08120072 & 09070153BUILDING DIVISION PERMIT
I BUILDING ADDRESS:
20374 CLIFDEN WAY TBD - T(
OWNER'S NAME.
erIONE:
ARCHITECT/ENGINEER:
u O 0p LICENSED CONTRACTOR'S DECLARATION
UI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z with Section 7000) of Division 3 of the Business and Professions Code, and my license is
y in full force and effec
z License Class Cu
Date ugantor
= y
ARCHITECTS DECLARTION
a< I understand my plans shall be used as public records
D U
m
y
U. H Licensed Professional
O < OWNER -BUILDER DECLARATION
I hereby alTirm that 1 am exempt from the Contractor's License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
Pi which requires a permit to construct, alter. improve• demolish, or repair any structure
4;- w prior to its issuance, also requires the applicant for such permit to file a signed statement
- Z < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
xF G (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
0 I• as owner of the property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code- The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements arc not intended or offered for sale. If.
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li
-
cease Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the contractor's
License Law.
❑ I am exempt under Sec. B & P C for this reason
')wncr Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
] I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code. for the performance of the
cork for which this permit is issued.
-1 I have and will maintain Worker's Compensation Insurance, as required by Section
1700 of the Labor Code, for the performance of the work for which this permit is issued.
,4y Worker's Compensation Insurance carrier and Policy number am:
arrier.
Policy No.:/-
4
o:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Job Description
ADD 867 SQ FRNT ADDTN(BEDRM#3,#4,MSTR SUITE& LUNG
RM& FOH:�",R &RMD KTCHN(75SQ)
(This section need not be completed if the permit is for one hundred dollars ($ 100)
Ir less)
I certify that in the performance of the work for which this permit is issued. I shall not
.mploy any person in any manner so as to become subject to the WorkersCompensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
L.endces Name
Lender's Address
I certify that 1 have read this application and state that the above information is
COMM 1 agree to comply with all city and county ordinances and state laws relating to
building concoction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTAND AND WILL COMPLY YYITH ALL NON -POINT
SOURCE REGULATIONS. 7/�-�-
Signature of Applicant/Contractor Date /
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
Dyes ONo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
0Yes 14 No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building
does not currently have a tenant, that it is my responsibNty to notify the occupant of the
requirements wh ch�rtust bc�met prior l0 issuan�a Cct hcatc of Occupy cry i_
Owner or
�q. Ft. Floor Area
36936020.00
Issued b:
Re -roofs
Type of Etoof
Valuation
125000
Occupancy Type
Required Inspections
U
All roof,; 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.
Signature of Applicant
All roof coverings to be Class'tf or better
Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20374 CLIFDEN WAY
CONTRACTOR: UW CONSTRUCTION INC
PERMIT NO: 09070153
OWNER'S NAME: MULKA RAVI
847 SEVELY DR
DATE ISSUED: 07/22/2009
OWNER'S PHONE: 4084768647
MOUNTAIN VIEW, CA 94041
PHONE NO: (408) 687-8282
❑ LICENSED CONTRACTOR'S DECLARATION
r r r—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie. #
MECH RESIDENTIAL COMMERCIAL r—
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION:REVISION IS TO ADD BEAM & FOOTINGS@
(commencing with Section 7000) of Division 3 of the Business & Professions
LIVING RM;ORIG
Code and that my license is in full force and effect.
#08120072
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: $0
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
permit is issued.
APN Number: 36936020.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
l
9.18.
Iss d by: Date:
Signature Date
r2
d OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
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, Icaner
or author'zed agent
become subject to the Worker's Compensation provisions of the Labor Code, I must
ate:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTI ENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
t �i1Lcl'�
Licensed Professional
Signature Date !
