HomeMy WebLinkAbout13070179CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6382 COTTONWOOD CT
CONTRACTOR: PETER CONSTRUCTION
PERMIT NO: 13070179
OWNER'S NAME: SURT AND JOYITA ROY
5925 TOMPKINS DR
DATE ISSUED: 10/17/2013
OWNER'S PHONE: 4089731276
SAN JOSE, CA 95129
PHONE NO: (408) 529-6412
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class__ Lic. # 8:74�= &q 7
ADDITION OF 800 S.F. TO ENLARGE (E) MASTERBD RM &
CREATE (N) STUDY/DEN, LIVING RM, DINING AREA & 36
Contractor Date /p —/�_(/
S.F. OF (N) PORCH AREA. REMODEL (E) MASTER BATH
1 hereby al,904. 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.
1 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: $140000
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: 36918012.00
Occupancy Type:
permit is issued. /—_7
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
80 DAYS OF PERMIT ISSUANCE OR
WIT7AOM
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 DF LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of die
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:/O.7 /7
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date iO —/ r (3
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
70-
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)
1, 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 1 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 Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 6533 and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:
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, atter making this certificate of exemption, l
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
1 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(@cupertino.orq
❑ NEW CONSTRUCTION Rf ADDITION ❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS _ 2&�2 C6ITC113W,6D Go C.: e T
APN N
7
OWNER NAMESCJ I1 Jb'i!'(1g %�V
7
PHONE
4of?97_3- i2
E-MAIL
S4 Tr i"Royce ygNa,
c.�;, t
STREET ADDRESS 63&,:p CC;iEoN�C)GD GOV QT'
CITY, STATE ZIP
c PcIZ'r1r,, (.)
FAX
u
CONTACT NAME
SuJ1`t Q�7
PHONE
4t�e �}3�12�6
E-MAIL
Su.ilf2-�r@�64-heo•�xM
STREET ADDRESS 63852 C"C'TT6 J Wnr' Co Lt T
CITY, STATE, ZIP
FAX
�.t P �T, r" e cit 9So �
�WNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME ((''}}-.-
-TeuCx IO,J
&MAIL11
PGc,N S' yC.TIUW 6�+�dvl0.i {.Gtr
FAX
STREETADDRESS �;qZS I-0" PKrN,S 1)Q1Uc
CITY,STATE,ZIP 5A.J 5cZ6,C_A W2n
+J
PHONE �85��
2-4S
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAMEPel` �� (.
E-MAIL �F�o=., SiQc7GT16'�1 •r-+N%I
FAX
STREET ADDRESSS
z125 to ry pi<rnrs piArvc
CITY, STATE, ZIP
� .a -•,t .icer✓ �,c� �j 5 t 2�}
PHONE Livs SI -1 .2 9+
DESCRIPTION OF WORK
r4nolrloN "f -o t=R.ti. A -+J1) SlI)e el U005,6CW 5 E)
.
. c
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA V_,o
NEW FLOOR
AREA 1X(3C_J
DEMO
AREA
TOTAL
NET AREA aOC)0
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UMTS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
7
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION FINES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
REC • BY: I TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NOI
is ' C>T�j
s behalf. I have read this
By my signature below, I certify to each of the following: I am the property owner or authorized ayAnrro`actowT5e propeee
to
application and the information I have provided is correct. I have read the Description of Work and verify < is agrcomply with all applicable local
ordinances and state laws relating to building const tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:- it Dater _7— 1 3 Q / ,�0 i 3 '
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER -THF 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
Lf' STANDARD
ElPUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
j❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/21/11
WN
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
f El
it; 1':'r;ur,'. Jr�r�, i,� ;.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Wclriet olr )_ Thoco fooc aro hncod an Iho nroliminary infnrmalinn availahlo and nro anly an aclimalo_ Cnnlarl Iho non/ far addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Eff 71'LL)
ADDRESS: 6382 COTTONWOOD CT
DATE: 04/28/2014
REVIEWED BY: MELISSA
MISC ITEMS
APN: 369 18 012
BP#: 13070179
'VALUATION: Iso
°-PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE: A
WORK
REV # 1 - WIDEN 3 WINDOW OPENINGS - ISSUED 4/28/14
SCOPE
f El
it; 1':'r;ur,'. Jr�r�, i,� ;.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Wclriet olr )_ Thoco fooc aro hncod an Iho nroliminary infnrmalinn availahlo and nro anly an aclimalo_ Cnnlarl Iho non/ far addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Eff 71'LL)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
hours Plan Check, Hourly
$139.00 1STPLNCx
Suppl. PC Fee: Q Reg. (0 OTTO-07
h r s
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee;Q Reg. Q OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C.nlZ,;lrtirjiu/7 /:r.t.
