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13070018CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21104 TULITA CT
CONTRACTOR: C AND D FREITAS
PERMIT NO: 130700/8
CONSTRUCTION
OWNER'S NAME: ANJALI PALKAR
23610 MORREL CUT-OFF RD
DATE ISSUED: 12/17/2013
O ER'S PHONE: 4087999350
LOS GATOS, CA 95033
PHONE NO: (408) 353-1900
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. IST FLR,
License Class Li 2.`aS l7
2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F.
Z ' �Z'13
Contrac fitoki�
BALCONIES & PORCHES/578 COVERED
/te
I hereby affirm that I am licensed under the pr' visions 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 have and will maintain a certificate of consent to self -insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $914000
performance of the work for which this permit is issued.
ave 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
APN Number: 32628070.00
Occupancy Type:
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. 1 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 ED 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
113
granting of this permit. Additionally, the applicant understands and will comply
Iss i'Z
with all n oint regulations per the Cupertino Municipal Code, Section
9.18.
l
��e y /
RE -ROOFS:
Sign
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 1 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 (Sec.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
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 1 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 C Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, S n 2 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Date: /a �` 7
permit is issued.
Owner or authorized age
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
CONSTRUCTION LENDING AGENCY
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
1 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,
ARCHITECT'S DECLARATION
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
CUPERTINO
SNEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.oM \
❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 21104 Tulita Ct.
APN # 326-28-W 04-0
OWNERNAME Prasad and Anjali Palkar 408-799-9350
E-MULprasad.palkar@gmail.com
STREET ADDRESS 1731 Calgary Dr
LCITYSOTATE,ZIP Sunnyvale CA 94087 FAX
CONTACT NAME Antoine Meo
PHONE 925-963-8646
EMAIL. tonymeodesign@gmail.co
STREET ADDRESS P.O. Box 610
CITY, STATE, ZIP Sunol CA(44586
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT fARCHITECT NGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEO r p��?
LP
LICENSE NUMBER
LICENSE TYPE
BUS. LIC a
COMPANY NAME
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENG[NEER NAME Antoine Meo
LICENSE NUMBER
BUS. LIC k
COMPANY NAME /� y G l7 R
I
E-MAn
/-
STREET ADDRESS �Jn�a
CITY, STATE, ZIP O � �
PHONE�
DESCRIPTION OF WORK 6t4a r-� I -y
1-51- 30215r- k� 17C
Z,A 2,113 Nk Ga-1/Gs IP&ak 66,3
EXISTING USE PROPOSED USE CONS TYPE II STORIES
I !_7L,/_ ,,, / 2
JAREA
USE
TYPE
OCC.
SQ.FT.
VALUATIONS)
NEW FLO(O ► 3 NETTOTAREA3���
EAREAG 1 3 6 AREAS Z/
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEI AREA
PORCH AREA
DECKAREATOTAfL
DtECVJPPORCH AREA
GARAGE AREA: DETACH
(l
O G
]o l7 i-+
Z �TTACH
# DWELLING UNnS.
IS A SECOND UNIT El YES
SECOND STORY JaYES
BEING ADDED' a'NO
ADDITION" NO
,
PRE -APPLICATION IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
_
TO AL VALUATION:
PLANNNG APPL 4 ❑ NO P1,ANN G APPR�OVpAL LETTER
C-1�',J
E]CHLER HOMEY �jc NO
By my Signature below, I certify to each of the following: I am the property owner or authori agent act on operty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and ver] is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Date:
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
J New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
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
El STANDARD
13 PUBLICWORKS
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
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
\
ADDRESS: 21104 TULITA CT
DATE: 07/03/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 28 070
_
BP#:
*VALUATION: $914,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes IS No
I
PENTAMATION 1 R3SFDW
I PERMIT TYPE:
WORK
CONSTRUCT N 2 STORY SFD - 3,025 S.F. 1ST FLR 2,193 2ND FLR 926 S.F. ATTACHED
SCOPE I
GARAGE & 668 S.F. BALCONIES & PORCHES/578 COVERED
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
11-B,III-B,IV,V-B
6,722
$3,748.40
IR3PLNCK
$5,040.88
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,040.88
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
�'
6f^
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
6,722
$3,748.40
Construction Tax: IBCONSTAXR
$5,040.88
N new
units
,Vc, ,. Plan Check
Phanh. Plan C'hcei
Plan Check
Mech. Permit Fee:
Plarmh. Permil Fre:
Elec. Permit l=ee:
Other Meeh. Insp.ET-1-
Other Plumb Insp.E]_L_
Orher Elec. Insp.
