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B-2016-3293CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3293 7864 LILY CT CUPERTINO, CA 95014-4212 (359 03 014) PERFECT HOMES CONSTRUCTION SAN JOSE, CA 95136 OWNER'S NAME: SOUNDARARAJAN RAJARAM AND KRISHNAKUMAR JAYA OWNER'S PHONE: 510-579-3588 LICENSED CONTRACTOR'S DECLARATION License Class B Lie. #556533 Contractor PERFECT HOMFB CONSTRUCTION Date 02/28/2019 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. 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 DATE ISSUED: 03/15/2017 PHONE NO: (408) 836-8457 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (99 S.F.) ADDITION OF BEDROOM/BATHROOM/OFFICE (472 S.F); iEL (249 S.F.); ADD (3) SKYLIGHTS; (N) COVERED PORCH #1 - RE -ROOF_• TEAR -OFF! INSTALL CDX• COMP performance of the work for which this permit is issued. I SHINGLES (28 SQ'S) - ISSUED 4/26/2017 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. r Signature Date 04/26/2017 (JERDEC ION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 2. 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. 3. 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 04/26/2017 Sq. Ft Floor Area: 630 1 Valuation: $120000.00 APN Number: Occupancy Type: 359 03 014 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: PAUL O'SULLIVAN RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. Ifa roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 04/26/2017 ALL ROOF COVERINGS TO BE CLASS "A" 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, Sectip4s 25505, 33, and 25534. Owner or authorized agent: Date: 04/26/2017 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION MA 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPiwRTfNfl(408)-777-3228 • FAX (408) 777-3333 • building (d)cupertino.oro " 1 ❑ NOW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION / DEFERRED ORIGEN?L PERI ,fIT PROJECT.ADDRESS 14 L l` O)WNTR NAMEv s� PHOI� J Gt �AiAIL s– %-I— f ST=ET.A-DDPESS CITY; ATE; P A_ /9p S FA X ND CONTACT NAh4E`e s u PHONE E -Ni IL v 1) STREET ADDRES 9 r ' CITY; ATE, ZIP t FAX ❑ 011ER M%'\FR-BUI DER ❑ OWNTRAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TExk,\,T CONTRACTORNANIE 6 LICENS - R 5 LICENSE T 'PE BUS. LIC4_ CO> P.ANY �' F.AX } S r T.ADD SS CI , ST�E IP 0 J s C HOE L –�j ARCHITECT,ENGLNEER NAN LICENSE N'UMMER BUS. LIC'.- C0NOANYN.A,6E I E-I�ZAIL FAX STREET.ADDRESS CTFY, STATE, ZIP I – PHONE DESCRIPTION OF A'ORIC &MAE e /f �\rl��•�b �y,�� EXISTL'dG USE ) PROPOSED USE CONSTR. TYPE ;: STORIES USE - TYPE OCC. SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DEN40 TOTAL --T AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER RF ODELAREA REB40DELAREA REMODELAREA o PORCH AREA DECK AREA TOTAL DECICPORCH SREA GARAGE AREA: []DETACH ❑ ATTACH D-WELLI,G UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BELNGADDED? ❑?.TO ADDITION? ❑No PRE-.APPLICATIO*"❑YES IF YES; PROVIDE COPY OF PLAN'! IN -G APPL= NO PLAN-NRvG.APPROVALLETTER ❑ ISTHEBLDGAN ❑YESBY`" EICHLERHODIE? NO ❑ O T VAL DATION' By my signature below, I certify to each of the follo\ ins: I am the property owner or authoriz d anent 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 