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12080263CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10960 SANTA TERESA DR CONTRACTOR: MOHAN RAM P AND PERMIT NO: 12080263 SHEILA OWNER'S NAME: MOHAN RAMP AND SHEILA 10960 SANTA TERESA DR DATE ISSUED: 08272012 OWNER'S PIIONE: 4082554431 CUPERT'INO, CA 950144768 PHONENO: ❑ LICENSED CONI'RACI'OR'S DECLARATION (- r_. C BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. b [ M DIEC11 RESIDENTIAL COMMERCIAL Contractor Dale I hereby affrm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RITCIIEN RCMODEL (120 SQFF) (commencing with Section 7000) of Division 3 of the Business d Professions Code and that my license is in full force and effect. 1 hereby affirm under penally 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 performance of the work for which this permit is issued. Sq. Ft Floor-Area: Valuation: $30000 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 AI;N Number: 35613003.00 Occupancy Type: permit is issued APPLICANTCF.RTI FIC TION I certify that I have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmRss the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: ��i�/✓ Z4G� Date: Of 9.18. Signature Date RE- ROOFS: ❑ (OWNER - BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If roof is installed without first obtaining an inspection, 1 agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I, as owncr of the property, or my employees with wages as their sole compensation. Signature of Applimnt: Date: will do the work, and the strucmrc is not intended or offered for sale (Scc.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to ALI, ROOF COVERINGS TO BE CLASS "A" OR REITER construct the project (Sec.7044, Business R Professions Code). hereby affirm under penalty of perjury one of the following three BAZARDOUS MATE.RIA I S DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self- insure for Worker's California health S Safety Code, Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the health S performance of the work for which [his permit is issued Safety Code, Section 25532(a) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ileallh .f Safely Code. Sections 25505, 25533. and 25534. 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 Ow r nr ewh rized Compensation laws of California. If, after making this certificate of exemption, I /V -- Date: become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRIIC`fION LENDING AGENCV I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that 1 have read this application and state that the above information is Lender's Name correct. I agree to comply with all city mid county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Leader's Address 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 ,\RCII I'I'ECI "S DECLARATION granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records, with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �, -71 ' Date License) professional Signature 1GUPERTINO I 1 \ILlll !`/+11CTD11r`TI(1AI CONSTRUCTION PERMIT APPLICATION 1� =uz�3 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingGncupertino.org �-I r I AnMTTInM e1 TrU ATIr1M /Tt I I RRViCirtM /r1FFFRRFII rwir.MIAt. PPPMITH PROJECT ADDRESS 1060 e_j\ F_ S-%' A P" /?— �vE OWNER NAME G L� �^ D' 1 PHONE Y 'C ,Vt� Fr���1f�ITY, -MAIL- &b kiruVtV 616 STREET D%RESS STATE, ZIP FAX D 6 Sanl� N �GIZC LiG1�E� r. NO CONTACT NAME ' n_ '^^ U PHONE g _ S, Q E -MAIL TTY's' YPli STREET ADDRESS S+AM(/G u� C1TY, STATE, ZIP FAX �ON'NER (3 OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSETYPE I BUS. LIC A G n/'rL ✓i r ti COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME _ / /V LICENSE NUMBER BUS. LIC N COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTMO USE PROPOSED USE CONSTR.TYPE TORIES 15 USE TYPE OCC. SQ.FT. VALUATION (S) ` ��./ EXLSTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA - �V r V5_ 2 / '7� 3U e) DO G C / v BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA //0 REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH ❑ ATTACH 9 DWELLING UNITS: ISASECON'D UNIT ❑YES BELNG ADDED ?JO SECONDSTORY [YES ADDITION? 10AO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPLI 0Y10 PLANNING APPROVAL LETTER ISTIIEBLDGAN ❑5 EICHLERHOUE? �.v�03 RECEIVED Y y, I�P.T' �r u A t + 4-' TOTAL VALUATION: By my signature below, I cenify to each of the folio% ing: I am the property 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 read the Description of Work and verify it is accurate. agree to comply with all applicable local ordinances and state laws relating to buil co�nsiru�c[ion. 1 auth/jorize.«�jprese�ntatt. Its of Cupertino to enter the ti5ed openy for inspection purposes. /ng 1above-yid > + /�'�` ° �"' T V y7 Signature of Applicant/Agent: /1/-- (/VLH� i —' Date: SUPPLEMENTAL INFORMATION REQUIRED •'i•L1 N exT'.ci:r�vP ;�„ - '�"• RourTS•c si.i'r'� r New SFD or Multifamily dwellings: Apply for demolition permit for existing buildine(s). Demolition permit is required prior to issuance of building w`- 'r' -�tq ,x`t•<'��'`� O \TSR'THI COU \TF,R J � Ll+ 1. 'K y +: '� � t= yw•' "�'�i`!,'r"sp •- °.J{- HUILDI\G.PLAT RE \IE \TR -N /� permit for new building. © I u xs �vf I y W;;, `..K ✓`t Y 4 . rNINC T' �E+IeWF„o _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -t` ©}�srA \unRn}�'„, r;' ,., 15' ' iaT.' � ioxlsy i°S *3s3 'r>t' form if any Hazardous Materials are being used as part of this project. . `+�i ❑�P�11 \ CF'�`PL4t IY } A 'a a�""``vy„ i �hFIREDErr °.r- SEE� _ Coy of Planning Approval Letter or Meeting with Plannin g P rior to submittal of Building Permit application. �+ " + °rE`.