which this permit is issued, I shall
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compl' nce with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Sa Code, S ctions 2 533, and 25534.
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.
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APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws relating
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
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.
ARCHITECT'S DECLARATION
Signature Date
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS Z'2 Z
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APN # � LIZ_ _ � `
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OWNER NAME �� ► `H /I wAD� -
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1-1 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT WCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
LICENSENUMBER
LICENSETYPE
BUS. LIC#
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COMPANY NAME
E-MAIL N� r
FAX
STREET ADDRESS tJ
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ARCHITECT/ENGTNEER NAME jN 10V6��
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME A /�
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STREET ADDRESS
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PHONE
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DESCRIPTION OF WORK - /ted �1 Jr
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EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
✓
I
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 DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVE -
TOTAL VALUATION:
PLANNING ADPL# ANO PLANNING APPROVAL LETTER
EICHLER HOME? E]NO
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have ovided is correct. I have read the Description of Work and verify it is accurate. I agree to co ly with all applicable local
ordinances and state laws relating o bu. ing c s on. I authorize representatives of Cupertino to enter the aljove-i t' lea e �fo coon purposes.
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Signature of Applicant/Agent: Date:
SUPPLEMENTAL IMMRMATIONREQUIRED
PInNc>cKi�PE
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OVER THE COUNTER
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Y BIIII DING PLAN REVIEW [
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New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
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PLANREYiMRIM
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as part of this project.
of Planning Approval Letter or Meeting with Planning to
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_Copy prior
SANITAR]ISEWERDISTRI
submittal of Building Permit application.,t�
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BldgApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
WNW FFF F.cTIN4ATOR - BUILDING DIVISION
NOTE:
NOTE: This estimate does not include fees due to other Departments (i.e. Punning, ruouc works, P/re, auuuury cewcr [iwii ea y —1—us
& d th !'mina in ormation available and are onlv an estimate. Contact the De t or addn'l in o.
District, etal. These ees are ase on a re
FEE ITEMS LI ee Resolution 11-053 Eff. 7/1/13)
22772 Alcalde Rd
DATE: 04/16/2015
REVIEWED BY: Sean
liaADDRESS:
APN:
BP#:
"VALUATION: $0
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE. : Addition
PRIMARY
SFD or Duplex
Other ;'twi'w lav".
PENTAMATION 1 RBCRW
PERMIT TYPE:
USE:
PME Plan Check:
$0.00
WORK
Construction of detached site retaining wall 70 I 6 ft max height).
Permit Fee:
SCOPE
Suppl. Insp. Fee -.0 Reg. Q OT
NOTE:
NOTE: This estimate does not include fees due to other Departments (i.e. Punning, ruouc works, P/re, auuuury cewcr [iwii ea y —1—us
& d th !'mina in ormation available and are onlv an estimate. Contact the De t or addn'l in o.
District, etal. These ees are ase on a re
FEE ITEMS LI ee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
ec..Phin
Plan Check Fee:
lslec. Pernrrt 1 .
,.<..
_
Other ;R ,kch. /;;,1p
Other ;'twi'w lav".
_V., r i;/' c'. frs/;.
Lj
Wec, t lnsp; I, -
PME Plan Check:
$0.00
NOTE:
NOTE: This estimate does not include fees due to other Departments (i.e. Punning, ruouc works, P/re, auuuury cewcr [iwii ea y —1—us
& d th !'mina in ormation available and are onlv an estimate. Contact the De t or addn'l in o.
District, etal. These ees are ase on a re
FEE ITEMS LI ee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F -7-0 —1l..
$1,575.00
Retaining Wall
1RETSTN Standard Retaining Wall
Suppl. PC Fee: Q Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction T(iv:
I I ,;,,,,.i,061,�,,, Fo,,
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Dywet Docuinentatwri _l "cje: :
Strong Motion Fee:
$0.00
Select an Administrative Item
Bld( Stds Commission Fee:
$0.00
SUBTOTALS:
1 $0.00
$1,575.00
TOTAL FEE:
$1,575.00
Revised: 04/01/2015