NVork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu ]ding consction. I autho 'ze representatives of Cupertino to enter the above -identified propertyfor ins tion purposes. s—& �. Signature of Applicant/Agent: /k of Date: e r n SUPPLEMENTAL PATI QLIRED z PLA\CHECKT1PE.NG o� ER THE coL^.TER - - BtILDInG PLA. rEti�EYt . New New SFD or MuItrfamlly dwellings: Apply for demolition pennrt for-- existins building s),. Demolition per -mit is required prior to issuance of building permit for new bulldm . ,. ElPREss>�="::�;::>:;=.;�.:;:::,,. , Commercial Bldgs: Provide a completed Hazardous Materials Disclosure❑ siA iD -RD IC 1i ORi S roan If env Hazardous Matenal� a.e bem_ used as ori Gf thl� ro ect. L iRGE FIFE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to hLAJOR S submittal of Building Permit application. ir�ITAR1 SEY�'ERDISTPJ A. ❑: EN\IRONWE'�TALHEALTPI-,' - BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3293 7864 LILY CT CUPERTINO, CA 95014-4212 (359 03 014) PERFECT HOMES CONSTRUCTION SAN JOSE, CA 95136. OWNER'S NAME: SOUNDARARAJAN RAJARAM AND KRISHNAKUMAR JAYA OWNER'S PHONE: 510-579-3588 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #556533 Contractor PERFECT HOMES CONSTRUCTION Date 02/28/2019 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. 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 Date 03-15-2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 2. 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. 3. 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 1 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. Date 03-15-2017 ISSUED: 03/15/2017 NO: (408) 836-8457 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT ADDITION OF BEDROOM/BATHROOM/OFFICE (472 S.F); REMODEL (249 S.F.); ADD (3) SKYLIGHTS; (I) COVERED PORCH (99 S.F.) Sq. Ft Floor Area: 630 1 Valuation: $120000.00 APN Number: Occupancy Type: 359 03 014 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 03/15/2017 RE -ROOFS: All roofs sball 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 ofApplicant: IbILADate: 03-15-2017 U 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' 255p05, 25533, and 25534. Owner or authorized agent - Date: 03-15-2017 -- U tr CONSTRUCTION LENIIING 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION (;OMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIX1150N .10300 TORRE AVENUE • CUPERTINO, CA 95014-3256 CUPERTINO � (•008) 777-3228 • FAX (408) 777-3333 • buildin (tr�.cupertino.oM { r �-•�� ,(, , � Zai `� 1 I NRW CY}MSTRT IC.TTnM k AnnY M(IM I—I A T min 'A -T111 III - r -I---- JECTADDRESS 7 � / i�t APN#9 3 Cl L�cJ^ UviL I0.N NERNAME�iW'M �0APA-A&�f" F PHONE AILJr%Y .t•rI(GtYyy �/1 y%�-fl�'•�t Y—�,s ,�!•ry�1-1{!�tavt J�-�`.. .510 •� 57 G�- 3.sb(' g 3V/T �J, aY1�t.Q[E.- IILv �L - EET ADDRESS ..7 U IYa'I t� L CITY, STATE, QIP FAX - CONTACT NAME �U�XV t n-'<k.1Vt[t`�CtJl A�1/LP✓a` !! PHONE -r� $ i q `- � 'S'g g E MAIL ,J OAy4Je-tl7 . YDL f t✓b aAI^ - STREET ADDRESS J t1� .4,/y ! C.(' CITY, STATE, ZIP FAX iG `j .e.a!�i rW GA OWNER ❑ OWNERBUILDRR ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ARCHITECT GINEER ❑ DEVELOPER ❑ TENANT ICENSE�U E 9 LICENS YPE BUS. T<IC# CONTRACTORNAM�t "I=-?722 �,E-� � CIJMPA AM .