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13070036-DCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10253 RICHWOOD DR CONTRACTOR: GRAND NEST PERMIT NO: 13070036 CONSTRUCTION OWNER'S NAME: BANNUR SUSHMA AND SATNUR SUNIL 13428 CHRISTINE DR DATE ISSUED: 12/11/2013 OWNER'S PHONE: 4088214401 SARATOGA, CA 95070 PHONE NO: (408) 891-8059 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALO COMMERCIAL 188 S.F. ADDITION ON 1ST FLR & 810 S.F. ON 2ND FLR License Class Lic. 1po v TO CREATE 3 (N) BEDROOMS, 2 & 1/2 (1) BATHS & (N) Contractor b thi SLjft /y" // ? v LAUNDRY RM I .hereby affirm 'that II a m licensed under the provisions of C apter 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $250000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36908045.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 DA M LA T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date• ) a • 1 - 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. Signature 1 I ` / Date / L / 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 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 (See.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 1 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 25$34. 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 I << `/ CUPERTINO NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 408) 777-3228 • FAX (408) 777-3333 • buildinqc@cuperfino.org ADDITION ALTERATION / Ti REVISION / DEFERRED ORIGINAL PERMIT # PRO]EcTADDRESS 10253 1\`_ II ( V. APN# %q-oK-oql_ OWNERNAME SUVA "orV V PHONE /I CJ` gn J. (1 I b L ` I O ( I EMAII STREET ADDRESS vYQ ` `-e s CITY, STATE, ZZIPJ FAX CONTACT NAME i VL ciV L PHONE" 1 Q/ . 4S S Z 0 E-MAIL v S MCA i STREET ADDRESS ((- LS f l1I1 lAF CITY, STATE, ZIPALA) ^e C /1 /Ij {) I FAX E3OwNER OwNER-BUB.DER 13 OWNER AGENT E3 CONTRACTOR 13 CONTRACTOR AGENT 13rARRcH11EC" I ENGD/EER DEVELOPER TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE AR EL'r/ENGINEFR NAME V i LICENSE NUMBER 1 (, , ^ ^ V` BUS. LIC # COMPANY NAME 1C11 E-MAIL , I I. 1 q( , - ^ FAX STREET ADDRESS p C CITY, STATE, ZIP Ci , \ CI l QII2 1 lclh/1 • ICIDESCRIPTIONOFWORK } „ , i , n nL v -(g til S /V +JCI C ACI I,V \ . y l vs - Cov il, 07,S s -F secv. -FIS v TINGU E PRO SID U E CONSTR TYPE STORIES Z USE TYPE OCC SQ+ -1 VALUATIONS) EX[STG AREA I W FLOOR AREA I ( 3, DEMO AREA Sga TOTAL NET AREA BATHROOM REMODEL AREA (/1JoUDECC/K\/ KrrCHEN REMODEL AREA / OTHER REMODEL AREA PORCH AREA AREA TOTAL DECK/ PO4>` R/CHYAREA GARAGE AREA: TACH 110- n 1107"110 ATTACH DWELL(INIG UNITS: ISA SECOND UNIT YES SECOND STORY YES BRING ADDED? "WO ADDITION? NO PLANNI G APDL # YES IF YES, PROVIDE COPY OF PLANNING APDL # NO PLANNING APPROVAL LE77ER IS THE BLDG AN (3EICHLERHOMEYNO T TAL V ATIIONN/: 4/Is.CJ, By my signature below, I certify to each of the following: I am the property owner authorized agent to ac n perty 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 b on. I authorize representatives of Cu er the above -identified roperty for inspection purposes. Signature of Applicant/Agent: Date: COG( Gb 20 I SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SUP OVER-THE-COUNTER El BUILDING PLAN REVIEWNewSFDorMultifamilydwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ElPuBLIc 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 MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 J/m CITY OF CUPERTINO h - i'`t/I FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: DRESS: 10253 RICHWOOD DR DATE: 07108/2013 REVIEWED BY: MELISSA PC FEE ID N: 369 08 045kAP BP#: VALUATION: 1$250,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? OYesONo OTC. 0 Yes 0 No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK 1188 S.F. ADDITION ON 1ST FLR & 810 S.F. ON 2ND FLR TO CREATE 3 N BEDROOMS 2 & 1/2 SCOPE I N) BATHS & (N) LAUNDRY RM 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 998 2,577.00 1R3PLNCK 1,617.00 IR3INSP Elec. Insp. Fee: 1,617.