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13040140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS.* ' 10094 RANDY. LN CONTRACTOR: SP HOME PERMIT NO: 13040140 IMPROVEMENT OWNER'S NAME:VIJAY ARORA 1030 WINDSOR ST DATE ISSUED: 04/18/2013 OWNER'S PHONE: 5089325830. '. SAN JOSE, CA 95129 PHONE NO: (408)777-8918 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL II License Class L►c.'# l l 3 9 3 REMODEL (E) HALL & MASTER BATHS, NO Contractor ��, Date STRUCTURAL CHANGES (TOTAL OF 130 SQ FT) I hereby affirm that 4, amli�sed 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 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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of theLabor Code, for the performance of the work for which this APN Number: 31623067.00 Occupancy Type: permitis 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 L 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 1 b Date: f 3 granting'of this permit. Additionally; the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. SignatureDaterl --( 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 I, as owner of the property, or my employees with wages as their sole compensation, Will do the work, and the structure isnot intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the. project (Sec17044, 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. I 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 forwhich this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Ili and will maintain Workers 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: - l g - ( 3 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 Compensation laws'of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY becorn subject to the Worker's Compensation provisions of the Labor Code, I must I 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 propertyfor inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep, harmless the' City of Cupertino against liabilities, judgments, costs, and expenses,whicii 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. i i Signature Date CONSTRUCTION PERMIT APPLICATION aO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255 M (4Q8) .777-3228 • FAX (408) 777-3333 • building (Q-culJertino.org NEW CONSTRuCTIO14 ❑ ADDITION " ❑ ALTERATION / Ti ❑ REVISION / DEFERRED\ ORIGINAL PERMIT # PROJECT ADDRESSOV R41 -)JO K LA/ APN # -3 l , - Z3 O 6 OWNERNAMS vim" I HONE O E-MAIL A-R0�1' d 7 STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME .CM PHONEZ STREET ADDRESS /'03 `j(, IV�'T u • ` L✓%' CITY, STATE, ZIP 2J U ©JL � / S/Z FAX �_ -77 `�L' 1/ ❑ OWNER . ❑ TOWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �15 �) LICENSE NUMBER `I LICENSE TYPE r2 BUS. LIC # COMPANY NAME / _ '. v t� _ _ / �,J-&p FAX S rl� E-MAIL �'�I.... �'�f/(/ e STREET ADDRESS CITY, STATE, ff PHONE 3 G� 1q5 o�'Z ST . /� J 05c G� 5'�I i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 130 EXISTINGUSE PROPOSEDUSE CONSTR. #STORIS USE TYPE OCC. SQ.FT. VALUATION($). EXISTG. NEW FLOOR DEMO TOTAL AREA . AREA - AREA NET AREA BATHROOM KITCHEN OTHER . REMODEL AREA REMODEL AREA REMODEL AREA .PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: �' LS A'SECOND UNIT EYES SECOND STORY EYES BEING ADDED? ONO ADDITION? []NO . PRE -APPLICATION []YES IF YES, PROVIDE COPY OF . IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL#. ❑NO PLANNING APPROVALLECTER EICHLERROME? [CO] NO o o 4 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the rty 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 buildi construc ' . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 12) Signature of Applicant/Agent:11 i Date: `� — 1 SUPPLEMENTAL INFORMAT ON REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s):..Demolition permit is required prior to issuance of building permit for new building. 