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Th l" (,/ Oocluncnfalilm Fc (c
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
1 $0.00
$139.00
TOTAL FEE:
$139.00
Revised: 04/01/2014
CITY OF CUPERTINO
ISI FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 6382 COTTONWOOD CT
DATE: 07/30/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 369 18 012
BP#: �� l'
*VALUATION: 1$140,000
*PERMIT TYPE: Building Permit
PLAN CHECK T PE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? 0 Yes G No
OTC? 0 Yes 0 N
PENTAMATION
1 R3SFDADD
PERMIT TYPE: A
WORKADDITION
OF }g3S.F. TO ENLARGE E MASTERBD RM & CREATE N STUDY/DEN LIVING RM
SCOPE
DINING AREA & 36 S.F. OF (N) PORCH AREA. REMODEL (E) MASTER BATH (60 S.F.)
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-6,111-B,IV,V-B
793
$2,577.00
IR3PLNCK
$1,617.00
IR3INSP
Elec. Insp. Fee'
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
793
$2,577.00
Conoraction Tux:
$1,617.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY ® Yes Q No
Mec=ir. Plan Crcck
('krmh. 1'lu1r t.hcc6
I:7cc�. Piurr C;hG<ck
11ech. Permit Fee:
Plumb. Permit 1,
Elec. Permit Fe,
Other Alech. Insp.
Other Plumb Insp.
Other Elec. Insp.
dlech. Insp. Fee:
Plumb. Irtsp. W.
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 nreliminarv, information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ETf 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,577.00
=s.f.
$626.00
Remodel, Bath (<=300 s fl
1REMRESBAT
Suppl. PC Fee: Q Reg. O OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conoraction Tux:
Administrative Fee:
0
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
IPLLONGR
$111.02
Select a Non -Residential
Building or Structure
G
0
Truvel Documentation Fees:
Strong Motion Fee.
IBSEISAECR
$14.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
1 $4,325.02
$626.00
TOTAL FEE:
1 $4,951.02
Revised: 07/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6382 COTTONWOOD CT
CONTRACTOR: PETER WANG
PERMIT NO: 13070179
OWNER'S NAME: SUJIT AND JOYITA ROY
100 CONCORD CIR
DATE ISSUED: 10/17/2013
OWNER'S PHONE: 4089731276
MOUNTAIN VIEW, CA 94040
PHONE NO: (650) 906-8788
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
ADDITION OF 800 S.F. TO ENLARGE (E) MASTERBD RM &
License Class Lic. #1 5?T_6�j -
CREATE (N) STUDYIDEN, LIVING RM, DINING AREA & 36
Contractor 0 Date
S.F. OF (N) PORCH AREA. REMODEL (E) MASTER BATH
I hereby affir that 1 am licensed under the provisions of Chapter 9
REV # I - WIDEN 3 WINDOW OPENINGS - ISSUED 4/28/14
(commencin 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: $140000
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: 36918012.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION'
I certify that I hav 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 FROM LAST CALLED 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining am inspection ove all new materials for
inspection.