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 1 hrs 0.00 PME Unit Fee: 0.00 PME Permit Fee: 0.00 Construction Tczx: 7T_ Administrative Fee: O Work Without Permit? 0 Yes IS No 0.00 TOTALS: 998 2,577.00 Travel Documentation Fees: 1 $1,617.00 Strong Motion Fee: 1BSEISMICR MECH, HOURLY © Yes 0 No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes 0 No MISC ITEMS reek FT luc. Plan Check Lti>ch- i Plumh. P 1,,le(, Pcrmit 1 A1ech. Insp. Al,& iter Plumb Inst).01her7_ Elec. Inst). Imp. Fee: Iwnh. hasp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Worcs, tare, SanttarySewer mistrict acnoot n.*. J*,.. ,,.,. Tt,.,o., F nc ...a l.ncod n., it.n nraliminnnr inPnrirrntinn nvni/nh/v and nrP nn/v an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: 2,577.00 Select a Misc Bldg/Structure or Element of a BuildingSuppl. PC Fee: Q Reg. 0 OT FO,0 hrs 0.00 PME Plan Check: 0.00 Permit Fee: . 1,617.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 1 hrs 0.00 PME Unit Fee: 0.00 PME Permit Fee: 0.00 Construction Tczx: 7T_ Administrative Fee: O Work Without Permit? 0 Yes IS No 0.00 Advanced Planning Fee: IPLLONGR 139.72 Select a Non -Residential 0 Building or Structure 0TravelDocumentationFees: Strong Motion Fee: 1BSEISMICR 25.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 10.00 SUBTOTALS: 4,368.72 0.001 TOTAL FEE: 4,368.72 Revised: 07/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10253 RICHWOOD DR CONTRACTOR: GRAND NEST PERMIT NO: 13070036 CONSTRUCTION OWNER'S NAME: BANNUR SUSHMA AND SATNUR SUNIL 13428 CHRISTINE DR DATE ISSUED: 12/11/2013 OWNER'S PHONE: 4088214401 SARATOGA, CA 95070 PHONE NO: (408) 891-8059 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATIONrise CONSTRUCT A 188 S.F. ADDITION ON 1ST FLR & 810 Class Lic. # f— S.F. ON 2ND FLR TO CREATE 3 (N) BEDROOMS, 2 & 1/2 N) BATHS & (N) LAUNDRY RM Contractor Date O I hereby affirm t at I am licensed under the provisions of Chapter 9 1 2/26/14 - REVISION # I - ADD ADDITIONAL 210 SQ FT TO FIRST FLOOR commencing with Section 7000) of Division 3 of the Business & Professions ANUAN ADDITIONAL 211 SQ FT TO SECOND FLOOR TO MAKE A TOTAL OF ADDITIONS TO 1419 SQ FT. (FIRE SPRINKLERSCodeandthatmylicenseisinfullforceandeffect. COMBINED EQ ED)-ISSD 4/1/2014 I hereby affirm under penalty of perjury one of the following two declaration 11 I have and will maintain a certificate of consent to self -insure for Worker's r](c Compensation, as provided for by Section 3700 of the Labor Code, for t R Valuation: $250000performanceoftheworkforwhichthispermitisissued. 5 t Floor Area: I have and will maintain Worker's Compensation Insurance, as ed APN Number: 36908045.00 Occupancy Type: Section 3700 of the Labor Code, for the performanceof the work or vi this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITE .S IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 DAYS 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 DAYS F M LAST CA LED 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: l , 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 All roofs shall be inspected prior to any roofing material being installed. If a roof is v installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 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 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. performanceSection3700oftheLaborCode, for the of the work for which thisp Owner or authorized agent: Date: permit is issued. 