15060107-Retaining wallCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22772 ALCALDE RD CONTRACTOR: ROCHA'S COMPANY PERMIT NO: 15060107
OWNER'S NAME: NEEL DHAMDHERE a(q I M0j
j ep-A 0 -Au Q, DATE ISSUED: 6/23/15
OWNER'S PHONE: (408) 221-3918 q:_� 2S TPHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r, ELECT r PLUMB
License Class Li., #_ �)� f 2—
Contractor
Contractor4Uet--MECH RESIDENTIAL COMMERCIAL
Date-2?
ense unde a provisions sions of Chapter 9
I hereby affirm that I am licJOB DESCRIPTION: _
(commencing with Section 7000) of Division 3 of the Business & Professions , I /f� ��x I D (� 7-A C_t4 rb -5A�
Code and that my license is in full force and effect. QQ M 01A,/
I hereby affirm under penalty of perjury one of the following two declarations: r` 4 f � 1 N lc
I have and will maintain a certificate of consent to self-insure for Worker's ( J 1
Compensation, as provided for by Section 3700 of the Labor Code, for the
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
permit is issued.
Sq. Ft Floor Area: Valuation:
APPLICANT CERTIFICATION
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 APN Number r r Do Occupancy Type:
to building construction, and hereby authorize representatives of this city to enter 'T I `
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF S NOT STARTED
granting of this permit. Additionally, the applicant un stands and will comply WITHIN 1 SOF IT ISSUANCE OR
with all non-point sour regul ' ns per th Cu in unicipal Code, Section
9.I8. 18 S FRO LLED INSPECTION.
Signature Dat — _s7
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: RE-ROOFS:
I, as owner of the property, or my employees with wages as their sole compensation, 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
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code) inspection.
I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material.
I certify that in the performance of the work for which this permit is issued, I shall Additionally, should I use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation laws of California. If, after making this certificate of exemption, I maintain compl' nce with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Sa
become subject to the Worker's Compensation provisions of the Labor Code, I must f Code, Sections 2 533, and 25534.
forthwith comply with such provisions or this permit shall be deemed revoked. uthor' e e
Date:,
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Name
costs, and expenses which may accrue against said City in consequence of the Lender's Address
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. ARCHITECT'S DECLARATION
Signature Date I understand my plans shall be used as public records.
Licensed Professional
A
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPFRTINO (408) 777-3228' FAX (408) 777-3333 • buildinaCa7cupertino ora
PROJECT NEWCONSTRUCTION
❑ ADDjI•F10N� g ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
'2-1172- A1 --(.6`-T 8... b � RD APN #
OWNERNAME j t� - / �e
C� E MAIL tI
STREET ADDRESS 2-.2--71 Z ®� f �` CITY, STATE, ZIP /j� AX
((` C rla-/J P ,�t l,
CONTACT NAME SA p 1 j -y � u e4_4A PHONE _ / t q
V 6`�.�S�w'� •
STREET ADDRESS 2- jo(���� CITY,STAMMZIP ")/S ` rq� rI ` FAX
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT t I MI-RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ��j� y � LICENSE NUMBER LICENSE TYPE
�_5 1 V i_ Rb C�1 A BUS. LIC #
COMPANY NAME E-MAIL
er
STREETADDRESS d s
V 4r°j't! ,4v'✓1'llid_ CITY, STATE, 2
ARCHITECT/ENGINEER NAME LICENSE NUMBER
COMPANYNAMF,ba E-MAIL,"
STREET ADDRESS v
CIT STATE, Z.
Altm
DESCRIPTION OF OP WORK��`
""�•'•" uan PROPOSED USE CONSTR. TYPE #STORIE:
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• nz
]k M
PHONE
4D
BUS. LIC #
USE I TYPE I OCC. I SQ.FT.
611- 6 11
VALUATION ($)
U AT TACH
#DWELLING UNITS:IS A SECOND UNIT ❑YES SECOND STORY OYES -
BEING ADDED? ❑NO ADDITION? ❑NO
PRE -APPLICATION [] YES IF YES, PROVIDE COPY OF Is THE BLDG AN
PLANNING APPL# El NO PLANNING APPROVAL LETTER EICHLERHOME? Q YES
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property oNvner or authorized agent to act on the properly owner's behalf. I have read this
application and the information I have p ovided is correct. I have read the Description of Work and verify it is accurate. I agree to cow ly with all applicable local
ordinances and state laws relating to bui Ing c s con. I authorize representatives of Cupertino to enter thea ove-id e p e y,fo ection purposes.
Sib atureofApplicant/Agent:
Date:
SUPPLEMENTAL " ORMATION REQUIRED
�� rrArrci�cTzTYrEgg
x��siiPh
New SFD or Multifamily dwellings: Apply for demolition permit for>�tx3 rr {
ERHIr�OTifiTER f BUILDING
existing building(s). Demolition permit is required prior to issuance of building OVs r 2 5 1?LANREVIEQY
permit for new building. r
EXPRESS K R E� PLAiQLQINGYLANS2EYIEW4 .
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
s n °PUBLTt�WO-T2FC5 a
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to�tF k+
submittal of Building Permit application.
B1dgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
dADDRESS:
22772 Alcalde Rd
DATE: 04/16/2015
REVIEWED BY: Sean
Plan Check Fee:
- APN:
BP#:
*VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYP E. Addition
PRIMARY SFD or Duplex
USE:
$0.00
PENTAMATION 1 RBCRW
PERMIT TYPE:
WORK
Construction of detached site retaining wall 70 I 6 ft max height).
SCOPE
0 0
+
Ytan ('heck 1'Izc:r:.h. Ai an Check Elec. J11an Check
tiuiech. 1''a'f?" h Pee: 1'raatr•I?, I'c'a'1%'Jt1 /`e£?: 1. fE'C..t''('t'llJtt
.......... --L--
C3a%r,; n,re ch. 7rr. '. €)a ae'r 1'Itattrh ?n.st;.ED t.lti;er 1>,'e'c, ns'p,ET
Ve: :{a. 1"IJIl. I'o-:'r.": 1': ad73?t). 1!3.5'!), °,c'i:': 1.7cc.. .177,�P. 1='c'c';
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'1 info.
FEE ITEMS (Fee Resolution 11-053 F. f 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= l.f. Retaining Wall
$1,575.00 IRETSTN Standard Retaining Wall
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee l Reg. Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
"Idirl"77ib'(ral;ve 1`e:e`;
0
')
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
i'f%L'e'a D,/.?t:7d7i'tf;'iitlX/7iJd't .FC'i',S;
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
�`..5T1BTClTALS
�. �.
$0.00
$1,575.00... r'N TIAFEE:r
$1,575.00
Revised: 04/01/2015