Untitled CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0133
854 S STELLING RD CUPERTINO,CA 95014-4270(359 22 011) B1LGA
CONSTRUCTION
FREMONT,CA 94538
OWNER'S NAME: Kuttiyam Prabhu S And Ramanathan Divya DATE ISSUED:01/22/2019
OWNER'S PHONE:859-333-0611 PHONE NO:(510)755-0048
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
= License Class¢ Lic.#890348
Contractor BILGA CONSTRUCTION Date 01/31/2021. X BLDG ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
REMODEL KITCHEN-(201 SF);INSTALL(N)GAS LINE TO
I hereby affirm under penalty of perjury one of the following two declarations: COOKTOP
1. 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.
,k5/ 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
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 22 011
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature � Date 01/22/2019 Issued by:Jasmine Archbold
Date:01/22/2019
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:01/22/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I"store or handle hazardous
3, I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533;and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall -
be deemed revoked. %owner authorized agent:
APPLICANT CERTIFICATION yi Date:01/22/2019
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
I hereby
correct.I agree to comply with all city and county ordinances and state laws affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9..18.
Licensed
Signature Date 01/22/2019 Professional
CONSTRUCTION PERMIT APPLICATION
rt, COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228 • building@cupertino.org PERMIT#B-Z 0 ii o t.33
CUPERTINOREV# DEF
Ei NEW CONSTRUCTION ❑ADDITION P LTERATION Q T.I. El MEP ❑RE-ROOF 0 SWIMMING POOL/SPA
PROJECT ADDRESSObi,5 i S s T ( APN# -eI ir2c-72-
OWNER NAME ' PHONE E-MAIL I
59 333
STREET ADDRESS CITY, STATE,ZIP
S STEL-/ C2 ( .-I.) C4)P[-f-T(No Cpl- ` sot
pt CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME / a + y� LICENSE NUMBER LICENSE TYPE
R �P i..- 5�GI 'l 1 CONS l C 0.3 3 B
STREET ADDRESS
-t o, Nicwos S(' CITY;STATE,ZIP
01j I ON c-Mt, CA '91-58 °�-�I
E-MAIL. , PHONE BUS.LIC# (4 9
bit X200 3 t1. CD S (O ® 7,55 . o a � �.
0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON
V4,^e,, Ok V e 1 CX,NT Q<lin Clet Lf‘ifiN) s-eqe-t. lob V00\11t1 'le ipli-tt oir-t-
"u o es x t s- c o. i S IN ► _ ASO I'Yl .91
\ ,,
.I5INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL f
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODELOTHR. GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
MUSING
13 YES YES
FIRE SPRINKLERS 0 NO EICHLER. OYES SECOND STORY ADDITION o NO
DWELLING. SECOND DWELLING Q.YES 0ATTACHED0DETACHED.OTHNO ER' _..._.-
uNLTS# UNITADDITON: 0 NO S F
POOLS! 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE D PREFABRICATED
POOL-SF SPA-SF ' SPA ATTACHED DYES 0 NO TOTAL-SF .-..
CEIVED BY: "� TOTAL VALUATION:
Commercial or Matti-Famiht Buildings with Public Swimming Pools requires Department of Environmental Heath approval14
�. — -^>"0,,
RE-ROOF)EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES IIII TILE OTHER(SPECIFY)
REMOVE(REPLACE Q NO 1 IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑yES #OF LAYERS THICKNESS❑5/" OTHER ❑OSB ❑CDX OTHER :12 A
__ PROPOSED ROOF TYPE:OBUILT--IIP ROOF DASPHALTSHINGLES D WOOD SHAKES DWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
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 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection p .a -s. I acknowledge and authorize all information contained on this application form
to be made available for public record. /
Signature of Applicant/Agent: ,_..47 - Date: ' "' -
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HQA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17