OIL
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
APN # Z b n _ 36-02D
Date: �J Z
Original Permit
Building Address: vv GU p( --A- 7) P
Mailing Address (if different from building address):
Owner's Name:
Phone #: z W �L 76 96 /,1
7
t -kA n -r/ A-E D.1> y
k
Contractor:
Phone: 7 Z
`Tn,So n wAnq
Fax:
Contractor License #:0
Cupertino Business License #:
Contact: QA -VI
Phone: _ Z6 _ 9k
Fax:
Building Permit Info:
Bldg E� Elect ❑ Plumb ❑ Mech ❑
Residential Commercial
Job Description: p r j h OC_ �7x-0,11 GC r el Y L r - kt Q--, �J kh e- e Qqm A -J
l file ~rC-�/-�c, �-�(ID LQvI��-
Ye-yv\, 0 v't ed, 0 t; --U A h fie, k-4 t~ Aov-r�l t-,�z � h L -v Q-A 6,q r
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Type of Construction (Usage Class):
* Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B ❑--�'
r
Valuation (cost of project):
8 vna
Project Size: Express Standard Large Major
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buflditgreen.org
Revised 01/07/09
CUPEI,T1NO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
-T CBS -C —
Cal Bldg Standards Commission
Fee
B
_ ALL_PERMIT
TYPES
IREVCOMNEW
Revision Commercial New
B
1*
1REVCOMTI
Revision Tenant Improvement
B
1* TI
IREVSFDWL
Revision SFDWL
B
1R3SFDW
1REVRESADD
Revision Addition
B
1R3SFDADD
1REVRESREM
Revision Remodel
B
1R3SFDREM
1DEFINSP
Deferred Submittal not R-3
Inspection
B
1DS
1DEFPLNCK
Deferred Submittal not R-3 Plan
Check
B
1DS
1DEFR3INSP
Deferred Submittal Inspection
B
1DSR3
1DEFR3PLNCK
Deferred Submittal R-3 Plan Chk
B
1DSR3
S'T'nsf=
0c
F�
W?
a.
UC
LL. F
� L
>4u
a
v
U2
1
CITY OF CUPERTINO�s�a,����
r.
—
BUILDING DIVISION pERNIIT
BUILDING ADDRESS:
PERMrr NO.
20374 CLIFDEN WAY
TBD — TO BE DETERMINED
OR120072
OWNER'S NAME:
PERMIT' [SUE DATE
PHONE:
SklffACONTROL NO.
ARCHITECT/ENGINEER:
BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
in full forte and effect, a ���
License tea" Lic'"
ADD 867 SQ FRNT ADDTN (BEDRM# 3 , # 4 , MSTR ,SUITE& LUNG
Da
Date Contractor
RM& FOHER &RMD KTCHN (7 5 SQ )
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
12 5 0 0 0
APN Number
Occupancy Type
Section 70315 by any applicant for a permit subjects Lite applicant to a civil penalty of
not more than five hundred dollars (S500).
36936020 .00
❑ Las owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work. and the stmelureisnot intended oroffered for sak(Sec.7044.Business
and Professions Code The Contractors Ucense Law does not apply to an owner of
q p
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements ate not Intended or offered for sale. If,
however. Lite building or Improvement is sold within one year of completion. the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed conuacuxs to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's U -
cense Law does not apply to an owner of property who builds or Improves thereon, and
•
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
C3I am exempt under Sec . B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is iaaued.
❑ 1 have and will maintain Workers Compensation fasurance, as required by Section
.
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No: Za,ov
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars ($100)
or Iess)
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 -e Compensation
Laws of California. Due
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction (ending agency for the performance of
the work for which this permit is Issued (Sec. 3097, Civ. C)
[.enders Name
Lenders Address
I certify that I have mad this application and we that the above information is
correct 1 agree to comply with all city and county ordinances and state laws misting to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accroe against said City
in consequence of the granting of this permit
�]
Date(J—
APPLICANT UNDERSTAND AND WILL COMPLY ALL NON -POINT
Issued by:
souRCE REGULATIONS. 3�� qq
L
Re -roofs _
Type of Roof
Signature of Appliant/Contrador Date
HAZARDOUS MATERIALS DISCLOSURE
Will the appBant or future building occupant store or handle hrurdoua material
as deMcd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes UN.
