15070074CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20085 NORTHWIND SQ
CONTRACTOR: VARGAS
PERMIT NO: 15070074
CONSTRUCTION
OWNER'S NAME: MALUNJKAR SANJAY C AND KOTHULE JAYA
664 RED ROME LN
DATE ISSUED: 12/04/2015
OWNER'S PHONE: 6505213938
BRENTWOOD, CA 94513
PHONE NO: (925) 437-9468
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F]
License Class 544Y
CONVERT ATTIC INTO LIVABLE SPACE (247 SQ FT);
Lic. #_
REMODEL BATHROOM #2 (50 SQ FT).
Contractor �� �� ,
��� /—��i�C Date l / Z
I hereby affirm that I am licensed 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.
JIffirm under penalty of perjury one of the following two declarations:
I, v nd 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. Ft Floor Area:
Valuation: $40000
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: 31638009.00
Occupancy Type:
permit is issued.
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
PERNUT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS O ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS LAS ED INSPECTION.
costs, and expenses which may ac�e%gainst said City in consequence of thegranting of this permit. Additi eapplicant understands and will comply
with all non -point source re iour the Cu ertmo Municipal Code, Section
9.18.
_
Signature Date
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
❑ OWNER-BUII59iR DECLARATION
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) sho I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equi nt or devices which emit hazardous
air contaminants as defined by the Bay a Air uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the C r uni pal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section , 25 d
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agen • Date: /, --2—
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
CONSTRU2NLENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is1ia 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
Lender's Address
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
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 L%(408) 777-3228 • FAX (408) 777-3333 . building@cupertino.org 154 7go 7
❑ NEW CONSTRUCTION n A nIITTT()AT V A T TCD A TYl XT /- F-1
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B1n V 131vlN 1 1Jrirr11Uk1SL) UKILHNAL FEFJV11T #
PROJECTDRESS tj
APN #
LID
OWNER NAME PHONE E-MAIL
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STREET ADDRESS , CITY, STATE, ZIP FAX
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CONTACT AOME PHONE
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STREET ADDRESS
CI�'Y, STATE, ZIP FAX
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El OWNER E3OWNER-BUILDER❑OWNER AGENT ❑CONTRACTOR ❑CONTRACTOR AGENT�ECII ❑� t-kElDEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
CT/ENGINEEoR�
rO;*
LICENSE NUMBER
BUS. LIC #
NAME
MAIL
FAX
ez l'
Le
STREET ADDRESS
CI Y, STATE, ZIP
H
L_G7
DESCRIPTION OF WORK
t
EXISTING USE
PROPOSED USE CONSTR
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA I
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA 1
KITCHE
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DEC ORCH AREA
GARAGE AREA: DETACH
4;25ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # E] No PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECEIV BY:
TOTAL VALUATION:
O _
By my signature below, I certify to each of the following: I am the 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 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 ilding consl tion. I lhorize representatives of Cupertino to enter the above -identified prope for iiyyinspectoRui�oses.
Signature of Applicant/Agent: Date: �V
SUPPLEMENTAL O QUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ ovER-THE-covNTERBUILDING
existing building(s). Demolition permit is required prior to issuance of building
PLAN REVIEW
permit for new building.
❑ EXPRESSPLANNING
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
submittal of Building Permit application.
❑ MAJOR
❑ SANITARY SEWER DISTRICT
ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06121/11
JIM;-,
� CITY OF CUPERTINO
1I FEE ESTIMATOR -BUILDING DIVISION
'
ADDRESS: 20085 Northwind Sq
DATE: 07/10/2015
REVIEWED BY: Sean
PC FEE ID
APN:
BP#:
*VALUATION: $40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? % Yes G No
OTC? 0 Yes 2;1
No
PENTAMATION
R3SFDADD
PERMIT TYPE: A
WORK
Convert attic into livable space 247 sq ft); remodel bathroom #2 50 sq ft).
SCOPE
Suppl. Insp. Fee: Reg. 0 OT .
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
247
$1,091.00
IADDPLCK
$1,057.00
IADDINSP
1.'lec. Insp. Fc'e: '
$1,057.00
Suppl. Insp. Fee: Reg. 0 OT .
O,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('01ast1'ttc1i0i'l 71ax:
,4dininit•trative 147ee:
0
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
247
$1,091.00
7i'(:Jl'c'l Igoe°tttne�ltlatirrrl Fees:
$1,057.00
Strong Motion Fee: 1BSEISMICR
MECH; TiOURLY Yes .,. •
Q Na
PLUlYIB, HOURLY . .Yes '� :No:
`ELEC, HOURLY Yes " No
A -tech. Plarn Check T
1'I.1110. Plan Check
Elec. Pkzn Check
;Weh. Permit Fce:
1'lurnh. Fermi lea:
Glec'. Permit Fee:
Ocher a/ech. Irrsjz
EELL
Other Plumb Insf).
Other Elec. Insp. -I_
;Vech. hup. I Pe:
Pl2ltltb, hup. Fee:
1.'lec. Insp. Fc'e: '
NUM INS estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminary information available and are only an estimate_ Cnntact the Dent fnr adds °l infn_
FEE ITEMS (Fee Resolution 11-053 L . 7/1,113,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,091.00
=s.f. Remodel, Bath (<=300 sf)
$645.00 IREMRESBAT
Suppl. PC Fee: (j) Reg. 0 OT
0 .0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,057.00
Suppl. Insp. Fee: Reg. 0 OT .
O,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('01ast1'ttc1i0i'l 71ax:
,4dininit•trative 147ee:
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$34.58
Select a Non -Residential E)
Building or Structure 0
7i'(:Jl'c'l Igoe°tttne�ltlatirrrl Fees:
Strong Motion Fee: 1BSEISMICR
$5.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
- SUBTOTAL:_'
$2,189.78
$645.00 = -- TOTAL:EEE
$2,834.78
Revised: 07/02/2015