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12030107 t CITY OF CUPERTINO BUILDING PERMIT BI111.DING ADDRESS: 21706 NOONAN CT CONTRAC-FOR:GOYAh MANOJ AND PIiRMITNO: 12030107 MONICA OWNER'S NAME: GOYAL MANOJ AND MONICA 21706 NOONAN Cl' DA'I'S ISSIII;D:03202012 OWNEIfS PIIONE: 4086568226 'Q. CUPERTINO,CA 95014 PHONE,;NO: ❑ LICI=NSF.)CONTRACTOR'S DECLARATION r F. r BUILDING PERMI•P INFO: RLDC ELECT PLUI\IR - License Class Lic.H M EC11 r RESIDENTIAL r COMMERCIAL Contractor Date 1 hereby afirnn 111111 am licensed under the provisions of Chapter JOB DESCRIPTION:SINGLE FAMILY DWELLING WINDOW REPLACEMENT (commencing with Section 7011(1)of Division 3 of the Business& Professions AND Code and that my license is in full force and effect. PA'I'10 DOOR;I8 IN TOTAL I hereby affirm under penalty of Perjury one of the following Iwo declarations: I have and will maintain a certificate of conscm to self insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the perfurnanee of the work for which this permit is issued. I have and will maintain Worker's Compensation hisuranee,as provided for by Section 3700 of the Labor Code,for(lie performance of flit work for which this Sy.Pt Fluor Area: \'aluntion:$12000 permit is issued. APPLICANT CEItTIFICA ION APN Number:35719071.00 Occupnney Type: 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 stale laws relining to building construction,and herehy authorize represenutives ofthis city to enter upon the above mentionedproperty for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnity aendnseP%%hich ss the ayacity ueagainsts idCno ityinst inconscoplcs,judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in conseyua,ec oldie granting oflhispermit. Additionally,[lie applicant understands andwill comply 180 DAYS FROM LAST CALLED INSPECTION. with till non-point source regulations per the Cupertino Municipal Code,Secti+aa 9.18. Issued by —� nate: 320-/2 Signature Date •.W.i OWNER-BUILDER DECLARATION RI';BOGIES: hereby affirm that I in,exempl from the Contractor's License Lawfor ane of All roofs shall be inspected prior to any rooting material being installed.If it roof Is the following Ida reasons: installed without first obtainingan inspection,I agree to remove all new materials for I,as owner ofthe property,or my employees with wages as their sole compensation, inspection, will,do[lie work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of ApplicanC Dater 1,as owner ohhc property,am exclusively contracting with licensed contractors to construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVERINGS TO BI?CLASS"A"Oil BE.ITER 1 herchy affirm under Penalty of perjury one of the fullmving three declarations: I have and will maintain it Certificate of Conscat bit self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 'Compensation,as provided for by Section 3700 of the Labor Code,for the I hove read the hazardous materials requirements under Chapter 6.95 of the performance of thework far which this permil is issued. California Ilcallh&Safely Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance.as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& Safety Code,Section 25532(a).shnuld I store or handle hazardous material. Section 3700 of the Labor Code,I'or the perlbnn:mec ollhe work fonvhich This Additionally,should use equipment or devices which emif hazardous air permit is issued contaminants as defincd by the Ray Area Air Quality Management District 1 will I certify that in the performance of flit work lbnvhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 geld the not employ any person in any manner so its to become subject to the Worker's Ilcallh&Safety Cade.Sections 255115,25533;and 25534. Compensation laws of California: If,after making this certificate mfexemption,I become subjcet to the Worker's Compensation Provisions of the Labor Code,I nmsl O"'n r+ author' 11 it: forthwith comply with such provisions or this permit shall be deemed revoked. Datcj//�._. CONS'PRIJCI'ION LF-NDINC AGENCY • AI'I'LIC,\N'1'Clilfl'I CERTIFICATION I certify that I have read this application and slate that the above information is I hereby affirm that(here is a construction lending agencyfor the performance of work's correct. I agree to comply with all city and comity ordinances and stale laws relating fiat Which this permit is issued(Sec.3097,Civ C.) . to building construction,and hereby amhorize representatives of this city to enter Lender's Name upon[he above mentioned properly for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and cepenscs which may accrue against said City in conscyucnce of the granting of this permit.Additionally,[he applicant understands and will comply ARCIII'1'FCI"S DECLARATION with all non-point source regulalin,s per he Cupertino Municipal Code,Section 9.18. �f I understandmy plans shall be used 1s public records. .Signature % Dat,,:�Z Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35719071 . 