B-2016-3138 i
1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3138
10518 E ESTATES DR CUPERTINO,CA 950144508(369 25 029) W C EXTERIOR CO
WEST SACRAMENTO,
CA 95691 I
OWNER'S NAME: NELLORE HYMANAND AND JYOTHIRMAI DATE ISSUED:X11/17/2016
OWNER'S PHONE:650-504-4276 PHONE NO:(616)234-0190
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: 1
License Class B Lie.#948508
Contractor W C EXTERIOR CO Date 06/30/2018 X BLDG _ELECT _PLUMB
_MECH X RESIDENTIAL—COMMERCIAL
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. JOB DESCRIPTION:
2ND STORY;CONSTRUCT ALUMINUM LATTICE TRELLIS(234 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 ENCLOSE OPEN ROOF TRELLIS TO A CLOSED ROOF
1. I have and will maintain a certificate of consent to self-insure for Worker's TRELLIS-ISSUED 11/29/2016
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
ili.- Section 3700 of the Labor Code,for the performance of the work for which this E
permit is issued. Sq.Ft Floor Area: Valuation:$7560,00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 25 029
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 Cup-rti o against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accru- ag:ins said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,th-a olicant nderstands and will comply with all non-point
source reguyy� 'e th- Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign.tureI,ar: Date 11/29/2016 Issued by:KIM DUNBAR
�. ' Date:11/17/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/29/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the°performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay• ea Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th .upe.ting unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C 1 de es'ons -05,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized age y
APPLICANT CERTIFICATION. Date:11/29/2016 'o
I certify that I have read this application and state that the above information is 9' S' ®k til t'
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/29/2016 Professional '
I
i
CONSTRUCTION PERMIT APPLICATION 1Vj.
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION -
r 14 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildincl ,,cuperlino.orq /3--2.D/& 3/3 $`
CUPERTINO
0 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI 1+ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
10s B Es4.0 s cz
'OWNER NAME 1. ei���� 4.4 1NIGI��V1G� PHONE cs0 5O50,4t(ii
I K7
E-MAIL.
STREET ADDREZSS p CITY, STFFATE,ZIP / FAX
OS
E De- otfo i4
CONTACT NAMEy ( (�i/ -7
I�ir�ksl Y, V 101504 PHONE 1 1 b S. l S?.0 E-MAIL kS c GYrI0716' co
STREET ADDRESSr CITY,STATE,ZIP
�{g I r{-vr,c'in A/e- w Sevo rn, ,e 1 F� CCDe1 I FAX (6 3 7,-f 63 ok
o OWNER ❑ OWNER-BUILDER 0 OWNER AGENT [a CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
M k5k.nr1 10‘.5°‘i CIL( 5-OIS
COMPANY
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COMPANY NAME / _ E-MAIL FAX
IJJAS± -t-onna Y5
STREET ADDRESS CITY,STATE,ZIP PHONE
Vii✓c 1 6 n w. sotevoi .640 G4 orE,91 l,.5'A-(g75 Z--()
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ` v/ ` 41-e-1) IJ 4 dO eak
KCv se eglIs 3 - eYM} "t2 a're irIcn Q, !1
EXISTING U s.. PROPOSED U°E CONSTR.TYPE #STORIES. • _
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL - -
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL'' A REMODEL AREA
PORCH AREA DECKAREA TOT' DECK/PORCH AREA GARAGE AREA: ❑DETACH -
❑ATTACH
#DWELLING UNITS: ISA SECON 0 UNIT ❑.YES SECOND STORY ❑YES -
BEING ADD 0D? NO ADDITION? NO
PRE-APPLICATION ❑YES IF YES,PROV ME COPY OF IS THE BLDG AN ❑YES ;RECEIVED$ '_ - = TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING'vROVAL LETTER EICHLER HOME? NO - -ted '
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 p ovided 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 bui ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
Q PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑`Oti,ER IiE Ci[ir z i ButioiNGPLAN,REVIEW
existing building(s). Demolition permit is required prior to..issuance of building
permit for new building. 0 EXPRESS ❑ PT ANNNIi 1G'PfAN REviEW ..
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ aLICWORK
form if any Hazardous Materials are being used as part of this project.
❑''.LARGE ❑ IRT;DEPT -Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR _ ❑ SANITARY SHWER DISTRICT
0:EISTYTII0fV111ENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B72016-3138
10518 E ESTATES DR CUPERTINO,CA 950144508(369 25 029) W C EXTERIOR CO
WEST SACRAMENTO,
CA 95691
OWNER'S NAME: NELLORE HYMANAND AND 7YOTHIRMAI DATE ISSUED:11/17/2016
OWNER'S PHONE:650-504-4276 PHONE NO:(616)234-0190
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#948508
Contractor W C EXTERIOR CO Date 06/30/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
2ND STORY;CONSTRUCT ALUMINUM LATTICE TRELLIS(234 S.F.)