/
❑ OWNER-BUILDER DECLARATION
Signature o want ate: /
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVER E 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 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
1 have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should 1 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 Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 3.L
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
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
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
11 1 Z-4
CUPERTINO
n NFW GONSTRUC
TON
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISI
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org
❑ ADDITION ❑ ALTERATION / TI N REVISION /DEFERRED ORIGINAL PERMIT 4 13 a 9 d I -�L 9
PROJECT ADDRESS
APN q — O/ 2
l
OWNERNAME>
PHONE-
f '(4-1AQ 0
E-MAIL L,ts L�- Cr'`C`-'
STREET ADDRESS
CITY, STATE, ZIP , FAX
COMPACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
174UT'ER ❑ OWNER -BUILDER ❑ ONT'ERAGEN-r ❑ COA'f'RACTOR ❑ COATRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME -
LICENSE NUMBER d
LICENSE 7YPE
BUS. LIC d
COM -PA NY NAME
E-MAIL
ff
AX
C ' c r
t
STREET ADDRESS
CITY, S ATE, ZIP
PHONE
ARCHITECr/ENGTNEER NAME LICENSE NUMBER
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE
CONSTR- TYPE
F 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: DETACH
ATTACH
F DWELLING UNITS:
OND UNIT ❑ }'ES
SECOND STORY ❑ YESDDED?
E]NO
ADDITION? E]No
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
VED B
TOTAL VALUATION:
PLANMNG APPL R ❑ NO PLANNING APPROVAL LETTER
EICHLER HOJME? ❑ N
By my signature below, I certify to each of the following: I am the property owner o Drize _ to act on grope ov\�ier's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify ;w- crura agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to e r the ve-identified property for inspection purposes.
Signature of Applicant/Agent: ^ � Date: 2-6 Lf
SUPPLEMENTAL INFORMATION REQUIRED
PLAN i=CKTYPi:
ROUTLNG SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
[' THE R
❑ 3U1 DING !'LAN
existing building(s). Demolition permit is required prior to issuance of building
GAIER -Col "I :
permit for new building.
d RI ,•
P! ,. I .. N h1,'%E,\
Bldgs: Provide a completed Hazardous Materials Disclosure
I_ n"':'D
_Commercial
form if any Hazardous Materials are being used as part of this project.
FiRi. D:rt,I..
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
\ A�'"`
SANl :!:x;�> \et,i sat;,trr
_.
-n11 Vi h!r\]3b` I, 1L HEALfE
BldgApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6382 COTTONWOOD CT
CONTRACTOR: PETER WANG
PERMIT NO: 13070179
OWNER'S NAME: SUJIT AND JOYITA ROY
100 CONCORD CFR
DATE ISSUED: 10/17/2013
OWNER'S PHONE: 4089731276
MOUNTAIN VIEW, CA 94040
PHONE NO: (650) 906-8788
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
ADDITION OF 800 SQFT TO ENLARGE (E) MASTERBD RM
License Class $ Lic. g �� 7
CREATE (N) STUDYIDEN, LIVING RM, DINING AREA & 36
K-100-119-
SQFT OF(N)PORCH AREA.REMODEL (E) MASTER BATH 60
Contractor Date
ovisions
REV # 2 - UPGRADE PANEL TO 200 AMP, SAME
I hereby affi m that I am licensed under the prf of Chapter 9
LOCATION. CHANGE ROOF -[NG MATERIAL FROM
(commencing with Section 7000) of Division 3 of the Business & Professions
ASPHALT SHINGLE TO LIGHTWEIGHT TILE - ISSUED
Code and that my license is in full force and effect.
,.
6/18/14
1 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: $140000
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: 36918012.00
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 DAY IT SUANCE 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 DAY M LAST 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
Date:
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.
RE -ROOFS:
Signature �� ?�' Date "" SL
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)
1, 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
1 hereby affirm tinder 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, 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25 nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued, 1 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, 1 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building 5)cupertino.org
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION / TI IM19tEVISION/ DEFERRED
ORIGINAL PERMIT # 7 G 0 1 :�,%
PROTECT ADDRESSc' , _ oPN
�y r✓���' ao 4 CrU La.tPE4/ /N �
d
OWN'ERN'AMEPHONE rrjQ- / ��s/���
su a 1� ka-r
E-MAIL SC45ij
STREET ADDRESS �• �d.
