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14020013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1118 HOLLYHEAD LN CONTRACTOR:JAHAN CONSTRUCTION PERMIT NO: 14020013 OWNER'S NAME: CHAUDHARY ANIL AND CHOUDHARY JYOTI P O BOX 2494 DATE ISSUED:06/02/2014 OWNER'S PHONE: 4082178291 MORGAN HILL,CA 95038 PHONE NO:(408)782-3102 8. LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] 773 SQ FT ADDITION TO INCLUDE(2) BEDROOM, FAMILY License Class_ Lia# 6 ZD / 0 ROOM, BATHROOM FRONT PORCH EXTENTION,PANEL Contractor to ! UPGRADE 200 AMP, I hereby affirm that I am licensed under the provisions of Chapter 9 REVISION#I-REDESIGN ROOF STRUCTURE BASED ON FIELD (commencing with Section 7000)of Division 3 of the Business&Professions CONDITIONS-ISSD OTC 8/13/2014 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 Compensation,as provided for by Section 3700 of the Labor Code,for the ,Performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000 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:36226028.00 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 F CULLED INSPECTION.Issued by: Date: 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. RE-ROOFS: Signature LAY�0 Date_ All roofs shall be inspected prior to any roofing material being installed. If a roof is ��ry 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(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 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: '' permit is issued. 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,I 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. w'ork's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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. Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1118 HOLLYHEAD LN CONTRACTOR:JAHAN CONSTRUCTION PERMIT NO: 14020013 OWNER'S NAME: CHAUDHARY ANIL AND CHOUDHARY JYOTI P O BOX 2494 DATE ISSUED:06/02/2014 OWNER'S PHONE: 4082178291 MORGAN HILL,CA 95038 PHONE NO:(408)782-3102 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ 773 SQ FT ADDITION TO INCLUDE(2) BEDROOM,FAMILY License Class —V,;sP_l Lic.# ��Zt)1510 ROOM,BATHROOM FRONT PORCH EXTENTION,PANEL Contractor_ nE,�c,•�. Date UPGRADE 200 AMP, 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$150000 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:36226028.00 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 I8�DAY SSUANCE 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 OM L D INSPECTION, indemnify and keep harmless the City of Cupertino against liabilities,judgment costs,and expenses which may accrue against said City in consequence oft e granting of this permit. Additionally,the applicant understands and will comp y Issued by: Date: 6 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ,� / RE-ROOFS: Signatureyti , �� Date AI I roofs shal I 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(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 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 25505,25533,and 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,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 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 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 1118 hollyhead In DATE: REVIEWED BY: APN: BP#: 'VALUATION: $150,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No PE TA SFD or Duplex OTC? ®Yes 1 R3SFDADD USE: �No PERMIT TYPE: WORK 773 s ft addition to include 2 bedroom family room bathroom front porch extention anel u rade SCOPE 200 amp, OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 773 $2,577..00 IR3PLNCK $1,617.00 IR3INSP TOTALS: 773 $2,577.00 $1,617.00 MECH,HOURLY Q Yes 0 No PLUMB,HOURLY 0 Yes E) No ELEC,HOURLY 0 Yes Q No Elec. Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT F-1 F-1Other 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 District,etc . These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 1_jf' 7.%1%13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 200 amps Electrical Suppl. PC Fee: (j) Reg. Q OTT-0.01 hrs $0.00 $47.00 IBELEC200 Services PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 0 Work Without Permit? © Yes (j) No $0.00 Advanced Planning.Fee: IPLLONGR $108.22 Select a Non-Residential Travel Documentation Fee: ITPA VDOC $47.00 Building or Structure i Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $4,417.22 $47.00 TOTAL FEE: 1 $4,464.22 Revised: 01/15/2014