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140701341)
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
14233 OLD WOOD RD
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
SARATOGA, CA 95070
PHONE NO: (408)390-5577
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL
6-7
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
License Class /� Lic. # %�C7-
ATTACHED GARAGE (400 SQ FT).
Contractors Date
I hereby affirm that I am licensed under the provisions of Chapter 9
DEF # 1 - ROOF TRUSSES/CALC'S - ISSUED 7/27/15
(commencing with Section 7000) f Division 3 of the Business &Professions
Code and that my license is in full force and effect.
l
REV # 2 - REVISE LOW ROOF FRAMING FOR TRUSSES -
ISSUED 7/27/15
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $600000
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.
APN Number: 35931038.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature / � Date
RE-
r ROOFS:
any
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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
1, 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or devices which emit hazardous
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 25 5, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
-- / y
Owner or authorized agent• �1 Date: b
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 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
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
CIlPERTItltO,
(408) 777-3228 • FAX (408) 777-3333 • build ingancuuerlino.org
❑ NEW CONSTRUCTION n AnnTT,nN I ' I T T�4 % TT(IT.T
runr LiC J_J V1ClUT1VAL Y1r1ZMIT
PROJECT ADDRESS®� ,g A.PN R ' -7 / r 0 3 Y,
OWNER NAME PHONE
STREETADDRESS CITY, STATE, ZIP FAX
E-14A]L
CONTACT NAME I PHONE 4V,110V L/
STREETADDRESS
CITY, STATE, ZIP
FAX
OW1ER ❑. OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGIMIMR ❑ DEVELOPER ❑ TENAN-r
CONTRACTOR NAME LICENSENUTABERp�® LICEN � E�
524
BUS. LIC R
A.
COMPANY NA1,S
E-MAIL
I FAX
STREET ADDRESS e
ems/
CITY, STATE, ZIP _50 g sr•�� qyb
P�
ARCHITECT/ENGINEER NAME LICENSE MUMMER
BUS. LIC,",
COMPANY NAME
__t
E-MAIL
FAX --
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR. TYPE STORIES Jf
N fr
{ USE -%PAF 4�jG��Oy ),SQ,
U:4LUATIOI,!•(5)
EXLTG NEW FLOOR DEMO TOTAL � F
AREA AREA AREA NET AREA
OTBATHROOKN HER
REMODEL�ARFA ML.4REA REAODELAREA J&PORCHAR
_i
,
DECK AREA TOTALDECK/PORCHAREA GARAGE AREA; 0 DET - H
'
❑ ATTACi
mDWELLINGUhTIS: ISASEGONDUNIT❑YES SECOND STORY ❑1ES Y
BEING ADDED?
1_5
ONO ADDITION? ONO
ALUATION:
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNINGAPPLR ONO PLANNINGAPPROVALLErTER I
TS THE BLDG AN p .�
EICHLERHOTIE?
kss� - �..
By my signature below, I certify to each of the following: I am the property ol;mer or zuthorized agent to act on Iiy ov ner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of �TTork and verify it ' curate. I agree to comply;vith zll applicable local
ction. I authorize rrepresentatives'of Cupertino to enter the above -identified property for inspection purposes.
ordinances and state laws relating to buildW__
Signature of Applicant/Agent:10-11
a Date:
SUPPLEMENTAL INFORMATION REQUIRED
= 1YiHE_
— New SFD or Multifamily dNvellings: Apply for demolition permit for
existing building(s). Demolition permit is required to issuance building
-- OG RTICO[1IISER
�BUIIDHIGP) AIQRE«;* a
prior of
permit for new building.
k�SiES�s ��
E�
I1i�jI�GPLt�4�ZEW�.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosures�+�aRD�
4
1�PI�s c olixs.�
form if any Hazardous Materials are being used as part of this project.
_
7 p �i�r azo S 4
_ Copy of Planning Approval Letter or Meeting nwith Planning prior toT
`
t��{.
submittal of Building Permit application. ' •
5- 524
�'
��SA�IIT3iRsE$SIs4
.
I< �.. �_ Gam•. '?.��"_
`i�.,�
MOM-
axa�l�.4•�ia7. �vn
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�I'i'Y.IItOIs'ME 2tiL HEATT'SIr. ��?
Bldg-App_2011. doc revised 06121111
H
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
14233 OLD WOOD RD
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
SARATOGA, CA 95070
PHONE NO: (408)390-5577
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class q L'Lg Lic. # ���
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
PQ- .52�
ATTACHED GARAGE (400 SQ FT).
Contractor Date /3
DEF # 1 - ROOF TRUSSES/CALC'S - ISSUED 7/27/15
I hereby affirm that I am licensed under the provisions Zf Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
REV # 2 -REVISE LOW ROOF FRAMING FOR TRUSSES -
ISSUED 7/27/15
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: $600000
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.
APN Number: 35931038.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
r �,
Signature Date *% J
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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
1, 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
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 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, 533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Z
permit is issued.