CITY, STATE, ZIP �(..iO�e% „�fV t-;4 .� f�;y
FAX
CONTACT NAME SU � % J �
PHONE Leo p. Cp.� % ���
J
E-MAIL S'U..1 / ( �•'`Y ,�y ({�{(C [) . Ltn./
STREET ADDRESS fs 2 cc i , o"ot cur) er
CITY, STATE, ZIP
FAX
� OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME -141 ...•
LICENSE NUMBER 0
LICENSE TYPE
BUS. LIC #
COMPANY NAME
c ��
E-MAIL
STREET ADDRESS , , h /� M� `P�
�/
CITY, STATE, ZIP %'� �frJ l � v
PHONE
J /
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC x
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Ke --J t OO A - AA ro
EXISTING USE
PROPOSED USE CONSTR. TYPE
I STORIES
USE
TYPE
OCC. SQ.FT.
VALUATION (S)
EXLSTG
NEW FLOOR
DE1`90
TOTAL
AREA
AREA
AREA
NET AREA
tb.
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECIUPORCH AREA
GARAGE AREA: DETACH
I] ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECOND STORY [:]YESBEING
ADDED? ❑NO
ADDITION? ONO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME?
.
By my signature below, I certify to each of the following: I am the property owner or autho an the pro 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 accu agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter th e-iid/e�ntified/property for inspection purposes.
Date:
Signature of Applicant/Agent:I'
SUPPLEMENTAL INFORMATION REQUIRED
PLM CHECK TYPE
ROUTING SLIP
❑ OVER -TAE -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 PLM REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q STANDARD
❑ PUBLICFVORKS
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 SENVER DISTRICT
submittal of Building Permit application.❑
1.1-1�.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
FEW FEE ESTIMATOR - BUILDING DIVISION
Elec. Plan Check 0.0 hrs $0.00
Elec. Permit Fee: IEPERMIT
P7
,1„�; Other Elec. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
1)istricL e1c). Thece feet are hnced an the nreliminary infnrmatinn availahle and are only an estimale. Contact the Dent for addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E ' 7.'1%/3)
ADDRESS: 6382 COTTONWOOD CT
DATE: 06/18/2014
REVIEWED BY: MELISSA
MISC ITEMS
APN: 369 18 012
BP#: 13070179
`VALUATION: Iso
`PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
REV # 2 - UPGRADE PANEL TO 200 AMP SAME LOCATION. CHANGE ROOFING MATERIAL
SCOPE
FROM ASPHALT SHINGLE TO LIGHTWEIGHT TILE -ISSUED 6/18/14
Elec. Plan Check 0.0 hrs $0.00
Elec. Permit Fee: IEPERMIT
P7
,1„�; Other Elec. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
1)istricL e1c). Thece feet are hnced an the nreliminary infnrmatinn availahle and are only an estimale. Contact the Dent for addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E ' 7.'1%/3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
1 hours Plan Check, Hourly
$139.00 ISTPLIJCK
Suppl. PC Fee: ) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
200 1 amps Electrical
$47.00 1aEt:EC2no Services
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. Q OT0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Construction TUU
Administrative Fee: IADMIN
$44.00
0
G
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
A
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldy, Stds Commission Fee: $0.00
SUBTOTALS:
$138.00
$186.00
TOTAL FEE:
1 $324.00
Revised: 04/01/2014
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: 3 h
PERMIT #
OWNER'S NAM
PHONE #
GENERAL CONTRAC OR:
BUSINESS LICENSE #
ADDRESS:
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 SUBCONT13,,ACTORS HAVE OBTAINED
BUSINESS LICENSE.
I am not using any subcontractors:
Signattje
Please check applicable subcontractdrrs and complete the following information:
A CITY OF CUPERTINO
9 --- / 7 -
Date
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
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date