1 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 CITY OF CUPERTINO rrF F QTTM A TnR — RI IiI ,DING DIVISION Aw ADDRESS: 10253 RICHWOOD DR DATE: 02/26/2014 REVIEWED BY: MELISSA PC FEE ID APN: 369 08 045 BP#: 13070036 VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? 0 Yes No OTC? 0 Yes PENTAMATION 1 R3SFDADD I PERMIT TYPE: i WORK 2/26/14 - REVISION # 1 - ADD ADDITIONAL 344 S.F. TO MAKE A COMBINED TOTAL OF 1,342 S.F. SCOPE I FIRE SPRINKLERS REQUIRED) 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 344 1,579.00 IADDPLCK 1,284.00 IADDINSP Permit Fee: 1,284.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs 0.00 PME Unit Fee: 0.00 PME Permit Fee: 0.00 4- 0 Work Without Permit? ®Yes No 0.00 TOTALS: 344$1,579.00 Select allon-Residential Building or Structure Trovc•l Oo' wricniuiimi Fars. 1,284.00 Strong Motion Fee: IBSEISMICR MECH, HOURLY 0 Yes O No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes Q No I I n__u._ ui__,.., E I - c:-,. (•,.„;s....., Q.,..,o. flicfri f .Ghon/ NOTE: This estimate does not include fees due to other Departments y.e. riannmg, Public morns, I tic, -111-1y •-• ---• • - _- i — -h, an octimato- Contact the Dent for addn'l info. District, eta). These fees are nasea on we preittrurtur FEE ITEMS (Fee Resolution 11-053 Ef' 7f113) w. urrr.u..v1. u.»....o. FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No 1,579.00 1 _4_j hours Plan Check, Hourly 556.00 1STPLNCKSuppl. PC Fee: 0 Reg. 0 OT 0.0 hrs 0.00 PME Plan Check: 0.00 Permit Fee: 1,284.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs 0.00 PME Unit Fee: 0.00 PME Permit Fee: 0.00 4- 0 Work Without Permit? ®Yes No 0.00 Advanced Planning Fee: IPLLONGR 48.16 Select allon-Residential Building or Structure Trovc•l Oo' wricniuiimi Fars. Strong Motion Fee: IBSEISMICR 2.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1.00 SUBTOTALS: 2,914.16 556.00 TOTAL FEE: 3,470.16 Revised: 01/15/2014 CUPERTINO f1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 408) 777-3228 • FAX (408) 777-3333 • buildingC5-cupertino.org r—I rl t3 nrn-r /TL`CL'DDL`T nD1!_11JAT D DWATT41 11\C.W L__a <`.- -- PROJECT ADDRESS 1 D ( 3 R 1 C I4 w C LI D R vI APN # j/ p_ D g ._ 1SOWNERNAMEc' V Vc ( r S !±T AJ V K PHONE t D `}Z6f E MAIIV LC i11 Si1Ll Y Y1A . C STREET ADDRESS 10 2 3 ' CITY, STATE, ZIP /' U P E 1 V A10` CA 9§ 0 1 Q1[ I FAX CONTACT NAME SU N f S T N V - PHONE -If 0 2 I "D 1g EER E-MAIL. _.._. J1'FAX STREET ADDRESS (0-2- 5-17, Q' .w o O .D DK CITY, STATE, ZIP COV P T1 N o 1(-A 9§_0 10 OWNER OWNER -BUILDER OWNER AGENT CONTRACTOR CONTRACTOR AGENT ARCHITECT ENGINEER DEVELOPER TENANT CONTRACTOR NAMEICL V 1 N IDU yQ 6, LICENSE NUMBER 1 LICENSE TYPE BUS. LIC # OCOMPANYNAMEG K r j D NEST N SYP-UCr 10 E-MAIL 1, W FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK f% A , I 1 A it -p- c J '` ` J Lc,\ C e Cvou5vv; r c ® 'Pt -! fi ry o Jl 0 n I C d -e . EXISTING USE PROPOSED USE CONSTR. TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM- REMODEL AREA KTTCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREPIMA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH DWELLING UNITS: ECOND UNIT YES SECONDSTORY YES ADDED? NO ADDITION? NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES RECPWFb BY=- TOTAL VALUATION: IM1/- PLANNING APPL # NO PLANNING APPROVAL LEITER EICHLER HOME? NO 1 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p perty owner's behalf. I have read thisapplicationandtheinformationIhaveprovidediscorrect. 