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12010148 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19986 BEEKMAN PL CONTRACTOR:BROTHERS HOME PERMIT NO: 12010148 IMPROVEMENT OWNER'S NAME: RAMAN SRIDHAR AND SRIDHAR VAISHNAVI 2510 DOUGLAS BLVD DATE ISSUED:01/25/2012 OWNER'S PHONE: 4088650684 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG �_.. ELECT _._ PLUMB License Class L" Lio.# (6q MECH RESIDENTIAL COMMERCIAL Contractor G`L——. Date I Z %— I —I hereby affirm that I am licensed under the provisions o Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING ONE STORY, (commencing with Section 7000)of Division 3 of the Business&Professions SEVEN(7)WINDOWS Code and that my license is in full force and effect. AND THREE(3)PATIO DOOR REPLACEMENT;NON-STRUCTURAL I 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 ofthe work for which this permit is issued. 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 till's Sy.Ft Floor Area: Valuation:$7600 permit is issued. APPLICANT CERTIFICATION APN Number:3163011 LOO Occupancy 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 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAPS OF PERMIT ISSUANCE OR granting of this permit. Addi nally,t applicant understands and will comply 180 DAB'S FROM LAST CALLED INSPECTION. with all non-print source . laticns" r the Cupertino Municipal Code,Section Issued by:„�,, Date/-2 S Signature./ �- Date � Z' v ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to rernove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the perfonnance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Health& Section 3 700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Managennent District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with a Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to becorne subject to the Worker's Health&Safelyde,S tions 25505,25533,and 2.5534. Compensation laws of California. If,atter making this certificate of exemption,I i� become subject to the Worker's Compensation provisions of the Labor Code,I must Owner gut a agent: , /� forthwith comply with such provisions or this permit shall be deemed revoked. �'��' Date:_l/e47 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Nwrk's correct.I agree to comply with all city and county ord nances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnity and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 31630111.00 DATE ISSUED. . . . . . . : 01/25/2012 RECEIPT #. . . . . . . . . BS000015831 REFERENCE ID # . . . 12010148 SITE ADDRESS . . . . . 19986 BEEKMAN PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . R114AN SRIDHAR AND SRIDHAR VAIS ADDRESS . . . . . . . . . . 19986 BEEKMAN PL CITY/STATE/ZIP . . . CUPERTINO, CA 95014 RECEIVED FROM . . . . : SEAN FERGUSON CONTRACTOR . . . . . . . : GENE V. CAVANNA LIC # 27964 COMPANY . . . . . . . . . . : BROTHERS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 25I0 DOUGLAS BLVD CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661 TELEPHONE . . . . . . . . : (408) 295-0680 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 600 .00 1.00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 7, 600 .00 0 .76 0 . 00 0 .76 0. 00 1WINREP EACH 8 10 .00 522 . 00 0. 00 522 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 523 .76 0. 00 523 .76 0 .00 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19586 beekmon pl. DATE: 01/25/2012 REVIEWED BY: bob s. APN: BP#: VALUATION; 1$7,600 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE; p PERMIT TYPE: woRK sfd 1 sto 7 window and 3 patio door replacement non structural. SCOPE NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These.Les are based on the relinina information available and are o2lE an estimate. Contact the De t or addn 7 in o. FEE ITEMS o!1 11-0 L' F ' ', 1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L10 I # Window/Sliding Glass Door Suppl.PC Fee: Q Reg. OT ®.0 hrs $0.00 $522.00 1 wrNREp Replacement PME 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 0 Work Without Permit? Yes Q No $0.00 0 $0.00 Select a Non-Residential Building or Structure 0 S_l'on"!, 17IBSELSAKCR $0.76 Select an Administrative Item. SUBTOTALS: $1.76 $522.00 TOTAL,FEE: $523.76 Revised: 1/19/2012 Building Department City Of Cupertino 2 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# I -2 C> ( C> OWNER'S NAME: PHONE# CIO 6 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: .SG *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTI N(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO CT HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - I am not using any subcontractors: l�- 1- Signature Date Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owne6/,Contr for Signature V1 � � N x----------------- L u j N -_} c ,' O CC :3 e o L, n m G c.= (.) C W !iU Vrl —E u J Vis) CL t7 Lu :cS T —j2 �1 1.'y ��dyy. BOJ �_ c ✓./'�� -, p O OF lzv ti v ) kj if, r a L 1 k � h > ICE Cf � CONSTRUCTION PERMIT APPLICATION 2 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinclCcDcupertino.or4 CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSn �$ 1 n imoi) Y < < 1 OWNER NAMEHONE E-MAIL XLL4dJ0qv)' I' 05--06H STREET ADDRESS CITY, STATE.ZIP FAX CONTACT NAME .sP ONE E-MAIL R)Z STREET ADDRESS CITY,STATE, ZIP ^ FAX AK, S G ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONKCTO NAME LIFENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX SOWN STREET ADDRESS CITY STATE,ZIPS 'A 9 Z PHONE -� �1G �5' 1-0761422 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK E(c3rrJS EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.Ff. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTS- (/'0 b AREA AREA AREA NETAREA BATHROOM KITCHENOTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ]YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG ANE]YES RECEIVED BY: 77 TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME'. E]NO (}� ad— By � By my signature below,I certify to each of the following: I am the pr rty owner or authorized agent to act on the prrperty owner's behalf. I have read this application and the information I have provided' orrect. I have the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi nstruction. rize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE AL INFORMATION RE D PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for �vEx-THE-COUNTER ❑' ING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FiiDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B ldgApp_2 011.doc revised 06/21/11