Owner or authorized agent: 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
CONSTRUCTION LENDING 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION, 61
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)_cupertino.crg
LUPE T[NO
NEW CONSTRUCTION ❑ ADDTTION ❑ALTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT # lYU.� vI y
PROJECT ADDRESS �a�'
APN #
S'eZ-Glw
OWNER NAME
PHONGEdf
IL
E-MA�e
h ���(.IkuG
,�
ib ��
GGG l
STREET ADDRESS©
CITY, STATE, ZIP
o
FAX
8 J
CONTACT NAME fipt, V I
PHO 6s r
S J T i
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ ONWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME / LICENSENUMBER ^L
i
LICENSETYPEqI6,C
BUS. LIC#
COMPANY NAME�S7
E MAIL
�L
FAX�bp ZI lives L%
STREET ADDRESS /CN6�
Lell
CITY, STATE, 71P _ G A iO �/,
(/N
PHONE wog O�S�
ARCHITECTIENGINEER NAME LICENSE NUMBER
BUS. LICC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
L'cv
CI%J
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE TYPE OCC. SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
--
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKJPORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEINGADDED? ❑NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN 11YES
VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
int
By my signature below, I certify to each of the following: I am the property off or' to a - e property owner's behalf. I have this
application and the information I have provided is correct. I have read the Description
ork an r1 itis accurate. I agree to comply with all applicab e -local
ordinances and state laws relating to building cons tion. I a thorize re sentatives of Cupertino to enter the above -identified property for inspection purposes:
Signature of Applicant/Agent:
Date: /
SUPPLEMENT L INFORMATION REQUIRED
P c Yr _ > _ � h 32ouTIIv S ,rW! :
.�
New SFD or Multifamily dwellings: Apply for demolition permit for
,�. rs' x 103..-!_"," '-: v-' y'k [.' }"'a kr. .8 i rr�.T
p ovEx TH><Coun7 R"� fa + Y - UJLDAVGPLANI2EVIER '
existing building(s). Demolition permit is required prior to issuance of buildingx
Rr { 3 v
permit for new building,
yC� xExPREss �> aliNAFivI> yv
ryi k�' `fir `.I�'.��� 'f�hL'tia�"
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Cla AxD �e ; P�IIBC wo11ucsu � s g4
_
form if any Hazardous Materials are being used as part of this project.
p .<{
I`I]
�� �.rFiiiEA Ti,x�A
Copy of Planning Approval Letter or Meeting with Planning prior to4ivni7oxs�
11RZi -y� IZ
`•�f�t {Y Ll' � �� i
Y,g�R ISTTci'h y
_
submittal of Building Permit application.��
BldgAppjOl 1. drevised 06/21/11
d-
CITY OF CUPERTINO
If V V -V -Ucrrnvr A TnR _ RT TTI ,DIRT(,, DIVISION
NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - -
1bl dare onl an estimate. Contact the DePt or addn'l info.
District, etc.). These Ty are based on the rehmma
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
A. • J J "ii --- v
Phinrb. Plan Check
Elec. Plan Check
a.9ech. Permit Fee:
ADDRESS: 1102 STEEPLECHASE LN
I DATE: 05/18/2015
REVIEWED BY: MELISSA
lia
APN: 359 31 038
BP#: 14070134
"VALUATION: $0
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
r— c....;mmj .V~,Pr District. School
PENTAMATION 1GENRES
PERMIT TYPE:
USE:
Permit Fee:
Suppl. Insp. Fee:E) Reg. Q OT Q.0
hrs
$0.00
$0.00
WORK
5/18/15 - DEF # 1 - ROOF TRUSSES/CALC'S
PME Unit Fee:
SCOPE
PME Permit Fee:
NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - -
1bl dare onl an estimate. Contact the DePt or addn'l info.
District, etc.). These Ty are based on the rehmma
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
ilfech—Plan CheckILL
Phinrb. Plan Check
Elec. Plan Check
a.9ech. Permit Fee:
Plarmh. Permit Fee:
Elec. Permit Fee:
Other iilech. Insp.
Other Plumb Insp. LJ
Other Elec. Insp.
�11�:ch. Insp. Fee:l
Phmmb. Ins Tet::
Llec. Insp. P•ee:
$0.00
■d7-1—
r— c....;mmj .V~,Pr District. School
NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - -
1bl dare onl an estimate. Contact the DePt or addn'l info.
District, etc.). These Ty are based on the rehmma
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
[n ormation ava[
FEE
a e an
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$286.00
Deferred Submittal
1DEFSUBM
Suppl. PC Fee: Reg. Q OT 0.0
PME Plan Check:
hrs
$0.00
$0.00
.
Permit Fee:
Suppl. Insp. Fee:E) Reg. Q OT Q.0
hrs
$0.00
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(,onsfit uetion Tax:
Administrative Fee:
E)
Work Without Permit? 0 Yes (
Advanced Planning Fee:
No
$0.00
$0.00
Select a Non -Residential
Building or Structure
E)
0
A
T raivl Docuinenlalion Fees:
Strong Motion. Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS .
$0.00
$286.00 TOTAL FEE 2
Revised. 05/07/201
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
21831 ALCAZAR AVE
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
CUPERTINO, CA 95014
PHONE NO: (408)390-5577
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL r_1 COMMERCIAL
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
License Class Lic. # �I �OS2'
ATTACHED GARAGE (400 SQ FT).
Contractor S
..n/ Date
.P11
REVISION #1: RECONFIGURATION OF BATHROOMS AND
41
I hereby affirm that I am licensed under the provisions of apter 9
LOCATIONS; ADD COLUMNS AT COVERED PORCH;
(commencing with Section 7000) of Division 3 of the Business & Professions
REVISE WINDOWS IN GUEST ROOM. ISSUED 4/17/15.
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
�� � l/
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: $600000
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: 35931038.00
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
B
�� Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by: ,
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
f
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)
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
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 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
Owner or authorized agent: Date:'—/)/
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
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 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
COMMUNI IY DEVELOPMENT DEPARTMENT • Br~UrIL�7DINMWFD.10y��1
10300 TORRE AVENUE • CUPERTMO, CA 95014=32'5 <
(408) 7.77-3228 • FAX (408) 777-3333 ° buildino(cDcupertino.org.
