B-2017-0181CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0181
7866 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: 03/27/2017
OWNER'S PHONE: 510-579-3588
PHONE NO: (408) 836-8457
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #556533
Contractor PERFECT HOMES CONSTRUCTION Date 02/28/2019
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:
SECOND DWELLING UNIT (800 SF) - DETACHED
I hereby affirm under penalty of perjury one of the following two declarations:
REV #1 - SHIFT 2 FT FORWARD TOWARDS THE FRONT_ OF THE
1. I have and will maintain a certificate of consent to self -insure for Worker's
PROPERTY AND ADD SKYLIGHT- ISSUED 4/12/2017
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
Sq. Ft Floor Area: 800
Valuation: $160000.00
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
"N Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
359 03 014
R-3 (Custom)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per t e Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 4_/12/2017
Issued by: AbbyAyende
--1/
OWNER-UTTILD DECLARATION
Date: 03/27/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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 (fec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 4/12/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
or
s. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any onn any manner so as to become subject tthe
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sectio 5505, 25533,,Ppd 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 4/12/2917
I certify that I have read this application and state that the above information is
CON NEND EN Y
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 4/12/2017
Professional
CONSTRUCTION PERMIT APPLICATION.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
� s( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 REVISION
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(a�cuper ino. rq! � REVISION
J�NEW CONSTRUCTION F— ADDTTTON F1 AT.TFRATTON/-nY nT InT�_wT
Nu
PROJECT ADDRESS _ I
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OWNERNAME F ny y, � !' ¢//�,
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
LICENSENUMBER
LICENSE TYPE
BUS. LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE y S
6
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK � --- - - — - -` >--
EXISTING US _
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
R
REMODEL AREA REMODEL AREADEL
=REMC�
AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: El DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RE LVED 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 t e property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons ;tion. I aut orize repre ntatives of Cupertino to enter the above -id ntified roperty for inspection purposes.
Signature of Applicant/Agent: Date: I t<
SUPPLEMENTAL INFORMATI4 RE IRED
FLAN cliIECK TYP : -
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-CbuNTER
BUILDING PLAN REVIEW JVW-1
existing building(s). Demolition permit is required prior to issuance of building_
permit for new building.
❑ EXPRESS
E PLANNING PLAN REVIEW N
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD'
AUBLIc WORKS Xfi IV�gq
form if any Hazardous Materials are being used as part of this project.
❑ LARGE _
❑��//-FTREDEPr
_ Copy of Planning Approval Letter or Meeting, with Planning prior to
El MAJOR
I111L'SANITABY SEER DISTRICT
submittal of Building Pon -nit application.
❑ ENVIRONMENTAL HEALTH
BIdgApp_2011.doc revised 06121/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0181
7866 LILY CT CUPERTINO, CA 95014-4212 (359 03 014) PERFECT HOMES
CONSTRUCTION
SAN JOSE, CA 95136
OWNER'S NAME: SOUNDARARAJAN RAJARAM AND KRISHNAKUMAR JAYA I I DATE ISSUED: 03/27/2017
OWNER'S PHONE: 510-579-3588 I (PHONE NO: (408) 836-8457
License Class 5 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:
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.
nj� 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.
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.
Date 3127/2017
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)
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:
r. 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.
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 3/27/2017
BUILDING PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
SECOND DWELLING UNIT (800 SF) - DETACHED
Sq. Ft Floor Area: 800 1 Valuation: $160000.00
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: Abby Ayende
Date: 03/27/2017
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.
Signature of Applicant:
Date: 3/27/2017
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: 3/2712017
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
J 0-ya,.d;,c V1 - I 0-1 a Y "a. I',''�J MA I I. Co vyi
CONSTRUCTION ,' a=>zk T APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
90300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPEi2l !l�i0 (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertirlo.or
-20 I -i-
,NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI I—I REVISION / DEFFRRRD ORTCiTNAT. PRRMTT #
PROJECT ADDRESS 1' &
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OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME + r
LI IBER
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BUS. LIC #
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ARCHITECT/ENGRNERNAMIA
LICENSENUMBER
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.IT.
VALUATION($)
EXISTO
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NETARHA
lf,
v�a
Y'1
�2'
crlsivrin
V?h
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BATHROOM
KITCHENOTHER
REMODEL AREA
REMODEL AREA
REMODELARE-A
PORCHAREA
DE_CKAREA TOTALDECKIPORCH.AREA GARAGEAREA: EIDETACH
[] ATTACH
I
BDWELLINGUNITS:
ISASECONDUNITSECONDSTORY
❑YES
BEINGADDED? -s-.-Os.
ADDITION? ❑NO
f
PRE-APPLICATION[IYES 7 YES, PROVIDE COPYOF
rS THEBLDGAN L] YES
D Y;
TOTAL VALUATION:
PI.ANNINGAPPL# ❑NO PLANNINGAPPROVALLETTER
F'CHLER HOME? ❑NO
)/J y,y�.71 ;f1 A'\
LJ C/ li
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ing construction. I authorize representatives of Cupertino to enter the above identified roperty for inspection purposes,
Signature of Applicant/Agetrt: Date: 7
SUPPLEMENTAL INF ATION REQi1IRED
PLANCHECKTYPL
ROUTING SLIP
❑ OVER -THF. -COUNTER
BUILDING PLAN RFVIE1V
_ New SFD or Multifamily dwellings; Apply for demolition pennit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
P rLANN vc.PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
VPUBLIC SYORKS
form if any Hazardous Materials are being used as part oftliis project.
❑ LARGE
❑�,/FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
C] MAJOR
I0f SANITARY SEWER DISTRICT
submittal of Building Pon -nit application.
❑ ENVIRONiATENTAL HEALTD
BldgApp 2011.doc revised 06121111
Building Department
City Of Cupertino
10300 Torre Avenue
I Cupertino,CA 95014-3255
Telephone 408-777-3228
CUPERTINO
Fax. 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS - PERMIT# O I °--Cf l
OWNER'S NAME / PHONE# O9/0
GENERAL CONTRACTOR. G(Home& C,®j0 BUSINESS LICENSE#
ADDRESS /cam"g,Aworr zdp.ofr 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 SUBC► 'T CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
7i -
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Fmishmg
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
4,11 947
ner/Contractor Signature ate