�t''s '}�s t "I ❑' ©- -t"l 1 °e .'a'4 Ir �AgiRy.�YYs S W o 1M'rtel c" r �t'" 'r �s � 1vF1 2 ©E NO h E LII BldgApp_2011.doc revised 06111111 � CITY OF CUPERTINO I "I FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). There fees are based on the nrelintinare information available and ari onli, an estimate. Contact lite Devi for addn7 info. FEE ITEMS (Fee Resolution 11 -053 F_ff 711111) ADDRESS: 10960 Santa Teresa Dr DATE: 08/27/2012 REVIEWED BY: Sean Alech. Permit. Fee: APN: BP #: 'VALUATION: $30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIRIARY SFD or Duplex USE: Eler. Gap. Fee: PENTAMATION 1R3SFDREM PERMIT TYPE: WORK Kitchen_Remodel 120 sq ft). SCOPE $0.00 NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). There fees are based on the nrelintinare information available and ari onli, an estimate. Contact lite Devi for addn7 info. FEE ITEMS (Fee Resolution 11 -053 F_ff 711111) Alech. Plan Check Plumb. Plan Check F.lec. Plan Check Alech. Permit. Fee: Plumb. Permit Fee: lilec. Permit Fee: Other• Afech.. lay. Other Plumb /nsp. Li I Oder Elce. In Ale.ch. hap. Fee: Plumb, bap. Fee: Eler. Gap. Fee: NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). There fees are based on the nrelintinare information available and ari onli, an estimate. Contact lite Devi for addn7 info. FEE ITEMS (Fee Resolution 11 -053 F_ff 711111) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 120 s.f. $600.00 Remodel, Kitchen (< =300 sf) IREAfRESKIT Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 0,0 his $0.00 PME.Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tiix Administrative Fee: Q E) Work Without Permit? Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non- Residential Building or Structure E) 0 A Travel Documentation Fees: Shona Motion Fee: IBSEISAHCR $3.00 - Select an Administrative Item Blde Stds Commission Fee: IBCBSC $2.00. SUBTOTALS: 1 $5.001 $600.001 TOTAL FEE: $605.00 Revised: 07/01/2012 y -- . CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - buildlna L(7, cu Denlno.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITEADDRESS ogbo SAiv r� tGar VV4 rC, APN BP# OWNER NAME' k C i/p „^ U/ '`'WAG OWNER ADDRESS n 1 DESCRIPTION OF WORK: li t C/VZ- We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) ,40_ 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. A` _2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. JAJ\-- 3. 1 understand as an "Owner - Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her / name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be o econnsidered an "employer" under state and federal law. 11! 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." 1 also understand my failure to abide by these laws may subject me to serious financial risk. J-Ar-t" 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, 1 may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc remised 04114110 4.t9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. 4& 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the Information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the p rmit is issued to verify the property owner's sin 9 ture. Property Owner's Signature:X Date: I - ---------- --- -- -- ----- -- - --- -- --- ------- ------ --- ------- - ---------------------- ------- ne-r-------------------------g------ (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderFornt 1010.doc revised 04114110 -C'u o'E= kr��u� AUG 217 2012 BYo- — -------------------------- ----------- ------ -`--------- -- - --- -- - I i . 61 N4 30 1 35,a I _ 1 7�� I I N' :.0 nr�t %c /s'•`' F` °v t,'��t "G'yiL /,y tip � I Yia}n 4w aYi�?�5ijjl ' i t '< 74000M AUNITY DEVELOPMENT DEPAI WENT ' o - WILDING gNISION L CUPS ] JO 0): N APPROVED ce) .. — N c _' rn Th s set of p ans and specifications MUS F be kv. at the ' V t .:..5g construction. It is unlawi /I to maKe pey ':4 � changes or alterations onisame, or o deviate X therefrom, without ah Koval from the BI II it 3 ' I The ping c th a plan .no ;pecifigatir ns : HP -L .3T _ ',a • ^'. to per._" or to b� • pH; royal c f the vk lati - Nany prr00% sion: r f any �ORy I)rd, ealFbe or ;tat 1 , •'In -DATE N PERMIT NO. LO CA LL r' .-la it M r I I I L w (s. ErICE ' f r \� \ \/rs /� y - .tom SCOPE OF WORK: KITCHEN REMODEL (120 SQ FT) Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010 Residential (2009 IRC), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC) and Energy Codes (2008 Building Energy Efficiency Standards) Energy code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (150(k)(8)) Plumbing plan notes: 3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 2.2 gallons per minute. (CPC 402.1.2) Electrical Plan Notes: 4. The installation of smoke alarms in all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 5. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 6. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 7. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built -in refrigerators or freezers, furnaces, AC units, built -in heaters or any other fixed appliance with a motor of Y< h.p. or larger shall be on a separate 20 amp. branch circuit. 8. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8) 9. In all areas specified in 210.52, all 125 -volt, 15- and 20- ampere receptacles shall be listed tamper- resistant receptacles. (CEC 406.11)