Mech. Insp. Fce
Plumb. hrsp. Fee:
Elec. Insp. Fee.,
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimates Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,748.40
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Feer Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,040.88
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
�'
6f^
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
N new
units
$647.24
Administrative Fee:
O
0
Work Without Permit? 0 Yes C) No
$0.00
Advanced Planning Fee: IPLLONGR
$941.08
Select a Non -Residential
Building or Structure
0
Trm,el Documentation Fees_
Strong Motion Fee: IBSEISMICR
$91.40
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$37.001
SUBTOTALS:
$10,506.001
$0.00
TOTAL FEE:
1 $10,506.00
Revised: 07/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21104 TULITA CT
CONTRACTOR: C AND D FREITAS
PERMIT NO: 13070018
CONSTRUCTION
OWNER'S NAME: ANJALI PALKAR
23610 MORREL CUT-OFF RD
DATE ISSUED: 12/17/2013
OWNER'S PHONE: 4087999350
LOS GATOS, CA 95033
PHONE NO: (408) 353-1900
❑ CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
�LINSED
CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. 1ST FLR,
License ClassLic. # MOMl7
2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F.
GA//� ( l
BALCONIES & PORCHES/578 COVERED
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
5/21/14 - DEF # I FOR TRUSS CALC'S- ISSD OTC 6/17/2014
(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
Sq. Ft Floor Area:
Valuation: $914000
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
APN Number: 32628070.00
Occupancy Type:
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. 1 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and ex es w 'ch may accrue again City in consequence of the
derstands and will comply
granting of is permit. AdditionWpeerti
Issued by: Date:
with a poi our egulatiMunicipal Code,Section
9.
7 `�'
RE-ROOFS:
S. Date /
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 (Sec.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
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(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, sho use eiJuipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as by a Ba i Management District I
performance of the work for which this permit is issued.
will maintain co ianc with th upertino Mu c 1 de, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & afety Cod ecti "
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or aut n : Date: 6
permit is issued.
d `
��
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
Compensation laws of California. If, after making this certificate of exemption, 1
CONSTRUCTION LENDING AGENCY
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
II
CUPERTINO
a*gl-1 7? - 3=g
TEMPORARY CERTIFICATE OF OCCUPANCY FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq(@,cupertino.orq
APN _ 7-2 , 7-0
32,�66
BP #:i3©7O� J
l
DAT
...
VALUATION:
APROJECT
SITE(�
ADDRESS: 2 LW 4 LUGITA 1. G C�,�, � C 4 1 Lk10
OWNER'S NAME:f
Pr d s «d ?CMIC-a r
PHONE#: g-ip$j 7qq -g rjs�
FAX #: u A_
MAILING ADDRESS (if different from site address):
S F
CONTRACTR:
G D r-kz l y,4s X?'R-Uoa'/di✓ CG
PHONE #4 'k 35-3 _( 0a
FAX #:
CONTACT: .—
l 6M 9( -Us
PHONE #: 4/ p r/y 7
FAX #: A4
TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION
BOND TYPE: ❑ SURETY BOND7ANT
(1 % VALUATION s �`�Q [BLDBONDS] CODE
❑ CHECK ❑ CASH BOND
ND: 5K min -10K max EDITION:
TCO EXPIRATION
6 � q-//
FEE: $286.00/mo
TOTAL FEE: $ 9 I/5 �° [1TEMPOCC]
DATE (6 MONTHS MAX):
sz/8
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
VA
sz/8
2 -
❑ APPROVED WITH CONDITIONS'
Public Works - tt
�.....
-?
❑ APPROVED
APPROVED WITH CONDITIONS'
. .. ........................ Date:.....:.'..�.�
Signature:..... 4
t e r:
❑APPROVED
APPROVED WITH CONDITIONS'
OTHER
OTHER DEPARTMENT / AGENCY APPROVALS:
anrnng . —
Wil/ ,/� S
❑ APPROVED
APPROVED WITH CONDITIONS"...,,:.........
Signature: .,./'.`✓...................................... Date:..:......
,:
ire ,
..f.. Scr..... J.Y.0 ...�5... Date:.....�T...-..�.
Signature: �., �.,.
[]APPROVED
❑ APPROVED WITH CONDITIONS'
Public Works - tt
�.....
-?
❑ APPROVED
APPROVED WITH CONDITIONS'
. .. ........................ Date:.....:.'..�.�
Signature:..... 4
t e r:
❑APPROVED
APPROVED WITH CONDITIONS'
Signature: ................................ ........................ Date:......................
60&;v (,(j Lup,ws csic-c c r
*CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property
stating the list of items required to be completed for each individual Department before final occupancy
can be granted. Include approximate completion dates for each item.
The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or J
buildings complete and ' compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration
date speci"d. If t ,s Trf�porary Certificate of Occupancy ex, the total amount of the bond may be forfeited and the non-compliance
may resU6 an f e action.