CUPERTIN
n NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI IJ REVISION / DEFERRED _ _ ORIGINAL PERMIT 4 _
PROJECT ADDRESSI APN 4 �j r 3 i 0--2,'8
t�oa s �e- I ��s� ��
OWNER NAME , PHUNE E-MAIL �r� r� :J Q A
�GLd'�j 2a l� I G6 6 —6 m� Esc
STREET ADDRESS' I CITY, STATE, ZIP. FAX '
i PHONE. E-. Ad _
CONTACT NAMEIL
'D +✓c: Olt- �� Glen ran 1 I t� c� )---;3.Q 6 � n -I nc�rri mall ry
STREET ADDRESS--- CITY, STATE, ZIP FAX
Loar1e__ C �C�So7�
OWNER '` '❑ ONNER-BUft_DER"' ` ' Cl O\1INERAGENT' ❑ CONTRACTOR ❑ CONTRACTOR AGEkT ' ❑ 'ARCiITECT ❑ ENGINEER ..,.DEVELOPER ; ❑. TENANT
COWDACTOR NAMEI LICENSE NTUMBER LICENSE TYPE
�i3�ic4�y J �nc0� ot10 0 6 C.—
BUS. LIC m
COMPANY NAME I
� i is _S 4"v [_ � I �'1
E-MAIL
FAX
STREET ADDRESS ®
CITY, STATE, ZIP
PHONE
ARCHITECTIENGINTEERN.A.ME I LICENSE -NUMBER
BUS. LIC'
COMPANTTY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
I PHONE
yoV Q i
DESCRIPTION OF WORK P�Y
3_v+e_ r i o r v t u-1 gv c-sfi 6c.,,�ro o ars � CjGs .moi a yj r�J oc_a_ti b-rN
1
EXISTP..GUSE PROPOSEDIISE CONSTRTYPE STORIES
USE TYPE OCC. I
SQ.FT.
VALUATIONS)
EXISTG
AREA
NEW FLOOR DE1d0
AREA AREA
---—
TOTAL
NET AREA
TT
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCB 4REA DECK AREA TOTAL DECK/PORCH AREA GARAGE• AREA: ❑ DETACH
❑ ATTACH
DIWELLD.GUITI'S: ISASECONDUNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRP•APPLICATION ❑YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ YES§nn F r _ Og - cam- g',mij RT TOT��?/T�11014;
-E ORO
PLA�'A7NGAPPL� E] NO PLAATTDSGAPPROVALLETTER I EICHLERHOME? ❑NO ff S'a_'�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o%vner's behalf. I have read this
application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building con ruction. I authorize rep sentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
RED f HM
PLAT\ CHECK YPE
SUPPLE.MEN AI, II,rFORMA.TION REQUI0.
x.3•.3° 2 _ p ar �1ti�r�'�`{Tp. '3. Y�'4•, '
New SFD or Multifamily dwellings: Apply for demolition permit for DESgirCOTJ�TE� 4I `BLILD'cL v y
N �.
existing building(s). Demolition permit is required prior to issuance of building s _ � z r RT
? r
�abt6`,tp 4
F �ExP�tEss w ^�`-r 41tRE LER
permit for neva- building.
6 —
"
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ZBLi �
x' 4 uff
_
form if any Hazardous Materials are being used as part of this project. � � xs -- t
7REDEPT RKWO : ONO
Copy of Planning Approval Letter or Meeting with Planning prior to
_ o 11?AJOR� £` trams t--.
submittal of Building Permit application.
BldgApp 2011.doe revised 06/21/11
������ CITY OF CUPERTINO
111<Y''�f//�il 1 F.F. FQT><MATn12 _ R1T11.D1rNC. DIVISION
M1
ADDRESS: 1102 Steeple Chase Lane
DATE: 04/17/2015
REVIEWED BY: Sean
Plan Check Fee: Hourly Only? 0 Yes (j) No
APN:
BP#: �,�
*VALUATION:
$o
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
$0.00
PENTAMATION
PERMIT TYPE: 1GENRE
WORK
REVISION #1: RECONFIGURATION OF BATHROOMS AND LOCATIONS' ADD COLUMNS AT
SCOPE
COVERED PORCH; REVISE WINDOWS IN GUEST ROOM.
;Lech, Plan Check Plumb. Plan Cheek I-lec—Plan Check
;Lleeh. Permit Fee:
Other AIec•h. Insp.
ditch. Insp. Fee:
Plumb. Permir Fee:
Other Plumb 7nsn.
Plumb. he p. Fee:
Elec. Perrnir Fee:
Other- Llcac. Imp.
Oec. Insp. Fee:
NOTE: This estimate does not includefees due to other uepartments (tie. manning, ruotic Frorns, L'lre, ounuury ucwcr LLJLI.1.,
_ ___,�______
___
...,t., .,..
.._ __. ___� _.�,..:.,.. ,...,.a,.r.t,. ,..,,t nor;....,Ie !'nnlnrr the Aunt for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E{f. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
1 hours Plan Check, Hourly
$143.00 1STPLNCK
Suppl. PC Fee: ID Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. C) OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i.OMP'L1Ct10Y1 7 (TY:
A.r:lrninistrative Fee:
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
�
Travel Doc wnenlalh-)n Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALSc=
$0.00
$143.00 ' TOTAL FE `'
$143.00
Kevisea: u4mi/zu,5
CITY OF CUPERTINO BUILDING PERMIT —7
BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 21831 ALCAZAR AVE
DATE ISSUED: O1/27/2015
CUPERTINO, CA 95014 PHONE NO: (408)390-5577
OWNER'S PHONE: 4086672446
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
License Class Lic. 4 l eros 2q ATTACHED GARAGE (400 SQ FT).
Contractor
L'Zq Date 1120-11
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.
