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B-2017-0443CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0443 22333 BAHL ST CUPERTINO, CA 95014-1006 (326 13 093) S & B CONSTRUCTION SUNNYVALE, CA 94087 OWNER'S NAME: NARAYANAN AND SHARMILA VIJAY I I DATE ISSUED: 04/17/2017 OWNER'S PHONE: 650-417-1932 License Class B Lic. #893195 Contractor S & B CONSTRUCTION Date 03/31/2019 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 PHONE NO: (408) 529-1818 BUILDING PERMIT INFO: X BLDG X ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: MASTER BATHROOM AND CLOSET REMODEL (130 S.F.); REMODEL STUDY (158 S.F.); INSTALL 4 LED LIGHTS - MASTER Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1 - REMOVE REMODEL STUDY - ISSUED 07-01-2017 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 r lations per the 5ertino Municipal Code, Section 9.18. Signature 1�"jti Date 07-05-2017 OWNER -BUILDER DECLARATION 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. 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 07-05-2017 Sq. Ft Floor Area: I Valuation: $25000.00 APN Number: Occupancy Type: 32613 093 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: 04/17/2017 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: 07-05-2017 TO BE CLASS "A" OR 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 withCu rtino Municipal Code, Chapter 9.12 and the Health & Safety od , Se tions 25505, 5 33, and 255 4. Owner or authorized agent: Date: 07-05-2011 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 ARCRITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTtNO (408) 777-3228 • FAX (408) 777-3333 • buildino(a)cuoertino.org 1 ) ❑ NEW CONSTRUCTION ❑ ADDITION El ALTERATION / TI VISIODV/DEFERRED Z-2014- n(4q3 ORIGINAL PERMIT n PROJECT ADDRESS 2.2 3 3 35 9 -Ji -4 S}- APN# OWNER NAME. y h Ci <-C'-1 ` c� �% c PHONE US -X ;10'-1 11.3 Z E-MAIL S\ \c��i cv+ 1 w ` S �`�! �n�• r� t l , STREET ADDRESS 2 L 3 3 3 16 m*J j CITY, STATE, ZIP C ff_ QA FAX /+ � CONTACT NAME �--yl -�l� int 6t-) PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX u 1111ER ❑ OWNER -BW -.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR 11 ARCHITECT 11 ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR NAME e I ���AGENT LICENSE NUMBER I17 13 LI 1 Q LICENSE TYPE I HUS. LIC # , ir, Vik yvculc r COMPANY NAME nit v ono�► E-MAIL 1C� rno � l C,�16 I .i0 FAX STREET ADDRESS yajjA� cr I vn I� V `^ X112_ CITY, STATE, ZIP al PHONE Sn L ARCHITECT/ENGINEER NAME Ca, e �i �a,Q r• LICENSE N MBER E�S cA�+ BUS. LIC # COMPANY NAME S1Q 1c�7 G� K�) Tor- E� CilT� STREET ADDRESS Q�rP CITY, STATE, ZIP ��Lo Cy-,A,c1 T l - PHONE S` O 3j j DESCRIPTION OF WORK � � • T .1?0\ CRg 'rte � \� Q EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES 1 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH I ❑ ATTACH k 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 RECERVED,BY: BY:., `` TOTAL VALUATION: PLANNING APPL # ❑ NO PLAONTNING 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 th 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 mg construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. e > Signature of Applicant/Aeent: Date: 2 1- SUPPLEMENTAL rNTFOR-MATION REQUIRED PL.4_N CHECK TATE I i OI=G SLIP ❑ OVER-THE-COUNTER LATER ❑ Buu DL\c PI 4NrENIEw 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. ❑ EXTRESS ❑. PLANNR� GPLAN 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. ❑ LaRCF ❑FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to -❑ MAJOR: ❑; SA.�-ITAii]SE\6`ERDISTRICT- submittal of Building Permit application. ' ❑- ENT,.,m r (ENTAL 11F 4,LTH BldgApp_2011.doc revised 06/21111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0443 22333 BAHL ST CUPERTINO, CA 95014-1006 (326 13 093) S & B CONSTRUCTION SUNNYVALE, CA 94087 OWNER'S NAME: NARAYANANAND SHARMIi.A VUAY DATE ISSUED: 04/17/2017 OWNER'S PHONE: 650-417-1932 PHONE NO: (408) 529-1818 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #893195 Contractor S & B CONSTRUCTION Date 03/31/2019 X BLDG X ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCL4,L with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MASTER BATHROOM AND CLOSET REMODEL (130 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: REMODEL STUDY (158 S.F.); INSTALL 4 LED LIGHTS - MASTER m. I have and will maintain a certificate of consent to self-insure for Worker's BEDROOM Compensation, as provided for by Section 3700 of the Labor Code, for the rformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, for by as provided Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $25000.00 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 32613 093 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. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino unicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. .Signature J �� Date 4/17/2017 Issued by: Abby Ayende Date: 04/17/2017 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 shallbe 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 (Sce.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: 4/17/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER L I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the 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(x) 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 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 C e, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, See ions 25505, 255 ,and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall `+ be deemed revoked. Owner APPLICANT CERTIFICATION or authorized agent: Date: 4/17/2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 ARCBTrECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 4/17/2017 Licensed Professional s. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.om 13 -zoic-- c ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ✓ J APN # L OWNERNAME / ITpr PHONE .69V l+1932 E-MAIL STREET ADDRESS aj , 3 y�- CITY, STATE, ZIP C& PIE R T 17Q ➢CA, 7 CONTACT NAME II PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER � j LICENSE TYPE F3o BUS. LIC # COMPANY NAME E-MAIL o _5A &Z( C� FAX STREET ADDRESS (� ,✓S CITY, STATE, ZIP /�N� // /1 i !©� `1 - zJ SIT PHONE ,�� e ARCHITECT/ENGINEER NAME G tM C OPPE I LICENSE NUMBER BUS. LIC # COMPANY NANM t. NEWOA S 6y 1 t tic - E-MAIL CL�Pr-L M.�41P_ t FAX STREET ADDRESS 11631 OLIVE & CITY, ST TE, ZIP 3 PHO sed 0 70R 1 DESCRIPTION OF WORK t#nAsRR MrnVELLEDAE) L.)77 tTh &Vbm TD BE WAIVEURD R 15,V0 Amen g y ARnpV/ O s 9 IA16 VAIL A10 6XaW 108 X00 i r-i4cnnN 7 f A,V, Ho ADDED SLi.,0WE rer, . EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES C -Xi* 77Af_ W51PW77�.� V_N Y USE TYPE OCC. SQXT. VALUATION($) EXISTG AREA 40 �! 6 NEW FLOOR AREA DEMO AREA /� � � TOTAL NET AREA � Q 8 �^ p ^ �.7 000 BATHROOM REMODEL AREA 130 3O KITCHEN REMODEL AREA OTHER REMODEL AREA b dp ©IETACH PORCH DECK AREA TOTAL DE�K/PORCH AREA GARAGE AREA: F (,�lJt/1 ATTACH # DWELLING UNITS: IS A SECOND UNLIT [-]YES SECO D STORY ❑YES BEING ADDED? NO ADDITION? 0 PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑` YES R CEIVED $ TOML VALUATION - PLANNING APPL # FIND PLANNING APPROVAL LETTER EICHLER HOME? GAA>NO By my signature below, I certify to each of the following: I am the property owner or authorized agent lo act in 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 building constru tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTINGSLIP ❑ OVER-TH&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 F1 MAJOR Q' SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL, HEALTH BldgApp_2011.doc revised 06/21/11