Owner ��Contractor
Signature:..°.[.....�..................... Date:.Sianature:.�.L:Da...!............S..
This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and
approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and
similar emergencies.
Building Official:: F . ...........................-.... .........Print:... .............Date:.-C.,�Z.`/&
DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file
TempOccForm_2011 doc revised 717114
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 v B
(408) 777-3228 • FAX (408) 777-3333 • building(a,cupertino.orq
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED OR]GINAL PERMIT H
PROJECT ADDRES(((S2-I �� 7u l_ 4 C ,
APN d
''���
OWNERNAME "S'f C�� y 1 R
L
PHONE4 _
EMAIL` I IMQI� CC".
srVr
STREET ADDRESS
CITE STATE, ZIP I
u
AX
CONTACT NAME �i �S -/d
orJS`l�t�(Iin/
PHONE
a
E-MAIL
STREET D ESSTY,
2_3(oto Mai c` ©F
STATE, ZIP
L s -a C At
FAX
+0�35 -Zu'
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGE/NT ❑ CONTRACTOR XICONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME(? 0 t �J f� 7� n
LICENSE NUMBER
LICENSE TYPE
BUS. LIC b
S S,
t
COMPANY NA CII.. C�Ac.�:VCFC ��I �/]S
E-MAIL CC _ T V ei�QS Oar
FAX 4 353 mezzo
STREET A4S
CITY, STATE, ZIP
vp
P NE
ki
ARCHITECT/ENGINEERNAME PQ r� sq P4 (T7 e_0
` 7`~
LICENSE NUMBER
BUS. LIC N
COMPANY NAME 7
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK I 1 PE (,( / W C 0,4r- ILOc)f- 7-9-U-9 CA( -'Z5
EXISTING USE
PROPOSED USE
CONSTR. TYPE
M STORIES
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: LJDETACH
I] ATTACH
I
9 WELLINGUt TI'S ISASECONDUNIT ❑YES SECOND STORY C] YES
BEING ADDED? []NO ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN S
RE TOTAL VALUATION:
PLANNING APPL 4 ❑ 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 th prope mer'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. 1 agree to comply with all applicable local
ordinances and state laws relating to building construcno uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicandAgent %M e£Ze1S L�.�e ��' Date: 2-1 r l y
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK 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 x ,"
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 SEwERDISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21104 TULITA CT DATE: 05/21/2014 REVIEWED BY: MELISSA
APN. 326 28 070 BP#: `VALUATION: $0
PERMIT TYPE: fjAN CHECK TYPE: Alteration / Repair
PRIMARY Dor Duplex PENTAMATION 1 GENRES
USE: PERMIT TYPE: ,
WOR 5/21/14 -DEF # 1 FOR TRUSS CALC'S
SCO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc. ). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn't info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1 %13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$278.00
Deferred Submittal
iDEFSUBN,
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
0,0
rhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G)
Work Without Permit? ® Yes (D No
$0.00
Advanced _Plannin Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Strong Motion Fee:
$0.00
Select an Administrative Item
1
Bldg) Stds Commission Fee:
$0.001
SUBTOTALS: 1
$0.00
$278.00
TOTAL FEE. --F-$278.001
Revised: 04/01/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21104 TULITA CT
CONTRACTOR: C AND D FREITAS
PERMIT NO: 13070018
CONSTRUCTION
OWNER'S NAME: ANIALI PALKAR
23610 MORREL CUT-OFF RD
DATE ISSUED: 12/17/2013
OWNER'S PHONE: 4087999350
LOS GATOS, CA 95033
PHONE NO: (408) 353-1900
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. IST FLR,
License ClasLic. #2SKY
2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F.
,—
BALCONIES & PORCHES/578 COVERED
Convacto Date
REV # I - DELETE 2 WINDOWS & ADD I WINDOW/CHANGE PLANS TO
I hereby affirm that I am licensed under the provisions of Chapter 9
REFLECT CHANGE - ISSUED 6/1/15
(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
Sq. Ft Floor Area:
Valuation: $914000
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
APN Number: 32628070.00
Occupancy Type:
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 DAYS LLED 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
l �'
granting of this permit. Additionally, the applicant understands and will comply
V: ate:
with oint ource regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
a�llnon-
6W WT '
Signature Date /J
All roofs shall be inspected prior to any rooting 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:
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 (Sec.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. 1 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 I
performance of the work for which this permit is issued.
will maintain compliance with theC11061,440 Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & SafetyCo a 05, 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
f/
Date:,6 '—r —/—'5permit
is issued.
Owner or authorized agent: .
