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12090033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10109 MELLO PL COYTRACTOR:STEVEN WINKLEPLECK PERMITNO: 12090033 OWNER'S NAME: NARAYANAN NARIIIANAN S AND SUJATIIA V 1299 WHITE DR DATE ISSUED:09/05/2012 OWNFR'S PHONE: 4087812317 SANT'.\CLARA,CA 950.51 PHONE NO:(408)476-8141 LICENSED CONTRACTOR'S DECLARATION r r rt p _c� -/� BUILDING PERMIT INFO: BLDG — ELECT PLUMB " License Class Lic.q /� f 2.2— q MECH (-. RESIDENTIAL 1_7 COMMERCIAL r Contmctor Date (—semi 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL TWO BATHROOMS 110 SQFT(MASTER&HALL (commencing with Section 7000)of Division 3 of the Business&Professions BATHS) Code and that my license is in full force and effect. I hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a cenificate 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 Sq.Ft Floor Area: Voluation:58500 Section 3700 of the Labor Code,for the performance of die work for which this permit is issued. APNNumber:36905031.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct.1 agree to comply with all city and county ordinances and state Imus relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments. WITHIN 180 D SYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City inconsequence of the 180 DAYS F LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulatims per the Cupertino Municipal Code,Section _ < �� )/J 9.18. Issued by: J / (/ Dale: Signature Date ❑ OWNFR-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any rooting material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining on inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: DA-ZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the[health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(0)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,SecyL25505.25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,alter making this certificate of exemption,1 Ow wrneuthoriz d ageml become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ,\PPI,ICANI'CER't'IFIC.VI'ION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may acerae against said City in consequence of the ,\RCI[ITECT'S DECLARATION of this permit.Additionally,the applicant understands and will comply vith all non-point source regulations per the Cupertino Municipal Code,Section 1 understood my plans shall be used as public records. .18. Licensed Professional 'ignature Date j201i c>L--)3---�> CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX (408) 777-3333 • buildinaCG),cuoertino.oro ❑NEW CONSTRUCTION ❑ ADDITION ,ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4 PROJECT ADDRESS a �w _ APNk 2 ] Q - o <> �� OWNER NAME .1 ^ ,.J 1 P'-IQ-Lo n PHONE('u_)\7r)_-?r)_ ` E-ISI IL I1/�4' My I"�aJ I_• LP.�'S. STREETADDRESS H.JYI-\0 CI tj('-.tSZ�O �i dL� CITY, STATE,ZIP ) FAX �-v�P��T rro/c�+-.9Jvr CONTACT NAMEC. n ,l (�F PHONE/.1 /��^ 1, r EMAIL 124W q,-y?,(130 STREET ADDRESS���, /,9 I(^J t �n CITY,STATE ZIP /S41J- l�� 6+ �< FAX •4''d Y_ N6 11 OWNER ❑ OWNER-BUB.DER 11 OWNER AGENT CONIRACrOR ❑CONTMCTORAGENT ❑-ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME�J��� ) 11�/�(cnI „� LICEISENUMBER O (lr^,1� LICENSE TYPE BUS.LIG �2 COMPANY NAM r = G,y 1IC�w�(�f-tJ -�/.'tom, t� EMAIL �/ L j iq��� ,�•e. FAX STREET ADDRESS/.?-J J -F/_/ I 'b2- CITY,STATE.Zi?. „„ �� �t p SbS PHONE 0�tq >� ENn� ARCHITECT/ GINEER'NAME LICENSE NUMBER t7rN,7P yS” / BUS.LICA rI l COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK _ 2en.(oaC2 V` S-TkQ- /13AT4 ,+Li._ 88:1-14 EXISTING USE PROPOSED USE CONSTR.TYPE I ftSTOR1E5 USE TYPE OCC. SQ.FT. VALUATION(s) EXISTG NEW FLOOR DEMO, ^ TOTAL AREA ' AREA J AREA I I U SS•F� NET AREA BATHROOM MCHEN OTHER REMODEL.AREA //( REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTALDECKIPORCHAREA GARAGEAREA: [ DETACH ❑ATTACH N DWELLING UMTS'. ISASECONDUNIT ❑YEs SECONDS1'ORY OYES IBELVG ADDED? /g]NO I ADDITION? 