I hereby affirm under penalty of pe"r"jury one of the following two declarations: t
1. 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.
MV i/ 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 I
permit is issued. Sq.Ft Floor Area: Valuation:$7560.00
APPLICANT CERTIFICATION '
I certify that I have read this application and state that the above j
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 25 029 i
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-.j ainst liabilities,judgments,costs;and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai -I said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,thf.licant nderstands and will comply with all non-point
source regular .- ,4 upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST GALLED INSPECTION.
,
Signature ,� Date 11/17/2016 Issued by:AbbyAyende
/ TIW' Date:11/17/2016
1 rhi t444:�Ii1I1J14t.r ._t: V 1 k.
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE=ROOFS,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/17/2016 1
I
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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 I
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 2553 a) ould I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I us at or devices which emit hazardous
air contaminants as defined by the 1 :•.Air 1 utility Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the ti, • r;•ipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co, t•ctio, 25 I 25 33,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. r
C._ Owner or authorized ag-nt: 11110:k
APPLICANT CERTIFICATION Date:11/17/2016 �_.�.
I certify that I have read this application and state that the above information is 1 N TI o h
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C:)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/17/2016 Professional
9
b201,(0--:NN
.. = CONSTRUCTION PERMIT APPLICATION 1 - _
N COMMUNITY DEVELOPMENT DEPARTMENT••BUILDING DIVISION j `IIIIE
- sir
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 1 rr.
(408)777-3228•FAX(408)777-3333•buildina(a cuBertino.orq 1
CUPERTI NO
❑7vEW CONSTRUCTION
ADDITION ❑ .ALTERATION/TI ❑ REVISION
REVISIO\
!DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS (0�1 ,. 6,..11s._ cL % ML ._ APN# 3L2 ..^ 02
OWNER NAME '9 Co/vas/via eV 40- — PHONE Ul -5D4a-`i-I MAIL
STREET
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CD 0 OWNER-BUDDER 0 OWNER AGENT .CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR,AM p LICENSENU. ero LICENSE TY E BUS.LIC" r
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ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS.LIC
COMPANY NAME E-MAIL :I FAX
STREET ADDRESS I
CITY,STATE,ZIP PHONE
•
DESCRIPTION OF WORK t ,I
24 Sfy . 2
_
•
EXISTING USE PROPOSED USE CONSTR TYPE P STORES - 1 -
USE TYPE OCC:{ SQ.FT. VALUATION(5)
EXIST° NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER _
REMODEL AREA REMODEL AREA REMODEL AREA
1
PORCH AREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: ❑DETACH ";
0 ATTACH
1.
DWELL-NG UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES •
BEING ADDED? 0 NO ADDITION? 0 NO
PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THE BLDG AN 0 YES P.EQEIV D BY .r 3 F r e1 TOTAL VALlIA.TION:
• U
PLANNING APPL4 0N PLANNING APPROVAL LE 11 ER EICHLER HOME' 0N �- .` � { _ ^���
By my signature below,I certify to elo,,- o f e fo owing: I pm the property owner or authorized agent te act on e property owner's behalf. I have read this
application-and the information I hat,. ded 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 J • .a o • ,tion. I authorize representatives of Cupertino to enter the above-i'i entifi.d property for inspection purposes.
,iiSiQnatureofApplicantrA zt. r—��A� Date:
1 (2 (ie
SUPPLE?\ -=�` O M ''ION REQUIRED
PL Is;:i_HEC TYPE, ? ._ �... ,<ROUTINOSLIP. ,
Net; SFD or Multifamily dwellings: Apply for demolition permit for l]' oa EI2 TILE tirAER 0 BL�ILAL",G PLA_'' REVIEW
existing building(s). Demolition permit is required prior to issuance of building o
permit for new building. 0 E\PIiEss 0 PL.-A_'. iNGPLNT.EIIEWt
. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STAND&RD i0 PUBLiCWORKS
form if any Hazardous Materials are being used as part of this project.
-0 LARGE.": FIRE DEPT
Copy of Planning approval Letter or Meeting with Planning prior to TMLAa;
oR
P SA_NrrARY SEWERDISTRICE
submittal of Building Permit application. - z , 4 &
s1'' .? pi kr.E;'�-\'IR6-.Mci IALHE4L'fH , --
BligApp_2011 doc revised 06/21/11
1