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 Valuation: $600000
erformance of the work for which this permit is issued. Sq. Ft Floor Area:
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: 35931038.00 Occupancy Type:
tp ermitt 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 WITIIIN IQn � �i Ei RMIT ISSUANCE OR
to building construction, and hereby authorize r6presentatives of this city to enter Iii" 180 DAYS OM CPALLED INSPECTIO
upon the above mentioned property for inspection purposes. (We) agree to save I.
indemnify and keep harmless the City of Cupertino against liabilities, judgments, p
costs, and expenses which may accrue against said City in consequence of the Issued by: Date:
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. RE -ROOFS:
Signature Date 2 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1, 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) HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project (Sec.7044, Business &Professions Code).
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
�lcontaminants compliance with the Cupertino it Qu pal Code, ality Management
District
I
2 and
performance of the work for which this permit is issued. the Health &Safety Code, Sections 25505, 25533, and 25534.
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 Owner or authorized agent: In/Date:—%
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 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 • building(d)cupertino.org
nXT r__1_ AnnT7'7nXT n AITTZPA-rmTKT/TT n RFv1C7C1N/DEFERRED OPIGINALPERMIT4
r� ..
PR IECf ADDRESS , I > • i
-
APN/ '5j /
fi`�in 9' Cr H
OWNERNAME
F (
STREET ADDRESS �C I CITY, STATE, ZIP I FAX
CONTACT NAME '. 3
\
J.
PHOPI�I E-MAIL l T.R I
F�YY HJT '
.
STREET ADDRESS —A p g � G
CITY S�i�^ �ZIP
` s' 1 P F �B' -3 33 —
� i /O Ey
Lr
�F��- '
❑ OWNER ❑ OVNER-BUILD�ERR ❑ ONT'ERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT M ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONRRACrOR NAME T6 9 I LICENSE NUMBER LICENSE TYPE
BUS. LIC m
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
a
ARCHlTECT/ENGINEERNA14E 1� LICENSE NUMBER � 13
•�
BUS. LIC
COMPANY NAME 113f94 @
E-MAIL
FAX
STREET DDRESS I (
�%
CITY, STATE, ZIP }� t (frq
PHONE
�J}Qp{ �p�y
L_q
- V
DESCRIPTION OF WORK
E 1sn1\,G USE y
PROPOSED i EE CONSTR. TYPE
4 STORIES
USE
TYPE
OCC. SQ.FT.
VALUATION (S)
AREA NEwFLOOR ` DEMO TOTAL
AREA AREA � �,°!�o01 AREA NET AREA
i
!�. 0
BATHROOM KITCHEN OTHER
AREA REMODEL AREA
REMODEL AREA REA40DEL
n
PORCH AREA
DECKAREA
TOTALDECK/PORCHAREA
GARAGEAREA: D ,ACH
ATTACH
m DWELLING UNITS:
ISA SECOND UNIT ❑YES
BEING ADDED? [1N�
SECOND STORY ❑ YES
ADDITION? ❑NO
— —PRE-APPLiC-A-SON—B-I=ES—IF—YES,-PAOYIDE_COP10F
LETTER I
LDG. YES
EICHLER HOME?
2E�EI EUs�Y' .,,"�..?i+*'� z
=` s�' `,. -• b� �. `
TOTAL VALUATIONI:
PLANNING APPL ❑ NO PLANNING APPROVAL
.n �r,4 �.�• , ^',
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 building co stru Ion. I a�t!rizepresentatives of Cupertino to enter the�ab]ove-identified Operty for spection purposes.
Signature of Appl icant/Agent: Date:
T iv 4 1 ,-r „�r1 i,t^ vim. ..
SUPPLEM TALINFORMATIONREQUIREDPLn�crcxT�� ROUTII�GSLTP_
`` r� yb i Rti ywa n4 t t't� k
..i uL+ 5 -J�.\'01 �"iL.1
,
New SFD or Multifamily d,,vellings: Apply for demolition permit for bVER T co>JtyTER r mTivari.GPL R VIEPV K t s�
i-rY T t� >t5
existing building(s). Demolition permit is required prior to issuance of building-mss,5drTy ryrl��� 5 , h
if51
ermit for new building. '© �.rESS r , YJ4i�G PLI3REVIERi`
P f�5x
R -+� ��ti' tiT 'W— ra i• i St .h ri`Y
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �sTA�i,D'AxDL{R
' `moi ''� f rJ "` af"
form if any Hazardous Materials are being used as part of this project. Y x� f is
�, S a J} r
y
_ Copy of Planning Approval Letter or Meeting with PIanning prior to �'Tvi2';A32I.SEY�RD�ST.RI�t:T
submittal of Building Permit application.i
BldgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
21831 ALCAZAR AVE DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
CUPERTINO, CA 95014 PHONE NO: (408)390-5577
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
F-icenseClass
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
Lie. # �' �D� 2�_
ATTACHED GARAGE (400 SQ FT).
Contractorn „ . i� i / Date
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.
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: $600000
erformance of the work for which this permit is issued.
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: 35931038.00
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
WI1 RMIT 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=AS OM L 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
Issued by: Date: 2 �'
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.
RE-ROOFS:
g iatuz ' # _;c'3.� /'� Date /gm
All roofs shall be inspected prior to an roofing material being installed. If a roof is
P P� Y g g
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (See.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. 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(x) 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
�!
s
I?,dor Date: i
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
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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
21831 ALCAZAR AVE
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
CUPERTINO, CA 95014
PHONE NO: (408)390-5577
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
License Classy _
ATTACHED GARAGE (400 SQ FT).
