15080206CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10320 LOCKWOOD DR
CONTRACTOR: SGK HOME SOLUTIONS,
PERMIT NO: 15080206
INC.
OWNER'S NAME: RAJESH SHENOY
3801 CHARTER PARK CT STE B
DATE ISSUED: 08/28/2015
OWNER'S PHONE: 4088369332
SAN JOSE, CA 95136
PHONE NO: (408) 264-6964
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
�+ � /� c
�D�
License Class 11 � Lic. # � liyV_W__S_
BATHROOM REMODEL (60 SQ FT).
9G �
Contractor. Date
I hereby affirm that I am licensed under the provisions of 1hapter 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:
N'al uation: $15000
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 the Labor Code, for the performance of the work for which this
APN Number: 34215053.00
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 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 FROM LAST 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
Issued by: Date:
��r9/yL�'/
granting of this permit. Additionally, the applicant understands and will comply
with all non -poi a re ons per the Cupertino Municipal Code, Section
9.18.
_.
RE -ROOFS:
Signature Date
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 is not 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 (Sec.7044, 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. 1 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 t lity Management District I
performance of the work for which this permit is issued.
will maintain compliance wit he Cupertino M ' pal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sec 'ons 2,5505-, 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agen . Date:
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
CONSTRDING AGENCY
become 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 property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which 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.
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq(o_cugertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS /0^rA�PN
32-d
vI G/KG'
/
/.�(! �'Lv'r(X
OWNER NAME 4 V
34
PHONE
E-MAIL
A T� CITY, STATE, ZIP �
STREET ADDRESS 03 ,)Ce4fD,,Z/72J
FAX
CONTACT NAME F& -7P () / °� 1 t1!
PHONE q0" / L
(i
E-MAIL
STREET ADDRESS /rjS7/ e l
CITY, STATE, ZIP / J�O,
❑ OWNER ❑ OWNER-BUII.DER ❑GCOWNER AGENT 1U CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME G /// _ /'
LICENSE NUMBER yJ®� 95
L
LICENSE TYPE/ � /
��J\/
BUS. LIC # `3
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS �7/R-
C/ t�7Ci
ITY, STATE, ZIP , ! �+�
J
PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
1
DESCRIPTION OF WORK /i0, -D Ve O
EXISTING
PROPOSE SE CONST
E
k STORIES
j
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA D
REMODEL AREA
REMODEL AREA
-
PORCH AREA
DECK
GARAGE AREA: DETACH
[TTALDECK/PORCHAREAAREA
❑ ATTACH
k DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEINCADDED? []NO
ADDITION" [:]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVWbY:
TOT ALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
D�
By my signature below, I certify to each of the lowing: 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 c ect. I have r d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construct) orize representatives of Cupertino to enter the above -identified property forinspectionpurposes.
Signature Applicant/Agent: Date.
of
SUPPLEMENTAL INF RMATION REQ RED
PLAN CHECK TYPE
ROUTING SLIP
/XOVER-THE-COUNTER
f
BUILDING PLAN REVIEW
—New SFD or Multifamily dwellings: ition permit for
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
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
.
❑ ` ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
Fm_� FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (&e Resolution 11-053 Eff' 711%13)
10320 LOCKWOOD DR
DATE: 08/28/2015
REVIEWED BY: SEAN
JimADDRESS:
APN:
BP#:
*VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PME Plan Check:
PENTAMATION
PERMIT TYPE: 1 R3SFDRE i
WORK I
BATHROOM REMODEL 60 SQ FT).
SCOPE
Suppl. Insp. Fee -12) Reg. ® OT
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (&e Resolution 11-053 Eff' 711%13)
Nfech. Plan Check
Plusub. Plan ChecA
Flec, Plan Check
:Rech. Term;
Plumb. ,c:
rlec. Permit tee
(Other A1ech. Insp
?then Plumb Insp.
Other Elec. Imp. Li
$0.00
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (&e Resolution 11-053 Eff' 711%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00F__66__1
s.f. Remodel, Bath (<=300 sf)
$645.00 IREMRESBAT
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -12) Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction T(Lv:
�Idministrative Fee:
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
t't"'¢ft ;'11,.,Cat.•/fr,EtralCtftr,<<' 1`�'2.S'
Strong; Motion Fee: IBSEISMICR
$1.95
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.95
$645.00 TOTAL FEE:
$647.95
Revised: 07/02/2015
0/y4 OA4G74
lo3ZD
Gvi°�r!L?1�6t>
V41s77AA�
V)
1�
�
.
LOP O; ��.1 � ,/ r r.tEti-
Lj ,IVISION c
o m
APPROVE
specifications
:';r-trjct!on. It is u;
cnan�ies or iIterations on say
�Z
there`,om, v itnc�.t approval from t
The S'. -:aping of tnis plan and speci'
be held to perm t or to be an appr
of any provisions of any City Ordi;
BY E.4
DATE -�
PERMIT #
,E COPY-'-
,5-'5el.2 "11,,a
/
DEPARTMENT
PERTINO
LUST be kept at the
a,hful to make any
ie, or to deviate
e Building Official.
-ahons SHALL NOT
;val of the violation
yce or State Lao
RECEIVED
AUG 2 8 2015
B'Y