� litJ"� t/ 1 . �f�✓, / e' Ill FAX ST EETADR 53 � l�} C STAT,' IP 1" � PHONE ARCHITECT/EAIE1wd BRNAME MOM— %�Ie� IC 0 U r – LICENSENUMEER � BUS. LIC 8 COMPANYNAMEDD,,.J• PFsrKfll STOP10 T MAIL ! } p S'�Arx.f•Ol':�" FAi: STREIirAUDRUSS �"$�- lVo i��SM�l fr' CITY`,SrATR,7.IP 57 ��f PHONE - .lf-D � •—b�j-�-2j X1.5 DESCRIPTION OFWORKAOLtil t 4/ � ,�,•,/ T t�,$�--P.�i,�J—��pKj�--'e``i+L-1..-1rS.dL�.$.t:.—!�"d.�'�I •77f 1t.rtPi^ t iV Lys-` +'° .S 'w"[-----:Y-'2--'TJY41.' y'*+•-c+� i'7izm_ AV1:944 —ra ., � jM1.,ILetrf { �Yli f •—`y ��y,UyL �-�a.tnn, '$'jJtj�jyt, J 7 6�;NI- yWG�.��'��R,ev�y-� `� u WASTING USE PROPOSED USE GONSTR. TYPE fF STORffiS USE TYPE OCC. SQ.FP. VALUATION ($) SAG FNEWFWORAREA � 3 ADEMO REA rTOTARL•A BATRROOM KITCHEN REMODEL'AREA REMODEL AREA _ RE OIDELAREA 3-a� PORCH AREA DECKAREAL11ASEE6W611RIT CK/PORCHAREA GARAGEAREA; ❑DETACH J [] ATTACH # DWELLING UNITS: DYES SECONDSTORY DYES ❑NO ADDITION? ❑NO PRE -APPLICATION DYES IFYES,PROVIDECOPYOF PLANNINGAPPLH QNO PLANNING APPROVAL LETTER IS THEIILDGAN DYTS EICHLER110MR9 [a] NO -- TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to a e property owner's behalf. I (lave read this application and the information Ihave 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 Um 'ng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgeiit- a Date: T SUPPLEME TINFORMATION RMA I N AL INFO ON REQUIRED _._.. _..;...:......._ ._ _. _:=;:_ :: :-, , ::._ _.::.:.::; :.:::::..:.:__ _..___:_.:__._... __ _ :.... _.......:........ ;--.-c;•::::: -,::=:::-:: ;;::::_ _ :...::.r: Now rM lfmil dwellings: for demoi s tcri for .... _ . - - R=THE-COUNT�}d�°__ -_ - - - e>istin building(s). Demolition ennitisrequired prior to issuanceofbuilding .--.:::.-.... ............. .... errnit for new building. II � -:::.__, EhTRCSS,„-• ,-_. . ::...:...:::..::.. :.::. .:=C7 `':.:.,.,,.,; ,. _:.._..PLAN\LNG $LA1V-REYI_Tr\�:.__._ :-: _.:.�_ Commercial Bldgs: Provide a completed azardassMate Materials _::�=-_;°=�_ _^,_ N-S--�TA'N:: =D.: =_�_ <^_�:-�::r_:-::::_-:.i;`.�:i`�:':°;_':'='_'•_:_�.��;._- PUBLIC �! ORitS.•., Tenn if any Hazardous Materials are being used as part of this project. _ ..-_ - _..: .....r::... Copy ofPlanning Approval Letter or Meeting with prior to . ,;_:;.--,:--;::.-;-_-:_�;:•..=::,;::::.....::::.::...,... _ I] .:..>_--,: --.:::_s::-:_s;:-:=::.�::-:•`;':.`;a;:-.:;_;,::._:-: &ANITARY:SE\VER➢iSTRIGT > i_ '- suUrnlitalofDutldtugPertnitapphcatton, .KAJORY' :�_,_::_:::.a�:;:_;-,-:::::-::_�=_.�:::•:._::_-.��:-_-:- . .:.::-.-=-.'.._:.::",:.: _ ..`::::..'.... =:o•-':.:. :. ENVIRQNMEATALHF.ALTIt..._ BIdgApp 1011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3293 7864 LILY CT CUPERTINO, CA 95014-4212 (359 03 014) PERFECT HOMES CONSTRUCTION SAN JOSE, CA 95136 OWNER'S NAME: SOUNDARARAJAN RAJARAM AND KRISHNAKUMAR JAYA DATE ISSUED: 03/15/2017 OWNER'S PHONE: 510-579-3588 1 1 PHONE NO: (408) 836-8457 License Class a Lie. #558533 Contractor PERFECT HOMES CONSTRUCTION Date 02/28/2019 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: 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. -. I have and will maintain Worker's Compensation Insurance, as provided for by jV $�%jiSection 