Contractor191,
REVISII+D 1 E.CONE � ION%OF B� - AND
10V
I hereby affirm that I am licensed under the provisions of apter 9
,HRQO
LO TTO S'v VIR CO i7�A 3 O FRET) ©R '
(commencing with Section 7000) of Division 3 of the Business & Professions,*'
" ` ' '
REVISE.WINT)O,�?1�5�''lNow"-�Swr O,:k 'ra S ED54(�1 /15.
Code and that my license is in full force and effect.
1 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: $600000
Rerformance of the work for which this permit is issued.
ave 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: 35931038.00
Occupancy Type:
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
�I e ' 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
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
�Gf�
Issued b Y Date:
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.
- T' -RE
t-:-,..�.1 - �.. _._ -_ - Ste-.
-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
1, 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
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 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 b
P P Y
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, and 25534.,
Owner_ox�altthorrzeilgent:rf '?+'{ Date -S
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
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. 1 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
E
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
14233 OLD WOOD RD
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
SARATOGA, CA 95070
PHONE NO: (408)390-5577
' LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
License ClassA, Lic. # 9�
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
ATTACHED GARAGE (400 SQ FT).
Contractor SAui Date rl m S
—
*, a
ID�O #' 1 dl 10 . , .. k SN711 GA C _ —«ISS ED 7/2ilY
I hereby affirm that I am licensed under the provisions f Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
REV # 2 - REVISE LOW ROOF FRAMING FOR TRUSSES -
Codc and that my license is in full force and effect.
ISSUED 7/27/15
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: $600000
erformance of the work for which this permit is issued.
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: 35931038.00
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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
~%
RE -ROOFS:
Signature Date r,
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)
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
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 1
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, 533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner `_ Date: 7 Z#=
permit is issued.
or authorized agent:_
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 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1102 STEEPLECHASE LN
CONTRACTOR: JBS CONSTRUCTION
PERMIT NO: 14070134
OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI
14233 OLD WOOD RD
DATE ISSUED: 01/27/2015
OWNER'S PHONE: 4086672446
SARATOGA, CA 95070
PHONE NO: (408)390-5577
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
License Class 04, - ' Z Lic. # 9 -foot G
CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT);
ATTACHED GARAGE (400 SQ FT).
Contractor,Date+r,2,oz/ :7 b/ c
--- ;-.-, � ..,... • a , —
,
DEF # 1 - ROOF TRUSSES/CALL S - ISSUED 7/27/15
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
R�-T''_ WISE=�EOs�6!*>R,O®1F1INJF�DR&RSS,.B'
Q 9
Code and that my Iicense 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: $600000
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: 35931038.00
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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature / ,a % I'..• Date , =
All roofs shall be inspected prior to any roofing material being installed. If a roof is
�'TY �,.r
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
r
❑ 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)
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
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 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 255 5, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent•
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
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPI_RTfO, (408) 777-3228 • FAX (408) 777-3333 • building9cupertino.org
l�
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI �Rr--ZIO DEFERRED
r L -
ORIGINAL PERMIT" 00 01-3�
PROTECT ADDRESS
APN R . / ` O 3 v
OV NERNAMEA PHONE 1 t-i�aIL
E �� U
d r
i
STREET ADDRESS CITY, STATE, ZIP
FAX
CONTACT NAME �� ✓ PHONE EMAIL
d�-39d -ss� S� � ��-
STREET ADDRESS
CITY, STATE, ZIP
FAX
Il OWNSR ❑. OWNER -BUILDER ❑ OWNcRAGENT ❑ CON'RACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINTER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NU744BER �D
LICEN EZ
BUS. LIC R
COMPANY NA1,4E
E-MAIL
FAX
STREET ADDRESS
(� /C
CITY, STATE, ZIP �� /D / ^ ��� ry _
T vl `'''1 rQ
PHOT 8 ���0
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC R
COMPANY NA-hM
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
I PHONE
DESCRIPTION OF WORK,,qZa s til J \
(�
r
f`� ic�C7 �•
EXISTING USE PROPOSED USE CONSTR TYPE
9 STORIES
USE Q. LUATttw'i5)
E.XISTG
NEW FLOOR
DEMO
TOTAL
j
AREA
AREA
AREA
NET AREA
1
- `
XN_ \
BATHROOM
KITCHEN
OTHER
\\\
REMODEL AREA
REMODEL.AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DET H
E] ATTA
g 1
'J M1
m DWELLINGUI`7rS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
t�rJ
BEING ADDED? NO
ADDITION? No
PP.E-.APPLICATION ❑ YES IF YES, PROVIDE COPY of
IS THE BLDG AN
I]$ - - _ TO ALUATION:
PLANATNGAPPL4 nNO PLANNINGAPPROVALLETTER
EICHLERHOME?
_-
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on 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 ' curate. I agree to -comply with all applicable local
ordinances and state laws relating to building cc ction. I authorize representatives'of Cupertino to enter the above -identified property for inspection purposes.
Si pature ofApplicant/Agent:
Date:
SUPPLEMENTAL D,1FOR1,1ATION REQUIRED
HE
3i0UTOC'�SLIP::=
New SFD or Multifamily dvvellings: Apply for demolition permit for
—-
��BUIIDLr
existing buildinQ(s). Demolition permit is required prior to issuance of building
otER Talr�oulrTEl_
GPLNREVZEG x:-:
permit for new building.
_ED,-
ExPrl ss Y
t
L� PL4isLnG2LAn R vow
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
jNg PuBicv oxT{s -,
_
form if any Hazardous Materials are being used as part of this project.