00 DATE ISSUED. . . . . . . : 03/20/2012. RECEIPT # . . . . . . . . . : BS000016325 REFERENCE ID # . . . : 12030107 SITE ADDRESS . . . . . : 21706 NOONAN CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GOYAL MANOJ AND MONICA ADDRESS . . . . . . . . . . : 21706 NOONAN CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MANOJ GOYAL CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : GOYAL MANOJ AND MONICA ADDRESS . . . . . . . . . . : 21706 NOONAN CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 ' TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ----------—- ---------- ---------- ------ ------—-- ---------- 1BCBSC VALUATION 12, 000 . 00 1 . 00 0 . 00 1 .00 0 . 00 1BSEISMICR VALUATION 12, 000 . 00 1 . 20 0 . 00 1 .20 0 . 00 1WINREP EACH 8 18 . 00 652 . 00 0 . 00 652. 00 0. 00 TOTAL PERMIT 654 . 20 0 . 00 654 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 654 . 20 VISA --------------- TOTAL RECEIPT 654 . 20 , CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21706 noonan ct. DATE: 03/20/2012 REVIFWFD BY: bobs. t BP#: VALUATION: $12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRRfL1Rl SFD or Duplex PENTAM ATION 1GENRES I USE: ERM IT TYPE: WORK sfd window replacement and patio door 18 in total. SCOPE dleoh.Phut Cheek Plumb. Plan Check Elec.Plan Check .blech. Penuit Fee: Plundh.pe.0won Fee.: 1•"!<¢•. Permit Fee: 01her.Ifech.Insp. other Pluuth lrsp, Oche, Flea.hi,p. Heck Int/t. Fee: P/umh.Insp.hce: Elea Inept.Fee: A'OTE: This estinune aloes not includefees due to other Departments(i.e. Planning.Public H'orks. Fire.Sanhaty Sewer District,Schaal District,etc.). Thesefees are Laver/on the prelininart in oruuttion available and are adv an estinnue. Contact the Dept or addn'I in n. FEE ITEMS (Fee Resolution /1-053 Eff 711/1/1 FEE QTY/FEF MISC ITEMS Plan Check Fee: $0.00 18 1 # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 $652.00 I H9NREP Replacement PMC Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ceinrtrticlion Tac: Aclainistrative Fee: Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a.Non-Residential Q Travel Documentation Fees: Quilting or Structure i SU'6ng Motion Fee: IBSEISMICR $1.20 Select an Administrative Item BldgS«Is Commission Pee: IBCBSC $1.00 SUBTOTALS: $2.20 $652.00 TOTAL FEE: 1 $654.20 Revised: 1/19/2012 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 - FAX(408)777-3333- buildino(a�cuoertino.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN BPR SIL NUUuAu GT OWNE.R2 NAIutE OWNER ADDRESS /�114N0f CA 4401 ICC C,_c114L 706 /VWX ,4&/ C7 DESCRIPTION OF WORK: Re 2)ao lmaia cel t,2rhdH We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval Of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information) t"V 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowners insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. NAk2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. rA(.- 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit riled in his or her name instead of my own. PAS^ 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. r4(X 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value Of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. tA(4- 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 1`4('7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed our within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. ',t 6. B. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. AvnerBuilde Farm_2010.doc revised 04/19/10 el 9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benetit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 14" 10. 1 am aware of and,consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. (A 11. 1 agree that, as the party legally and financially responsible for-this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. #'A(r12. 1 agree to notify the issuer of this form immediately of any'additions, deletions, or changes,to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to,protect the public. If you contract with someone who does not have a license, the Contractors'State License Soard,may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractorsmay be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable Or damages. If you obtain a permit as Owner-Builder and wish to hire Contractors;you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the follow✓ing construction lending agency information.) 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.