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15040044 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10325 ANN ARBOR AVE CO TRACTOR:WYSE PROPERTY PERMIT NO: 15040044 SER ICE OWNER'S NAME: SRINIVASAN LEELA V AND GANAPAT 3208 WASHINGTON BLVD DATE ISSUED:04/07/2015 OWNER'S PHONE: 4084465664 FRE qONT,CA 94539 PHONE NO:(408)838-6904 LICENSED CONTRACTOR'S DECLARATION JOf DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ RE ODEL(E)MASTER BATH,NO STRUCTURAL License Class 1-:4 Lic.# �� CH 4,NGES(80 � S.F) Contractor ate 7 1 hereby affirm that I am licensed under t 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: 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.14 Floor Area: Valuation:$4000 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 AP1S Number:32655022.00 Occupancy Type: permit is 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 DA IT 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 18 Rom ALLED 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 granting of this permit. Additionally,the applicant understands and wly Iss a y: te: i p with all non-point source regulations per the Cupertino Municipal Code,Section 918. I RE-ROOFS: Signature_ Date `N All i oofs shall be inspected prior to any roofing material being installed.If a roof is instilled without first obtaining an inspection,I agree to remove all new materials for insp ction. ❑ OWNER-BUILDER DECLARATION Sigr afore 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 is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the Cal fornia 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: He Ith&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 for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's 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 Ow rier or authorized agent: ! Date: permit permit is issued. 4/ 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 become subject to the Worker's Compensation provisions of the Labor Code,I must I he reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wo Ws for which this permit is issued(Sec.3097,Civ C.) Lei der's Name APPLICANT CERTIFICATION Lei ider'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 property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I ur derstand 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 Lic nsed Professional 918. Signature Date 0 O CONSTRUCTION PERMIT APPLICATION b its COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION I,\ 10300 TORRE AVENUE•CUPERTINO, CA E 5014-3255 (_fJ CUPERTINO (408)777-3228•FAX(408)777-3333•buildi cu ertino.or \ ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/Ti El REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS `/ APN# '7772, -bw Aa�_ OWNER NAME , PHONE - E-MAIL C/ ' 77 Va et ."n 1 V"VS4.6, 4-a F4-Wtz&I STREET ADDRESS [ [y0 CITY,STATE,ZI �y� 5 � FAX CONTACT NAME f_ /v PHONE E-MAIL / VIS' C t Z3 STREET ADDRESS " / � CITY,STATE,ZI AX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRA TOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �JLICENSE NUMBER 0,� LICENSE TYPE BUS.LIC# t COMPANY NAME - C E-MAIL _ FAX a1,,--,-.n STREET ADDRESS74ic CITY,STATE,ZIP e � �� PHONE �r ?,X/o k ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# S COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIF ,,may PHONE DESCRIPTION OF WORK _ O"X/ A o u dvY4 �.e EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES 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 A TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF is THE BLDG AN ❑YES . V I PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO By my signature below,I certify to each of the following: I am the property owner or aut orized.96-0M.act onowner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Vork and verify it' e. I agree to comply with all applicable local ordinances and state laws relating to building pamtruction. I aut rize representatives of pertino to enter the above-iden f I pro rty for inspection purposes. Signature of Applicant/Agent: Date: l SUPPLEMENTAL INFORMATION REQUIREDON k, � "RovT>ivcs >P :_ _New SFD or Multifamily dwellings: Apply for demolition permit for r ta O R OU�TER�"� �� ❑, 'IOILDINGPLANREVIEw ,r�rF'# existing building(s). Demolition permit is required prior to issuance of building t s> a � f permit for new building. X17� xEs ❑ ` LANNINC Py�Art it>•rVi r>;w�, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '�� ❑"PUBLI�oRKS x x t s Win, : form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to 't„ i �`m g"&i "~ O ❑k tTr�$X SEW,FRDI TtICT� submittal of Building Permit application. ` �. NVIROIVMENTrn HEALT�I BldgApp_201 1.doc revised 06/21/11 CITY OF CU ERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10325 ANN ARBOR AVE DATE: 04/07/2015 REVIEWED BY: MELISSA APN: 326 55 022 BP#: *VALUATION: 1$4,000 *PERMIT TYPE: Building Permit PLAN CH ECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDRE WORK REMODEL E MASTER BATH NO STRUCTU L CHANGES 80 S.F. SCOPE y y Lhech. Mari('heck Phtmb. Plan Check lilec,Ilan Check ;L9ec;h. Permit Fee Plumb. Pern it Tee: ec, Permit Fee: Ocher a/ech, In ln. Otlier Plumb Insp. LJ Other Elec.Insp. Wech Insp_ Fee: Plumb.Insp.,Fee: Lilec. Insp. Fee: Hij NOTE:This estimate does not include fees due to other Departments(i Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina information ava Table and are onlyan estimate Contact the Det or addn7 info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 80 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: E) Reg. ® OT 0.0 hrs $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fee $0.00 Select a Non-Residential 7i�ut�el L?c�ct�tnentatzrin I ees: Building or Structure i Strom Motion Fee: IBSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 S. _ $1.52 $645.00 �TO L FEET $646.52 T . t Revised: 02/14/2015 J,- 77 ----------- --------- Ji- w.___ ; __.)_, i ..___f_..-1 _ _.� _i,.�. _ J i U i J 7_6 �till!4 L_J -z1,-rj- lU zj� OEE� P _uj "caio r, ap orto 0(2.� Ua:1 iC �j froin tjjb-Bi -Cil ....... 7--f-r-J sficlaL n .0 S, ,,,tions S�IAL�NOT o son* vblailon: of 3) 7 .74 _ 1 J4 n c a Law, or st o: LL J. AMA ,�C_ ............... 7,7 U,