15030189 (5) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10640 GLENVIEW AVE CONTRACTOR-&e✓ t tlC1N PERMIT NO: 15030189
GdX'-%TkfJV'-T} dN
OWNER'S NAME: BHAGWAT YOGESH A AND BHAGYASHREE Y DATE ISSUED:05/04/2015
OWNER'S PHONE: 5103661833 PHONE NO:
(1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CONSTRUCT ONE STORY ADDITIONS(317 SQ FT);
License Class,_ Lic.# G�S�O(j/f BATHROOM REMODEL(60 SQ FT); OTHER REMODEL(338
�j��� SQ
Contractor �p�' 0�i DateZ �x FT); ELEC PANEL UPGRADE(200 AMP).
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.
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 which this permit is issued. Sq.Ft Floor Area: Valuation:$150000
N 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 APN Number:36925001.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 WITHIN 180 D RMIT 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 O LLED PECTION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Date: S
granting of this permit. Additionally,the applicant understands and will comply °e
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
_ RE-ROOFS:
Signature Date,"A`J 44 6 All roofs shall be inspected prior to any roofing material being installed.If a roof is
T installed without first obtaining an inspection,l 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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 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 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 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 25 ,25 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: -L�f
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 C STRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,1
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,clic applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
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•building(a)cupertino.om
❑NEW CONSTRUCTION ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
QAW
OWNER NAME C� �` PHONE�1Q _ b k$ E-MAIL �N4. W 4t 11.q;•I, CaM
STREET ADDRESS 1f CITY,STATE,ZIP O FAX
to 6 4 o GSI a�.u; C_ Q If't��.o_ a
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT & ARCHITECT KNGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERR AMEN 1 4 LICENSE NUMBER ` BUS.LIC#
V'� `+ 3eDO
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
6 d.
DESCRIPTION OF WORK
EXISTING USE PROPOSED USENS .TYPE #STORIES
2. S�L V USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL / /
AREA , AREA 3 1 AREA O NET AREA Zeno/ 31-7 4
BATHROOM KITCHEN OTHER r'll7 1 U�
REMODELAREA2 1 1 REMODEL AREA Q� REMODELAREA Z 6 Q,
PORCH AREA DECK A/REE/A TOTAL DECKIPORCH AREA GARAGEE AREA: DETACH t%T
5 Z• `� V -2• 9" 44-1.6 TTACH
#DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY YES
I BEING ADDED? MAgO ADDITION? �2id
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN � , r TOTAL VALUATION:PLANNING APPL# MKO PLANNING APPROVAL LETTER EICHLER HOME? 7 y� {
By my signature below,I certify to each of the following: I am the property owner or authorized agent to a property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bung construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 3/ 7-0(/s
SUPPLEMENTAL INFORMATION REQUIRED
>:t,',z' f >> ✓ i` ` ' 1 ,'
Q
_New SFD or Multifamily dwellings: Apply for demolition permit for c r x tl�i", 7F 1,� �,��'a' "
OVERyTHE COUNTER y, DWG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. O EXP�tEss PLANNWC P�AN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STArH)ARD L ❑ PI)HLIc{;wOcs
form if any Hazardous Materials are being used as part of this project.
❑' LSARGEj. _5 r ' 1 ❑ FIRE DEPTI'
Copy of Planning Approval Letter or Meeting with Planning prior to
Cl MAJOR SAN ARYSEWERtDIS7RICTi
submittal of Building Permit application,
' ;:.,tf ,� ,.+.,,. 1 O.'r`iENY1RON111ENTAL',HEAGTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10640 Glenview Ave DATE: 04/16/2015 REVIEWED BY: Sean
APN: BP#: �� "VALUATION: $150,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Du lex 2nd Unit? Yes • No PENTAMATION
USE: p OTC? 0 Yes E)No PERMIT TYPE: 1 R3SFDADD
WORK Construct one storyadditions 317 s ft • Bathroom remodel 60 s ft • Other remodel 338 s ft • Elec
SCOPE panel upgrade (200 amp).
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 317 $1,626.00 IADDPLCK $1,323.00 IADDINSP
I
TOTALS: 317 $1,626.00 z $1,323 00
a.
MECiOURLY a
EkEC„HO17RT,Yr ®r des ,Q No s
Aleft. Plvn C'h,>rrh• Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00
M,,/,- Permit Fee: Plaaarh. Perini(Fee': Elec.Permit Fee: IEPERMIT
Otker'A-h!(:h./asp. Other Plrrmh hrsp. Other Elea,Insp. 0.0 hrs $48.00
A,kc'h. Insp. Fee: rnub, 1rup. Pec': lace:. hash.Fee;
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E : .'1:'13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,626.00 F_601 s.f. Remodel,Bath(<=300 s fl
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $645.00 1REMRESBAT
PME Plan Check: $0.00 338 s.f. Remodel,Other
Permit Fee: $1,323.00 $503.00 1 1REMRESOTH
Suppl. Insp.Fee.0 Reg. Q OT 0,0 hrs $0.00 F200 I amps Electrical
PME Unit Fee: $0.00 $48.00 IBELEC200 Services
PME Permit Fee: $48.00
ConstructionTax:
ldininistrative Fee: O
Work Without Permit? O Yes O No $0.00 0
Advanced.Planning Fee: 1PLLONGR $44.38 Select a Non-Residential 0
Travel Documentation Fee: ITPA VDOC $48.00 Building or Structure 0
i
Stronp-Motion Fee: 1BSEISMICR $19.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $6.00
$3,114.88 $4 310.88
Revised: 04/01/2015