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
1 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertinLg
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI tR REVISION /DEFERRED
ORIGIINIAL PERMIT # S O T CiL L
PROJECt ADDRESS 11'4_A
11A
APN 9ZZ C)^a
�(✓
OWNER NAME PHONE
/E799 qs-
E-MAIL 0g��r�1'-V
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE O J y E-MAIL e l ( ^TZ) AOL.
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC 0RNAMELICENSE E q -7
t
IC LSTYPE
BUS. LIC N
COMPANY NAME
E-MAIL((�� }
�c Cr a l.2 cV . c
FAX
STREET ADDRESSZ
2.36
STATE, CITY, A, IP
(,c� v� �-'
PHON
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
1
I)PSCRIPTIff 0WORK
c e l � �, 1.� �
� � I C VJ� e� �
EXISTING USE
PROPOSED USE CONSTR
TYPE
4 STORIES
USE
TYPE OCC. SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR,
AREA
DEMO
AREA
TOTAL
NET AREA
-
BATHROOM
REMODEL AREA
KITCHEN.
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA; DETACH
❑ ATTACH
k DVVELLING UMTS:
IS A SECOND UNIT ❑ YES
BEING ADDED? El NO
SECOND STORY ❑ YES
ADDITION? E] NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
PLALTTNG APPL X []NO PLANNIIJG APPROVAL LEITER
IS THE BLDG AN ❑
EICHLER HOME? ❑ NO
., y, ". _ _., ' ` - ^ -. TOTAL VALUATION:
By my signature below, I ce e 01 ng: I am the property owner or authorized agen ac on t e property owner's behalf. I have rea
application and the inf ation vi d is c rrect. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state ws relating etc ns ction. I authorize represee natives of Cupertino to enter the abgve-,den fled pr ope for inspection purposes.
Signature, of Applican ! �- d /� 7)$ Date:
SUPPLEAdEI�ITAL TON REQUIRED
New SFD or Multifamily dvvellinQ�s: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
P
P>;
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project,
�o
'
.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 06121111
corn
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13)
ADDRESS: 21104 TULITA CT
DATE: 06/01/2015
REVIEWED BY: MELISSA
btech. Permit Fein
APN: 326 28 070
BP#: 13070018
`VALUATION: Iso
FPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Plumb. hrsp. F-ce.
PENTAMATION 1GENRES
PERMIT TYPE:
WORKREV
# 1 - DELETE 2 WINDOWS & ADD 1 WINDOW/CHANGE PLANS TO REFLECT CHANGE -
SCOPE
ISSUED 6/1/15
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13)
FEE
Phwfb. PlaoChcc°ti
MISC ITEMS
btech. Permit Fein
Plumb, Permit Fee,
-lec_ Perrnir Per-
__L_
071We ' AACh, InspED__L_
Ocher Plumb Jose
Other Elec. Ins/ F-1
14ech. Insp.
Plumb. hrsp. F-ce.
Elec°. Insp. Fee.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes Q No
$0.00
1 hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: Q Reg. Q OT
ro.fl
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con.mwctlon Tax.
Aclininistrative Fee:
0
E)
Work Without Permit? C) Yes C) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
A
Trm,el Doc ulnentation Fees.
Strong Motion Fee:
$0.00
Select an Administrative Item �J=__
Bldg Stds Commission Fee:
$0.00
x. SUBTOTALS:
$0.00
$143.00 TOTAL FEE:
$143.00
Rev sed: 05/07/2015
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: �.I 10 1. U (-I-T , UT,
PERMIT # 13 C -i v(o 1
OWNER'S NAME: ttsa�C> �� �
PHONE # $ W3-,960
GENERAL CONTRACTOR: C -*D art' )..,.tST-xu
BUSINESSLI ENSE# XIC14
ADDRESS: X_34/C) ok®rl - .
CITY/ZIPCODE: oS Qf)Z?5 0,0 5�13
*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 am ot using subcontractors.
CI, e- A �i�/T.�S Z" 10 —,LS-
-K
-/S -K S ell /rs; ,EP /scL,e.; Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME g, BUSINESS LICENSE #
abinets & Millwork
-b2 3.35'
Cement Finishing
_
Electrical
2(a
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
51 V_
Lathingj�*
t
�! �,$ �✓4�S TEN° i�l/( ie c e a to c
Masonry
Painting / Wallpaper
Paving
Plastering _ - -7 , g - 795a
_�
lumbing
L 49e 0 4 K M31,V6
Roofing
Septic Tank
Sheet Metal
_ o _S z _ 2-0
Sheet Rock
�l C 1 C' ,+¢�. /� 2- S a -
Ti1e
0U7W,¢ / r 3 4 a R A
�-�og_Zog_�zza
ner / Contractor Signature
Date