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 constru im, I luthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: 212-4 I 2-0 , Signature of Applicant/Agent: ' SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER BUILDING PLAN REVIEWNewSFDorMultifamilydwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS Form if any Hazardous Materials are being used as part of this project. LARGE FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR SANITARY SEWER DISTRIcr submittal of Building Permit application. ENVIRONMENTAL HEALTH. BldgApp 2011.doc revised 06/21/11 MW CITY OF CUPERTINO BUILDING PERMIT WILDING ADDRESS: 10253 RICHWOOD DR I CONTRACTOR: GRAND NESTI PERMIT NO: 13070036 CONSTRUCTION OWNER'S NAME: BANNUR SUSHMA AND SATNUR SUNIL 1 13428 CHRISTINE DR I DATE ISSUED: 12/11/2013 OWNER'S PHONE: 4088214401 I SARATOGA, CA 95070 I PHONE NO: (408) 891-8059 11 LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # (— & 11 Contractor IX i fir_ 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 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. 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature j / Date IC- OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the billowing two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 1 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature. Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL E] CONSTRUCT A 188 S.F. ADDITION ON 1ST FLR & 810 S.F. ON 2ND FLR TO CREATE 3 (N) BEDROOMS, 2.& 1/2 N) BATHS & (N) LAUNDRY RM REVISION #2- REMOVE CRIPPLE WALL/CLOSET BELOW STAIRCASE; RAISE BEAM AT ENTRY AREA FROM 9 TO 12- ISSD OTC 8/21/2014 Sq. Ft Floor Area: I Valuation: $250000 APN Number: 36908045.00 1 Occupancy Type: PERMITEXPIRES IF WORK IS NOT STARTED WITHIN 18 YS OF PERMIT ISSUANCE OR 180 DAYS LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roof's 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent:_ _ Date: CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO I ""Yr l FFF F TIMAT047— BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, fire, 3anuary Sewer uisrricr, acnooi L --- 4 __'L._ .. .,I:.«:..nry .nfn s,n/inn a„a;lahle and are nnly an estimate. Contact the Dept for addn I info. strict, cc" ! /{CJC GGJ "'. u .. v FEE ITEMS (Fee Resolution 11-053 E . 7/1113) ADDRESS: 10253 richwood dr DATE: 08/21/2014 REVIEWED BY: Mendez Plan Check Fee: Hourly Only? 0 Yes Q No APN: BP#: VALUATION: Iso FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lexP PME Plan Check: PENTAMATION 1 GENRES PERMIT TYPE: USE: Permit Fee: i WORK REVISION #2- REMOVE CRIPPLE WALL/CLOSET BELOW STAIRCASE; RAISE BEAM AT ENTRY SCOPE AREA FROM 9 TO 12- ISSD OTC 8/21/2014 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, fire, 3anuary Sewer uisrricr, acnooi L --- 4 __'L._ .. .,I:.«:..nry .nfn s,n/inn a„a;lahle and are nnly an estimate. Contact the Dept for addn I info. strict, cc" ! /{CJC GGJ "'. u .. v FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE Plan Check Fee: Hourly Only? 0 Yes Q No 0.00 1 hours Plan Check, Hourly 143.00 ISTPLNCK NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, fire, 3anuary Sewer uisrricr, acnooi L --- 4 __'L._ .. .,I:.«:..nry .nfn s,n/inn a„a;lahle and are nnly an estimate. Contact the Dept for addn I info. strict, cc" ! /{CJC GGJ "'. u .. v FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No 0.00 1 hours Plan Check, Hourly 143.00 ISTPLNCKSuppl. PC Fee: Q Reg. Q OT 0.0 1 hrs 0.00 PME Plan Check: 0.00 Permit Fee: 0.00 Suppl. Insp. Fee -.0 Reg. Q OT FOTO hrs 0.00 PME Unit Fee: 0.00 PME Permit Fee: 0.00 l u!rrr li-ti lrr.r. Work Without Permit? 