_
�
_ �
FlizEvEPT _
Copy of Planning Approval Letter or Meeting with Planning prior to
_
fl TC47oR
'SAi�'TTARYSESRDTSTRICT -�
submittal of Building Permit application.-
,i
}
Bldg,4pp_2011.doc revised 06/21/11
V4
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building (aDcupertino.org
;CUePETING
ONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT 9
PRO.IECfADDRESS -
APN# r3 J"-9 _ _? / _
OWNER NAME'
PHONE
E-MAIL 4 G v�./
STREET ADDRESS ®
CITY, STATE, ZIP
7
FAX
d
CONTACT NAME ,} L ,
PHO
E-MAIL
�� rC
b� J
a b
STREET ADDRESS `
CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
�
LICENSENUMBER
LICENSETYPEA/LJ,6_
BUS.LIC#
/
/�OS2^�
COMPANY NAME
E-MAIL
FAX / OjO14/- I
N �q 14 O
STREET ADDRESS /C�
[
CITY, STATE, 7IP - -Vv
(/N orf
PHO ' `6 pl - O s�
�t 74
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE TYPE OCC. SQ.FT.
1
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA _ -
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
E] ATTACH
# DWELLING UNITS:
ISASECONDUNIT E] YES
SECOND STORY ❑YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES REP EIJW Do l , AL VALUATION:
Fp
PLANNTNG APPL # F-1NO PLANNING APPROVAL LEITER
EICHLER HOME? ❑ NO
MOW zm
By my signature below, I certify to each of the following: I am the property oNI or' nt to a e property owner's behalf. I have this
application and the information I have provided is correct. I have read the Description ork antg-Mfrily it is accurate. I agree to comply with all applicab 8 -local
ordinances and state laws relating to building cons tion. I a thorize regvesentatives of Cupertino to enter the above -identified property for inspection purposes
Signature of Applicant/Agent: fi/� Date: /
SUPPLEMENT L INFORMATION REQUIREDri
❑
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER THEG0TIRTER� 4
,}h F,
4�4 BUII,DING PLAN REVIEW .,
„� T
permit for new building.
k i r.
❑,Pa AIaT�GrLA1VREv�EW
Commercial Bldgs: Provide Hazardous Materials Disclosure
,f
D'
❑ruBLlcwoRxsc
a completed
srANnaxDyf,
r
form if any Hazardous Materials are being used as part of this project.
L �f
Copy of Planning Approval Letter or Meeting with Planning prior to
_
submittal of Building Permit application.
wag,
B1dgApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
1102 STEEPLECHASE LN
DATE: 05/18/2015
REVIEWED BY: MELISSA
rltech. Permit Fee.'
APN: 359 31 038
BP#: 14070134
"VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Plumb. hrsp..Fee:
PENTAMATION
PERMIT TYPE: 1GENRE
WORK
5/18/15 - DEF # 1 - ROOF TRUSSES/CALC'S
SCOPE
.e
e
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Thesefees are based on the prefinmdina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 M. 711113)
illech. Plan Check
/'110. Plan Cheek
Elec: Plan Check
rltech. Permit Fee.'
Plumb. Permit Fee:
Rec. Permit Fee:
Other Hech. Insp.
Other Plumb Insp.Li
Other Elec. Insp. E1_L__
:Llech. Imp. Fee:
Plumb. hrsp..Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Thesefees are based on the prefinmdina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 M. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$286.00
Deferred Submittal
IDEFSUBM
Suppl. PC Fee: 0 Reg. 0 OT,
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -(j) Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction .Tax:
Administrative Fee:
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planniniz Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Documentation Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS,:
i
$0.00
$286.00
w TOTAL•.FEE"
$286.00
Revised: 05/07/2015
g -A
ICUPERTINO
I NFW CONCTRT]C'
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT' DEPARTMEN BBUILDI§IDIV IO
10300 TORRE AVENUE • CUPERTINO, CA 95. 13355 — B.
.(408) 777r3228 • FAX ((408) 777-3333 • buildiinn,gCcDcupertino.org
MON I. I AT)T)MnW I AT.TFRA-rinW/TT IVI RRVTSTnN/T)FFFRRED OR]CTTNAT.PFRMT7T V
PROTECT ADDRESS. -i (O
APN R 7 3 �j
C a. ii
OV,NNERNAME , PHONE E-MAIL ,
�a►�-� kro- Q
i v 6 d -6 v �,
STREET ADDRESS' I CITY, STATE, ZIP. FAX ...
CONTACT NAMEPHONEE-., AIL
`D2_i� clan actin 1 3 -Z3a 6 e o�erri mai '
STREET ADDRESS -'
r rg-- Lo,-
CITY, STATE,,, ZIP
-gSo-71D
FAX
13 6.9 S. �_ S.q n
o r� C
OWNER '` '❑ OWNER-BUI-DEI "" ' ❑ OWNERAT.NT ❑ CON RACTOR ❑ CON7RACTORAGENT'' '13 ARCHITECT ❑ ENGINEER ...•,tVDEVELOPER- ❑. TENANT
CO?viRACTORNAME J n�
LICENSE NUMBER LICENSETYPE
°t
BUS. LIC 4
�r1 GF
C) 5 L -
COMPANY NAME
3'•a s C-0-6) sfiry C rt i a -r)
E-MAIL
FAX
®
STREET ADDRESS
CITY, STATE, ZIP
PHONE
j
ARCHITECTIENGINEERNAME
LICENSE NUMBER
BU'S. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
F'Q-y I S i 0-Y) E xte- r \ o Y- — c—v l V YY\ n 5— C z C A OQ )
ayx+e-rior - �e,ln�1ic-,--J 5,ves-t a1�room dnSk1 r-0-10c��itrn
a-rNJ
b' vii •In� o\nr –�o r -1-�I 5 rda W1 :.. ..