0 PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTIIEDLDGAN El YES 6RECEIVED D} °�"' i'i'3 tf�`. TfTAL VALUATION: PLANNINGAPPLY []NO PLAM:DIG APPROVAL LETTERF,ICIILER HOME? 'gro 2 $*L 1?t ..a n�•4�h1J; O i J c�� By my signature below,1 certify to each of the following: 1 am the 6perty owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 have provided is correct. I have reed the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to bbuuu I construction. 1 authorise representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicandAgene ISL/ Date. 7 — 5-- /o/2— SUPPLEMENTAL BN'FORI IATION REQUIRED L=7..1 is n ?i _New SFD or Multifamily dwellings: Apply for demolition permit for F* o` Cr r –'V=wj X1 7Fs' Fn�•'-�s! •�rY– �'b` '� ❑'tO\ER::ru EGCOUN-ITR t y�\FBUILDINC r1 41 R1\IFRA` existing building(s). Demolition permit is required prior to issuance of building `1 U c T� a'� .Ky rr`q permit for new building. ❑�'�}ruessZ`f'1.�t '/a `+ ❑ 1 LA's c I uv Re\t`ewyq ” _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑Kst Au`ucoli `' » �I`t uiluc\\o I's form if any Hazardous Materials are being used as part of this project. j- rt \� -' "� - tom.., a'' �6 g}J ?:-4i:}'' Hrvace � _Copy of Planning Approval tetter or Meeting with Planning prior to Qnio7nJs submittal of Building Permit application. ©FsA nA RYs�ee eR`DISTRA 7_;.JYL En'\VIRO,YNIEN'TACHFALTH L B/dgApp_2011.doc revised 06/11/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10109 Mello PI. DATE: 09/05/2012 REVIEWED BY: gs APN: BP#: 'VALUATION: $8,500 *PERM1IIT TYPE: Minor Building Permit PLAN C11ECK TYPE: Remodel, Bath (300 s.f. max) PRIMARY Residential PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK Remodel 2 bathrooms SCOPE FEE ID FLR AREA s.f. 1REMRESBAT 1 Neck Plan Check Plumb. Plan Check Flec.Plan Check ,Meeh. Permit Fee: Plomh.Permit Fec: Elec. Permit Fre: Other Mech. Insp. Other Plumb Insp. Oilier Cler. Imp. Meech.Insp.Fee: Plumb. tosp. Fee: Elec.bup.Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning Public IVorks, Fire,Sanitay Sewer District,School District,etc). These fees are based on the preliminail information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-059 E2711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PC Fee Plunth.J,ble ch.X1ec Permit Fee: $600.00 suppl. lnsp Fee Pbmtb./A•lech.1Elec Plumb.1,11ech.lElec Pe'nit Fee: Construction Ta Administrative Fee: Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fees: A Strong Motion Fee: IBSEISAIICR $0.85 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $601.85 $0.00 TOTAL FEE: $601.85 Revised: 07/01/2012 / 7 ° _ ; / J } E 0 � /}\\ 0. �Q § }l ƒ /\ k > j\ ` : ; 0v ° , `9 \ $/ ) }K} ƒ /� ( 2 {k -00 9} ) cgvIJ � � � \ / () - 00k 0 22 ` ^ 6 } /} �o/ �M \ (( 'W G _ - C0 . \ ] \ � � � @/ mo . ;] L {\\/ 3 2r-M ' ) K R q , K � 2 U mo ( / /\ 7 \ ! § §� /$ »; }§ \ \\� }� { \ 00 zm J ! 1e § m \ § m / f2 � . . 0 /; z 8 w m m j -0 D/ T 2868 T n m m 9 � O N m b m o � o A I 0 g 1 b r( 0.� U .} 5 '�. 5'-0-- —7.8' .�. 17-2-�. I 25•-6' m m A O A A m ;m; D t�rN m ama �m D �> 2 2� c� n o z D �T zmg O0 m�� DS mr i Or> m m0 <m j0 N nm0Z a V Ta�- m mr �A ' = e O zm AA A nNin� D ;on iA -m >O tO G A N A m s cn w ( \ § ƒ 4 24 68m § 80��- _ \— � \ 0 - ! 0 � !� § § ) - --—— % & \ 'EXTE } RIOR 23 § ! §\; ) §§ | §\ § \( §! �\§ M-0 § !§ t ! ! !§!; ») \) ) ( ) § § ! )| | !§ § t z§) \) ) ) 0. \ )k §| , ° > * y. §5 § \m# m 00% (). e! e �I « - Ri ® 2°, e ; :m / $ ©R g §)[) S 27 f{ ) ],! �d / / Building.Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 L U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: p p /VI U P PERMIT# DD OWNER'S NAME: A ( N ,¢.J PFIONE # m -4-7t,- a1/ GENERAL CONTRACTOR: (��,� Z�'L BUSINESS LICENSE# ADDRESS: (21k/6- I CITY/ZIPCODE: iSv *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 SUBCONTRA ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSFs. I am not using any subcontractors: s — Signature Date Please check applicable subcontractors and complete the following information: 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