'P 4 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure z' form if any Hazardous Materials are being used as part of this project. t _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06121/11 Meeh. Plan Check. Phanb. Plan Check Elec..Plan (:;heck R1e,,A 1'c:rrxitFee: Plumb. Permit Pee: Elec. Permit Fee: Other Meeh. Insp. Other Plumb Insp. Other Elec. In A:I.ech. lnsp..Fec: Plumb. leap. Fee: Dec. Insp. Fee: 7VOTFr This octimate aloes not include fees due to other Departments a e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'1 info, . FEE ITEMS, jFee Resolution 11-�53 E . 7, ff' /1/12) ADDRESS: 10094RANDY LN DATE: 04/18/2013 REVIEWED BY: MELISSA APN: 316 23 067 BP#: *VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0,0 PENTAMATION 1 R3SF.DREM PERMIT TYPE: � WORK REMODEL E HALL & MASTER BATHS NO STRUCTURAL CHANGES TOTAL OF 130 SQ FT SCOPE $0.00 Meeh. Plan Check. Phanb. Plan Check Elec..Plan (:;heck R1e,,A 1'c:rrxitFee: Plumb. Permit Pee: Elec. Permit Fee: Other Meeh. Insp. Other Plumb Insp. Other Elec. In A:I.ech. lnsp..Fec: Plumb. leap. Fee: Dec. Insp. Fee: 7VOTFr This octimate aloes not include fees due to other Departments a e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the relimina information available and are onlyan estimate. Contact the De t or addn'1 info, . FEE ITEMS, jFee Resolution 11-�53 E . 7, ff' /1/12) FEE QTY/FEE Plan Check Feer $0.00 130 s.£ $600.00 Remodel, Bath (<=300 sfl MEMRESBAT Suppl. PC Fee:. .Q Reg:: Q OT 0,0 hr $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp: Fee -.0 Reg. Q OT 0 0 hrs $0.00 PN E Unit Fee:. $0.00 PM E. Permit Fee: $0.00 ( Onslritctioii Tax: Adininistrative Fee: Work Without Permit? 0 Yes � No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 ®, Travel Documentation Fees: Strom Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds'Commission Fee: 1BCBSC $1.00 $2.00 $600.00 $602.00 MISC ITEMS Revised: 04/01/2013 i Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACT.OR LIST JOB ADDRESS: 10614- N P LAI PERMIT#: , L � t < D OWNER'S NAME: 1 d �- PHONE #; --;� "O 222 GENERAL CONTRACTOR: -�;.M ,+ BUSINESS LICENSE # :` ADDRESS: 1p-�D w i N P5 &-s- 5 r. s Sit CITY/zIPCODE:, *Our municipal code requires all businesses working in the city to have, a City -of Copertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE "OBTAINED A;;CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Oat,4--f R .-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 i Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date IQO o 4---A4 �(-,J T Ft,C-LWA�f r SOLID K OV&K WA A/&O PPC. B4W)cc- {�1?0 ��FZi �" Or�1N EZ . woof i A4 1 o674- RAA)!>r L,-4Ajc-- GbP MKT r k) o ► C'A dj sa 11 r-- SLA -6 )?esi5T4NT C&) FLo R -rlLr- Avv z �— pN : 3 l 6 23 0 6 �� �C FF16:. 1 iN I ' Y l QED Al, -13 at') BYo s COMtglUiuiT`r' DE 7-LOP;i,,- ,'T DEPART N T i T !MEr BUILDING D!V';S!0N - „UPERTiNO 5C,OpC- OF- WORK Fj*LL &Aj Ro APPOR VED �) NO I uT� `^ I This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. 3) I J &W '50b D MA -R gLr-_ -5 L'q-r2,> The stamping of this plan and specifications SHALL NOT O BJofea Wftjj 4,it kto!%a r l Ly E -W VAAJ 1'f Y~e �. PLL)m Q fDATE City Ordinance or S ate Law. s-) NEr-J W4 -J -L M N .. r 6) ti&W i ' / 30 o<Y0 oo 7� ll)v 64t+Al �Z'" F6YZ .TO1 LLQ' -4- �� 4LARMs-5111441,L. 13C- _�Rt7vi,D�- �nl 194,1- 5z�OW IQO o 4---A4 �(-,J T Ft,C-LWA�f r SOLID K OV&K WA A/&O PPC. B4W)cc- {�1?0 ��FZi �" Or�1N EZ . woof i A4 1 o674- RAA)!>r L,-4Ajc-- GbP MKT r k) o ► C'A dj sa 11 r-- SLA -6 )?esi5T4NT C&) FLo R -rlLr- Avv z �— pN : 3 l 6 23 0 6 �� �C FF16:. 1 iN I ' Y l QED Al, -13 at') BYo SC P & OF 600k{< C M q-5 T E2 fA74-} (Z(3o rpt ) �) /uo LA-ro o T C-�AA)CT&— . To i L: -T -4- FLOOR, MLC- WILL tic- ►Q�-�/a-i n� 3) t kPL4CC- CES 'SW OW EZ -PA/4 W III Ti C cD 54bW iR PA&j 4-) tiC-N - t c- EA)e.LoSUR& w►TO ",DJR pc4<, ok "WoAJDe 8>04RD " PL')k A)C-w Si lowE-P, 6� A)EW 1AOAJI T r , TOP 4.. .pLmt3W� rtx-rop - 7) VAhQTr b G �h bCW�/.�NG� $ENso/Z Sw 1-7 L�-f s) A&W t&MP. c LQ -s 5d ooc-R ,POR PRDPEERTr Or-WeR ; 4Eovj T,4hl PPOPBQTT A.D9RE-!;S 10014- PAAvDY LAN& C-upeAPAJ O , CA ` 5-01 - do5r:T 2L - s F J 3 N V r,\ v v