EXISTING USE PROPOSED USE CONSTR TYPE 4STORIES
USE
TYPE
OCC.
SQ,FT.
VALUATION (S)
— _—
EXISTG NEW FLOOR I DEMO TOTAL
IT
AREA AREA AREA 7 NET AREA
BATHROOM
KITCHEN OTHER
REMODEL AREA
RE -MODEL AREA REMODEL AREA
I
PORCH AREA
_
DECK AREA
TOTAL DECK?ORCH AREA
GARAGE AREA: []DETACH
❑ ATTACH
m DWELLING UNIT
IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES
'
BEING ADDED? ❑ NO ADDITION? ❑ NO
PRF -APPLICATION ❑ ITS IF YES, PROVIDE COPY OF I IS THE BLDG AN ❑ YES
_-Cgj
PLAN?7NGAPPL: ❑NO PLAlt�*nK' GAPPROVAL LETTER EICHLERHOA4E? ❑i�0
€
By my signature below, I certify to each of the following: I an the property owner or authorized agent to act on the property owIier'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 building co ructia. I authorize rep sentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofAppl Y- gen .Date:
SUPPLEMEINTT7AL INFORMATION REQUUtD
-
_
�OZERTfI1rCO7I�TERBLIID�GPL4i�ERE��\y
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.
ExrREss j
Y
r� ar.rnGPixE«Eti;
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sT1.DARD
'PUBLrcivofixs3 �F
_
form if any Hazardous Materials are being used as part of this project.
K 1'
}
Copy of PJanning Approval Letter or Meeting dlith Planning prior to
❑ y
�>SAI�TTARY'.SEF)'ERDISTRICT `�
submittal of Building Permit application.
MAJOR
F �_.:.�� > n`4s`��.._.r-_ s..:�:- �..� _
•L� E2r�'IItON'T1EI�TA�HE'�I1A_, _U ._�.
BldgApp-2011.doc revised 06/21/11
Y)
CITY OF CUPERTINO
FEE ESTIMATOR — EUILDING DIVISION
imADDRESS:
1102 Steeple Chase Lane
DATE: 04/17/2015
REVIEWED BY: Sean
Plan Check Fee: Hourly Only? 0 Yes (j) No
APN:
BP#: l3
"VALUATION: iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1GEnIRE
PERMIT TYPE:
WORK
REVISION #1: RECONFIGURATION OF BATHROOMS AND LOCATIONS; ADD COLUMNS AT
SCOPE
COVERED PORCH; REVISE WINDOWS IN GUEST ROOM.
Mech. Plan Check
blech. Permit Fee:
0/her Hech. Insp.
..9<lech. Ince. Fee:
Phvnb. Plan Check
Plumb. Permit Pipe:
Oilier Plumb Insp,
Phinib. Insp. Tee:
Elec..Plan Check
Vee. Permit Fee:
Odwr Glee. Imp.
Elec. Insp, Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are haled an the nreliminary information available and are nnly an estimate_ I'antart the Dent for addn'l info_
FEE ITEMS (Fee Resolution 11-053 E.(f.' 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
0 hours Plan Check, Hourly
$143.00 1STPLNCK
Suppl. PC Fee: Q Reg. 0 OT
10.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. ® OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction :fax:
Administrative Fee:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building
Building or Structure 0
Travel Docrcrnentaticrrr Fees:
Strom Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission .Fee:
$0.00
SiTHTOTALS. '
$0.00
$143.00 TOTAL FEE.
$143.00
Revised: 04/01/2015
CITY OF CUPERTINO
IM -7, FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 1102 Steeple Chase Lane
TYPE OF
CONSTR.
DATE: 07/30/2014
REVIEWED BY: Sean
APN:
BP#:
e ®
*VALUATION: 1$600,000
-PERMIT TYPE: Building Permit
PLAN CHECK TAPE-
New Construction
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes (D No
PENTAMATION
PERMIT TYPE: 1R3SFD i
WORK
Construct two story residence 2540 sq
ft • attached garage 400 sq ft).