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
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yrs j4Nu
1 have mad the l uzandmus materials requirements under Chapter 6.95 of the Califor-
nia Health & SafdyCodc, Sections 25505, 25533 and 25534.1 understand duct if the building
does not currently have a tosser that it is my responsi 'ty to notify the occupant of the
'
requirements which ntst be and prior to issuz= of a e of Occupancy.
Signature of Applicant Date
2
All roof coverings to be Class 'n" or better
Owner orautho' n Dim
.
a
CUPEkTINO
CITY OF CUPERTINO
ADDITION/REMODEL
PERMIT APPLICATION FORM
o e /,Z 00-7 _'�
APN #
3�t. .co•�� r Ci
Date: 1 p
Z10gl02
Building Address:
2037 c.1�i��
Mailing Address (if different from building address):
Owner's Name:
Phone #
MU1
Contractor:
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone #: -4t5, 5157 7-7,5:6
Fax #: -4-1s. 77 7 -
Building
Building Permit Info:
Bldg. ✓ Elect. E]r Plumb. ID1, Mech. [Ef Hillside ❑
Job Description:
Addition -What is being added?(Be Specific): 06C71P TF4v T AvpjTiot ,
- 4y� gV-PRM # 3, 4,t lbw ,J a,
-- (N) LiJV" rJA'i fwlt sx., TX-( L Ki►�Gt{�{y Vt pfj►J�f ,
What is being remodeled (not including addition)?
Remodel Includes Re -Roof. Yes ❑ No [✓] If yes list number of squares
Remodel Includes Structural: Yes ❑ No [�
Do you have the pre -application planning approval? Yes ❑ No ❑ '
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: g67 Porch: Deck: Garage: Detached Attached ✓
�0'1"'Bath
Remodel: Kitchen 35 Other -�ovv
Type of Construction (Usage Class):
Occupancy Type: jz 3
1-A, 1-13 ❑ II/III/V-A ❑ I1/111 B, IV -HT, V -B d
Valuation: t Mo.
Please check this box if the project is a
.f Larfew°.OD
second -story addition ❑
Project Size: Express ❑ Standard []r Large ❑ Major ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved: 7C=,
include in plan set & the sheet index.
***For Office Use Only***
Over -the -Counter ❑
Revised 10/01/08
ia
CUPEkTINO
CITY OF CUPERTINO
ADDITION/REMODEL
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
Sq Ft
ADDITIONS
1R3SFDADD
PLLONGRNGR
Long Range
PL
Plannin esidential
1 R3INSP
Dwellings Inspections
B
O
IR3PLNCK
Dwellings plan check
B
1R3REPINSP
Dwellings Repeat
B
Inspection
1R3REPPLNC
Dwellings Repeat Plan
B
Check
1R3HINSP
Dwellings Hillside
B
inspection
1R3HPLNCK
Dwellings Hillside plan
B
check
1R3HREINSP
Dwellings Hillside
B
Repeat Ins ection
1 R3HREPLNC
Dwellings Hillside
B
Repeat Plan Check
1 R3ALTINSP
Dwellings Alternate
B
Materials Inspection
1 R3ALTPLNC
Dwellings Alternate
B
Materials Plan Check
1 PCESS
Cesspool
P
1 PPRSEWG
Ea. Private Sewage
P
Disposal System
1 PRSEWER
Sewers
P
1BPSPRINK
Lawn Sprinkler/Backflow
P
1BPWSVCS
Main Water Service
P
1 BSEISMICRE
SeismicResidential
B
1REROOFRES
Residential Re -roof Each
B
100 SF
DECKS
1R3SFDADD OR
1R3SFDREM
1 DECKWOOD
Deck (Wood) -Each
B
(Each)
1 DECKRAIL
Deck Railing -Each
B
(Each)
CITY Of
CU PEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: 2p37� C4.ifj>F—N
PERMIT #
/aDo'12
OWNER'S NAME: wjt-K gill
PHONE #
GENERAL CONTRACTOR: TqV.
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date