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the ify may be required to be presented when the permit is issued to vert the roe `owner's sin re. Property Owner's Signature: Date: 3 9d /Z (NOTE: The following Authorization Form is required to be completed by the property ov✓ner only v✓hen designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s) to apply for, sign, and 51e the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may required to be presented when the'permit is issued to verily the property owners signature. Property Owner's Signature: Date: OwnerBuilderFornt 1010.doe reric-d 04/14/10 1 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Mar f` M0✓I1Cct, 60 yg( Project address. ,9 /7a6 NCOA-14 v C,i "R44;401; C44 4S4n14 Contact person. Mctnoj or /cc, e2taft-� Phone.(4 C46 )%z7.3 A.3 C, 4C2&s6 ¢224 /i, Fax. Net square footage of lot. i 7ocx) lop V& Existing Proposed UJSquare footage: First floor: Second floor: Garage: TOTAL: LAW LLW Are there at least two 10 foot by 20 foot clear spaces inside the garage? e-Y N — � 1s privacy protection planting required for the project? ey �1 Build it Green Total Points On what floor(s) is work being done? / _ /7 Brief description of work. 1 n�2P1Q,-eam��,r�l� a-aY uc/n /c h P-c P�o e54ue � OS-) Code editions: 2010 CBC . (LOYD N)2010 CFC (�Y:)N)2010 CMC (Y-N)_ 201 O CPC (Y - N)201 O NEC (Y- N) COMMUNITY DEVELOPMENT DEPARTMENT California Green Building Standards Code 2010 BUILDING DNISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the Effective 1/01/11 fob site during construction. It is unl awful deviate make any changes or alterationsoval from the Building Official, therefrom,withouttapp The stamping of this plan and sp cifirations SHALL NOT pro al of the violation be held to permit or to be y city Ordinance or State Law. of any provislon�� BY.�- / 0// '1-� DATE PERMIT No. Plan Review Process Work Book Page-8- Revised 12/21/10 _ J- /1114 I I I I I I I I I I I � z I I I I I r, I I I I I I I I I I Jai rw ke lI C J qtr 6 Opo r7,K WK Mill IIIII IIII Hill /MSN 4-4 z: W/A�bC9N F id t I I I I I vi,_�ut�uu I I I I I I I _ I I I I I I itMillI Iill t3c�2��t 3 I I I T I I 4 N0L-1-1 #_LLI_ 11 III ' , I II I I I IHill I Hill Illil HillI -YN i —114 I . 71111111 ± I I I I I IU nnogn��+ ncr{ivirn s nv 9 is N 6 Q D /M ENS✓o ivS 70 ryX 36 70 "x31C ri 93 % �� 79- _ I �ii��ntDo,i,w I� i�vi�v'D'oN rD�+ F;ifC �14C,2 TI_ #1 S��1 11/Iw+(�. S�Y I pig 1}o ` W I_ d - I � I I - niF�Ml Vo �- 2vo of I I I OW II I I s � k N I � � o T 14� Zell P T cl lilt I II I Ili II I l FOY, I I I I I I I I I I II I Z A ''atiiQ r�rS M �iT Fr- I I FAX�� ry b/HENS/u Al /M6,&/o,✓ 1ME `'370'v IZ12.x F, L II . wi�saw Fixes D, h,/, �c,al►AJ� d I /V/vv,r QI,�I� �O^' I `I T I I I M � i CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE: CUPERTINO, CA 95014-3255 t CUPERTINO (408)777-3228• FAX(408)777-3333 •buildino(a)cupertino.oro ❑ Nf:W CONSTRUCTION ❑ ADDI'T'ION ❑ AI:17iRA'1'ION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSX1/706 "00 ALI C--r AP'VN OWNERNAME 77 'Y ION J E-}fAIL r-(ewoZl If- /1400 )CA -0,144 4v (o$C -�27 L rMor)o 4dymcA11-cVrift- CIyY,STATE•ZIP FAX G NAi Airl,ri C 'T C.L1nF/LT i.•u r'i so/ C( CONTACT NAME HONE PINTAIL M r)I,) +ur Maillr �` �fr5 L�56-SZZG rnohn'1 Aiofm S'rRELT ADDRESS CITY,STATE.ZIP FAX /� d✓ ❑OWNER 19 WpTR.DUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCIM'ELT ❑ENGINEER 11 DEVELOPER ❑TENANT CONTRACTORNAME rr~ n •,(,� LICL'NS EN,U7N1pER / LICENSE TYPE DDS.LICY Zf COMPANY M: lX /•I rCMAIILy FAX �14�K sr STREET ADDRESS CI'rY•SrATE•ZIP POU ! / ARCIIITECfENGINEERNAME ` , ,T LICH\SENUMBER BUS.LICK ? COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE.ZIP PHONE DESCRIPTION OF WORK l£>— r EXISTING USE PROPOSED USE Co'SM TYPE 0STORIES I f FFI cT:I INF 0N1.Y Orr TYPE )F!sCRIPTiON o IT VATOATIOSI(S" a EXISTG NEW FLOOR DEMO TOTAL ` R �M AREA AREA AREA "'TAR. V(� 'V•` BATHROOM KITCHEN OTHER - •' REMODEL AREA REMODEL AREA REMODEL ARIIA PORCHAREA DICK AREA TOYALOLCKIPORCHAREA GAKAGHARBA: ❑ DETACII ❑ ATTACH .DMI]LP:O IPRPS: I.SASECONDUNIT 0Y." SEC0\DST0R\' HONCADDEDI ❑\b ADUITMI! NO PPIidPn.IC.\TION ❑ YFi 6VF.1,PROVQX(TN•Y(%' PI,\TTTA'SFM4i: W!CI!Il'ED BI'( %.M'VALUATION. PIANNauu APPL. No PIA•NIAG APIROVAL LETTER LL"9/ OOU'.OU 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 IEC information I have pre4idcd is cone I hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and SUIC laws relating to co slruc I a orize representatives ofCupcnino to enter the above-identifiedProperty for inspection purposes. Signature of Applicanl/AgenC Date: .3 / r Z SUPI'LIiMIiNTAI,INP RMA"I' NR8QUI12hD ' 1•i <ry cuFicK'I'rrP: _ _ ROUTING si:ie i New SPD or Multifamily dwellings: Ap ly for demolition Permit for . \.E IN.i EliuH.6L t'f" INc'"I.A.1 .VIiEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. !❑ rXi•RESS 0 PI:ASNING PLAN REVIEW i _Commercial 13ldgs: Provide a completed Hazardous Materials Disclosure r❑ sc\Npnliip ❑ :1•IIm.ICN'ORKs form if am•I lazardous Materials are being used as part of this project. I ... El:LARGE ❑ FIRE NEEP _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ Ni•aoR ❑ sanrr,\RYsewelinurlilcr submittal of Building Permit application. i - -- - - r Cl E.u\9 iiGN'AIFp"I`,\UTI B,UlI II /1/dgApp_201 Ldoc revised 0311611