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
2,940
$3,067.05
IR3PLNCK
$3,012.15
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,012.15
Suppl. Insp. Fee:(D Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
2,940
$3,067.05
Construction Tax: 1BCONSTAXR
$3,012.15
#new
units
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, sanitary sewer District, school
n:atri,;t otr) Thoco fooc aro hacod nsn tho nroliminaru infnrmatinn available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711,113)
FEE
P1,11!117b. 11100 (hc:!'A
i7ri:. N( 1, C.'r11iA
Plan Check Fee:
$3,067.05
r)(1.11. 7a; F!!1i'; ;r?5';'
E3
Suppl. PC Fee: Q Reg. 0 OT
0.0
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, sanitary sewer District, school
n:atri,;t otr) Thoco fooc aro hacod nsn tho nroliminaru infnrmatinn available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711,113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,067.05
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,012.15
Suppl. Insp. Fee:(D Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXR
1
#new
units
$667.63
Work Without Permit? 0 Yes Q No
$0.00)
Advanced Planning Fee: 1PLLONGR
$411.60
Select a Non -Residential
Building or Structure
Select an Administrative Item
0
0
Strong; Motion Fee: 1BSEISMICR
$78.00
Bldg Stds Commission .Fee: 1BCBSC
$24.00
SUBTOTALS
F$7,260.43
$0.00
TOTAL FEE:
$7,260.43
Revised: 07/10/2014
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408).777-3228 • FAX (408) 777-3333 •.building ,cu ertino.org
CION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGII,TALPERMIT 9
PR ]ECT ADDRESS dol -266 clwt-et o
APN / 0 3
-1p,
/
OWNER NAME qe yy P 1 I ` r— L
13�
t lI ,CIIT tY,
STREET ADDRESS STATE, ZIP FAX
CONTACT NAME � 1 J�
�
11 sy
PHONE
E-MAIL., &q
�
STREET ADDRFss7V;
CITY, STATE, Z
A 'tK 1 1 2- F VS -A :�.33
/ -
❑ OWNER ❑ 01AINER-BUMDERR ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT N' ARCHITECT ❑ ENGWEER ❑ DBVELOPER ❑ TENANT
CONTRACTOR NAME ✓� I LICENSE NUMBER LICENSE TYPE
,7
BUS. LIC m
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME 1` e LICENSE NUMBER � � l�
[
BUS. LIC �
COMPANY NAME fn �I` �„j,
E-MAIL
FAX
STREET D����
CITY, STATE, ZIP
PHONE
feY��4�1 o
DESCRIPTION OF WORK a n
1 e �
e
E ' STING USE
'VZ
PROPOSED � j
CONSTR TYPE
'� STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION
+ {
e a the+
f�V IDEMO i
v
(S)
EXISTG NEW FLOOR
AREA AREA -1 ,yD
AREA
TOTAL
NE'rAREA
v
BATHROOM
REMODEL AREA
KITCHEN OTHER
REMODEL AREA REMODEL AREA
-76
V
VVV
j
PORCHAREA
DECK AREA
TOTALDECK/PORCH AREA GARAGE AREA:D�r"fACH
ATTACH
m DWELLING UMTS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? [ed0'
ADDITION? EDNO
—PRE-APDLIGA3ION—❑1'-ES—IF—YES,-PROMDF-COE]_OF
PLANNINGAPPL: ❑NO PLANNING APPROVAL LETTER
�-JS,CHE'.LDG AN YES
EHOME?
'CEIlrE �m Y's -; `' -: -- TOTAL VALUATION:
RE
� u f
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 building coi Stru ion. I aut rize epresentatives of Cupertino to enter the above -identified operty far spection purposes.
72'7
SignatureofApplicanUAgent: Date:
SUPPLEMYNTAL INFORMATION REQUIRED
'� °� pig, csEcx
,siiPj.:
TVPE
New SFD or Multifamily dwellings: Apply for demolition permit for
.�'�'OVEIZTAIrCOU1tTER4wr 3a
BUII,bL\GPS,4TRE�'SE�v��."`-��y
existing building s). Demolition permit is required prior to issuance of building
x
r
permit for new building.
3'4 gQF_`r''v S"-2•,TL�' d,�tr �i� i`�5.
� r' �� �.� ,�1�• rr �iS 4�5 �
_Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure
form if Hazardous Materials are being used as ofthis
�s nrtyD
��'Y�a,�
pusLT�cwocsX f
any part project.
�
U." zx J
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
4„i�p�[AJDR $ ��i
SA2�ITAT2I sERERDIST.RICn
BId.-App_2011.doc revised 06121111
CITY OF CUPERTINO
WE FEE ESTIMATOR — BUILDING DIVISION
imADDRESS: I IOUteeple Chase Lane
TYPE OF
CONSTR.
DATE: 07/30/2014
REVIEWED BY: Sean
APN:
BP#:
/
*VALUATION: 1$600,000
`PERMIT TYPE: Building Permit
PLAN CHECK T PE:
New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes E No
PENTAMATION 1 R3SFD i
PERMIT TYPE:
WORK
Construct two story residence 2540 sq
ft • attached garage 400 sq ft).
SCOPE
1 hrs
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
2,940
$3,067.05
IR3PLNCK
$3,012.15
IR37NSP
Permit Fee:
$3,012.15
Suppl. Insp. Fee:Q Reg.© OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXR
1
#new
units
$667.63
llehnirdstra ive Fee:
Work Without Permit? 0 Yes Q No
$0.00
TOTALS:
2,940
$3,067.05
"I'rovel Dociunenleuiori roses:
$3,012.15.''
Stroma Motion Fee: IBSEISMICR
_,.
L ech, Flan Cher:k
Phurrb, Plan Cheek
E/ec.. Plan Check
ILIec;Jr. Permit Fee:
Plumb. Peimi! Fee:
fa<eC. Perl?dt haze:
OAer lvlecrh. h -up.
Other Plumb Insp.
01her Elec. Insp.
Vlech, Insp. Fce:
Plumb. h,?sp. Fee:
EiCc, Insp, FC:
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 teased on the oreliminary information availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,f: 7f 11113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,067.05
Select a Misc Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,012.15
Suppl. Insp. Fee:Q Reg.© OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXR
1
#new
units
$667.63
llehnirdstra ive Fee:
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee: IPLLONGR
$411.60
Select a Non -Residential Q
Building or Structure 0
i
"I'rovel Dociunenleuiori roses:
Stroma Motion Fee: IBSEISMICR
$78.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$24.00
f ° .zST7BOTALs:$7,260.43
$0.00 TOTAL FEE'
$7,260.43
Revised: 07/10/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: /pi Ibq1C
PERMIT # f
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSI7VESS LICENSE # oZ�U7
ADDRESS: jk2,4g P pD
CITY/ZIPCODE: ,,�q
*Our municipal code requires all businesses working in4 ie city to have a City of Cupertino 6 sinedlicense.
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: / l
Signature ate
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing2,7O
Electrical
Excavation
�' C
Fencing
C
Flooring / Carpeting
Linoleum / Wood
S
Glass / Glazing
Heating
34101
Insulation
Ji
IfIl
Landscaping
S
Lathing
/ S
0
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
l
O er / Con ractor Signature Date