0 Yes (j) No 0.00 Advanced Planning Fee: 0.00 Select a Non -Residential G) Building or Structure O Strong Motion Fee: 0.00 Select an Administrative Item BldgStds Commission Fee: 0.00 SUBTOTALS: 0.00 143.001 TOTAL FEE: F$1143.00 Revised: 07/10/2014 U CUPERTINO r-1 _ CONSTRUCTION PERrvnT APPL[aT COMMUNITY DEVELOPMENT DE; ARTMENT • BU111 1,4U' DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014- 32551 408) 777-3228 • FAX (408) 777-3333 • buildinc(a)cuoertino.org r, ,, F7 .,r-n IT111T,-t n RFinctnt7/TIPPERRFD ORIGINTALPERMITn 1 07GU-36 LJ NEW GUNSIKuI iluN I— I HLL1IIuiN u PROJECT ADDRESS 102,5 3 hI G H W Q Q D ' APN '- 3,61- 0 9- O 4 S OWNERNP.ME S V N 1 L S A'r IJ V PHONE 4 Og- pl) -44,01 I E-MAIL SL,, SCI YJ i@ W4^ STREET ADDRESS ' O f-, G N W o o D D R I CITY, STATE, ZIP / .. C 6 -r Q A C A "' S O I t I FAX W f CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX 53 OWT°ER O'ArNTR-BUILDER OWN'ER AGENr CONTRACTOR COt TKkCTOR AGENT ARC.= -CT ENGLIN'EER DEVELOPER TFNAN'T CONTRACTOR NAME K EV I JJ eD0 N (3) I LICENSE NUMBER LICENSE TYPE I BUS. LIC R COMPANY NAME N F- j D NEST c0 N vrQUC r u) N E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARCHiTECT/ENGIN'EER NAME I ' cs C E M LI V • I I LICENSE NUMBER W C• BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS J'Z 4 5 14 Ago iJ p R CITY, STATE, ZIP PHONE DESCRIPTION OF WORK p MOV (ZIPPLE FALL laoSET ge" w 9TAIxc-A S E 2 . f -A199 geAm Ar EW()2y AP -EA FRoM 1 TO 121 SUPPor75 .SAME LOAD E7aSTING USE PROPOSED USE CONSTR TYPE I t STORIES USE TYPE OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL NET AREAAREAAREAAREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARF I GARAGE AREA: E)ATTACH R DWELLING UNITS: ISA SECOND L?NIT TES SECOND STORY PES BEING ADDED? NO ADDITION? []NO PRE-n-PPUC.A,TaoN-) ES IraES,-PROSIDE-COP10F LETTER I IS1HP sLDc aN 1rs R.E BY 2- 11 TOTAL V. . TION: EICHLERHOME? []NO PLANNINGAPPLk NO PLAN;NINGAPPROVAL s iAM 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 thisandtheinformationIhaveprovidediscorrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable localapplication ordinances and state laws relating to buil hing const4tion.1 I authorize representatives of Cupertino to enter the above -identified rope ty for inspection purposes. Date: I21 Zo4 Signature of ApplicanUAeent: CKTYrESUPPLEMENTALI?ttFORMATION REQUIRED „ PLAI CaEEM New SFD or 1`4ultifamily dwellings: Apply for demolition permit for o«R TlcouNTER w BuuRE'rv Demolition is required prior to issuance of building siswexistingbuilding(s). permit . w , Q, S' GPLt AREi permit for new building. ® KE3LPRESSx y pz 4Nn); ytkL'iT'£ - S' a'"`.,s" `r''}*,..PUBLIGSSCommercialBldgs: Provide a completed Hazardous Materials Disclosure DAxD form if any Hazardous Materials are being used as art of this project. P P .1 C*i:7 I2G ` ¢. ' '.FI D x Copy of Planning Approval Letter or Meeting with Planning prior to iA7 1T7\RI Sfi3«RI S— 4 r IRON'M 1,T submittal of Building Permit application. Bldg4pp-2011.doc revised 06/21/11 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: J /C PERMIT # O O OWNER'S NAME: i 'p d PHONE # / 0 r r - GENERAL CONTRACTOR: , rc (' BUSINESS LICENSE # ADDRESS: G ) , ' o CITY/ZIPCODE: Our municipal code requires all businesses working in the city to have a City of Cupertino business license. 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 7 I am not using any subcontractors: r"-% l Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date