15120051Wt
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10640 GLENVIEW AVE
CONTRACTOR: LEI WEN
PERMIT NO: 15120051
CONSTRUCTION
OWNER'S NAME: BHAGWAT YOGESH A AND BHAGYASHREE Y
432 HONOLULU CTR
DATE ISSUED: 12/07/2015
OWNER'S PHONE: 5103661833
UNiON CITY, CA 94587
PHONE NO: (408) 509-9700
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL Ej COMMERCIAL
REPLACE (E) SEWER LATERAL BETWEEN FOUNDATION
// /
License Class ® Lic. # ®� do 15
AND
�S'
vJ Date s� L-�.v0 lS 1
PROPERTY LINE. LINKED TO MAIN PERMIT# 15030189
Contractor s
i hereby a arm 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 declaratio
I have and will maintain a certificate of consent to self -insure for Worker's %)ANITA
V
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:
al tion: $0
'Ii'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
WITHIN 180 DAYS OF PERMIT 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 DAYS FROM LAST 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
Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
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with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.'
Signature s 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.
❑ 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 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. 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 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, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:' Date r
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
CONSTRUCTION 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, I must
1 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
9.18.
Signature Date
/i
- GENERAL PERMIT APPLICATIONMEP
CC)MMUNITY DEVELOPAIiENT DEPARTMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 9501A 3255
(/,o 8) 777-3228 • FAX (4 (a08) 777-3333 • buildinacuoerilno.org
CUPERTII�iC? 19
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❑PLU'e NG ❑MBCIiANICAL ❑ELECTI iCA? ❑h/iISCELLa_1�FEO'US
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USE OF ❑ SFD- or DUPLF X ❑ NULTI-F.A10-Y PROTtCT N WPJLF?\'D ❑ YES PROECT IN ❑ YES
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DESCRIPTION OF 1VOR?C
TOT.ALVALUATION: xRECtI� DSS'
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By my signatm-e below, I certify to each of the following: I am the propeLly owner or authorized agent to act on the property owner's b lf, I have read this
application and the Lnfor_nation 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 la;;,s relztir!g to buDdir_g cons, -,ration. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
S1_—i..atCre ofA.pplicaDt/Agent: 6` V Date:
KiPPLEMNTAL \F'ORvIATION REQULRED
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A/Fr?dlisc,vp_2011.doe revised 06/21/11
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CITY OF CUPERTINO
lw� IFFF FqTIMATOR — 1111JILDTNG DIVISION
'OTE: This estimate does not include fees due to other Departments (I. e. Vlanning, rupue worKs, rare, aanuary Sewer vistrict, achum
-fees are based on the prelimina in ormation available and are only an estimate. Contact the De or addn'l in o.
District, etc.). Thesef _
ADDRESS: 10640 Glenview Ave
DATE: 12/07/2015
REVIEWED BY: Phuong
MISC ITEMS
APN: 369 25 001
BP#:
*VALUATION: I$o
';PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
P RIMARY SFD or Duplex
7
PENTAMATION 1 RPSS
USE:
PERMIT TYPE: A
WORK
Replace (e) sewer lateral between foundation and property line
SCOPE
'OTE: This estimate does not include fees due to other Departments (I. e. Vlanning, rupue worKs, rare, aanuary Sewer vistrict, achum
-fees are based on the prelimina in ormation available and are only an estimate. Contact the De or addn'l in o.
District, etc.). Thesef _
FEE ITEMS (Fee Resolution.1.1-053 Lf 7/11.13)
FEE
QTY/FEE
MISC ITEMS
A,,'ech. P/On
Plumb. Plan Check
0.0
hrs$0.00
PME Plan Check:
E!,x, Pfo,•
AW
!e,
Plumb. Permit Fee:
I
IPPERAflT
I
'k -l". /:
$48.00
Other Plumb Insp.
0.0,;.
hrs
$48.00
L0,h,er
Work Without Permit? C) Yes (E) No
$0.00
fee:
Travel Documentation Fee: ITR,4VDOC
$48.00
ee:
'OTE: This estimate does not include fees due to other Departments (I. e. Vlanning, rupue worKs, rare, aanuary Sewer vistrict, achum
-fees are based on the prelimina in ormation available and are only an estimate. Contact the De or addn'l in o.
District, etc.). Thesef _
FEE ITEMS (Fee Resolution.1.1-053 Lf 7/11.13)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PNM Unit Fee:
$25.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? C) Yes (E) No
$0.00
Travel Documentation Fee: ITR,4VDOC
$48.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
'SUBTOTALS:"'
$166.00
$0.001, TOT AtFEE16L.O�O
Revised: 10/01/2015
dhaunnnthanu C n rs LLC
flrchitect�iral and Engineering esi n Seruices
nthony 765 Moraga Road, Lafayette, CH 94549
0151-3®7-7538 ® anthonychaudesigns@gmaii.com
&.PARTNERS LLC
Building Department
City of Cupertino, CA 95014
Dec. 5h, 2015
Permit Application Plan Check Number: 15030189
Project Address: 10640 Glenview Av., Cupertino, CA 95014
Project Description: Horizontal addition and interior remodel
Upon request of the Owner, Mr. Yogesh Bhagwat and site reconnaissance of the Owner's
plumbing contractor, the existing sewer lateral needs to be replaced due to severe damages.
Please include this work into the scope of original.. building permit_ application.
Your cooperation is highly appreciated and please feel free to contact me if you have any
questions.
Best regards,
Anthony Chau
Architect (C30909)
Civil Engineer (73652)
M.S. Structural Engineering
FIC
4/
Ah THONY CH'O."�
CHAO
No. C-30909
REN, 02/28/2017
1