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 tjye Cupertina'it4unicipal Code, Section 9.18. Signature 4 Date 07-14-2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT ADDITION OF BEDROOM/BATHROOM/OFFICE (472 S.F); REMODEL (249 S.F.); ADD (3) SKYLIGHTS; (N) COVERED PORCH (99 S.F.) REVISION #1 - RE -ROOF; TEAR -OFF; INSTALL CDX; COMP SHINGLES (28 SQ'S) - ISSUED 4/26/2017 REV#2 - BATH REMODEL (2) (107 SF); REPLACE WINDOWS (3) - (LIKE FOR LIKE TO MEET EGRESS); (2)DOORS - ISSUED 7/14/2017 Sq. Ft Floor Area: 630 I Valuation: $120000.00 APN Number: Occupancy Type: 359 03 014 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 03/15/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 07-14-2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. 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 07-14-2017 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: Z1. - " Date: 07-14-2017 CONSTRUCTIBN 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING FI E1tklISION # 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI a REVISION / MWURRt i) ORIGINAL PERMIT `# PROJECT ADDRESS'7 91 f oU 1 c ] APN # r G� ._ 3 — O J 1/1,E OWNER NAMETA�I'YCYQ) CI PHONE) -IL Y�1(t"I�'L -S -X& I0iA'( i unw STREET ADDRESS CITY, STATE ZIP ?1LA rerz-rlm,C ysal FAX CONTACT NAME < �S I�Q�(� �[ 71 Y/j) Pw — — e ( �J E-MAIL STREF� ES , �J �J CITY, ST E ZIP ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT OR NAMQM E �� e CT ; J LICENSE NUMBER 5 r � 3 3 LICENSE IE B S. LIG # / �CrONTRAC t'1 p 7 ` (, COMPANY NAME E-MAIL FAX P,Cj'=AEC-r STREET ADDRESS CITY, STATE, ZIP PI (ONE �-710--0779 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION F W DD n 1b 2s71 3 ' EXISTING USE PROPOSED USE CONSTIL TYPE # STORIES I lSE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE BY: ' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 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 vided is correct. 1 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 bu ing conslru tion. 1 au rite representatives of Cupertino to enter the above-identifi pro for inspection purposes. Signature of ApplicanUAgent Date: ] ( 2-11-7 SUPPLEMINTAL INF01MATION REQUIRED PLAN CHEA TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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. ❑ 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 DISTRICI submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 Building Department / City Of Cupertino 10300 Torre Avenue e.I94.4, Cupertino, CA 95014-3255 Telephone 408-777-3228 i CUPERTINO Fax.408-777-3333 CONTRACTOR 6 SUBCONTRACTOR LIST JOB ADDRESS -4--g-6 q. Lit C7– PERMIT# 0,2 016 .32_53 OWNER'S NAME PHONE# 4c8 c'f 0 0 GENERAL CONTRACTOR. pe C1`— a C.C&I.Cr BUSINESS LICENSE# ADDRESS I S11c7,Je Lig M f/7 cS CiN 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 SUBCON CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. f n subcontractors: Il // I am not using any Signature Date Please check applicable subcontractors and complete the following information. V 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 Pavmg Plastering Plumbing Roofing Septic Tank Sheet Metal - Sheet Rock - Tile L I Owner/Contractor Signature Date