13100043 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21053 CHRISTENSEN DR CONTRACTOR:SOUGOUMARANE PERMIT NO: 13100043
SHANMUGANANDAM AND SUG
OWNER'S NAME: SOUGOUMARANE SHANMUGANANDAM AND SUG 21053 CHRISTENSEN DR DATE ISSUED: 10/04/2013
OWNER'S PHONE: 4089730346 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
BATHROOM REMODEL,38 SQ FT OBTAIN PERMIT FOR
License Class Lic.# UNPERMITTED WORK BEING DONE ADD SHOWER TO(E)
BATHROOM M,E,P'S
Contractor Date REV#2-REVISE LAYOUT OF 2ND BATHROOM REMODEL&ENLARGE
I hereby affirm that I am licensed under the provisions of Chapter 9 OPENING TO CLOSET,REPLACING(E)HEADER-ISSUED 3/18/14
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
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:32654004 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 P 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 DAYS F ST SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issu y. te:
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 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
I,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,Sectio 12 05,2553 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.
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
918.
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 aacupertino.org
CUPERTINO
❑NEW CONSTRUCTION
//� [:1ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# 131000 y
PR07ECT ADDRESS / /� / 3 C h SQs',eMo APN# 13 � 'D ('�
OWNER NAMES C( y M VV(0.0
� wa n d q n, S,9a y 1 n1& HONE 73 CS Cj� E-MAIL v
2 BEET ADDRESS :4'?'"
S � dr /, �j ko QS-01
CONTACT CITY, ATE,ZIP / q�0//- FAX
COINAME PHONE
l.G(�� PH(/O(NtEi( E-MAIL
STRE/Jlil vDl'S S P/l/1 Q'//, CITY, ZIP FAX
% ''x-17 tic `/ �C�
AX
❑OWNER X,OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,t �STATE,ZIP PHONE
DESCRIPTION OF WORK Q L
P/r1tic�OLP D ✓2 GD 1i► i' Y � �' T'�°� vY�-v� � GI vc�c9.�+ ��3S
EXISTING USE PROPOSED USE CONSTK TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
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
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY E]YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YE TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPRO AL LETTER EICHLER HOME? ❑-_ �� ,� "' :
By my signature below,I certify to e4ilding
wing: I am the property owner or authorized agent to on the owner's behalf. I have read this
application and the information I havorrect. I have read the Description of Work and verify I Is accurate. I agree to comply with all applicable local
ordinances and state laws relating to orize representatives of Cupertino to enter the above-dentified roperty for inspection purposes.
Signature of Applicant/Agent: Date:
d'12 01 (7
SUPPLEMENTAL TION REQUIRED PLAPI cHECK'TYPE ,'= ROUTING"SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for �❑ "O,'ER THE-COUNTER`- W ❑ Buu Dlxc PLAN REyIEw x
existing building(s). Demolition permit is required prior to issuance of building t �
�3;.a'�`&1-,r L , {ai
permit for new building. L7 .EXPREss' t �, ❑ PLANNING PLAN R�vrEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure-
form
isclosure form if any Hazardous Materials are being used as part of this project. ;
LARGE F ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
�a MpiJOR,� x ❑ SANITARY SEWERDISTRICT� �t
submittal of Building Permit application.
"� ❑;�ENVIRONMEIVTALIIEALTH" r�
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21053 Christensen dr DATE: 03/18/2014 REVIEWED BY: melissa
APN: 326 54 004 BP#: 13100043 VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex I PERMIT TYPE:
WORK REV#2 - REVISE LAYOUT OF 2ND BATHROOM REMODEL & ENLARGE OPENING TO CLOSET
SCOPE REPLACING (E) HEADER- ISSUED 3/18/14
z l'Jufi;l>. 1'Irrrt C`hc:<'r
C}rttEs il��c1a. rf;� Oijwr Plumb Asp. C3t`ra-t�/lrc.Ins�p.
fk=cr, rrf.;u. J'ce,: 11h1nz1 lisp.
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 prelimina information available and are only an estimate. Contact the Dept/or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes 1G) No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: (E) Reg. 0 OT 0.0 $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes (E)No $0.00
Supp/. Insp. Fee: Reg. Q OT 0,0 I hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
("'onstrurnon F71 —
C)
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
xrj-„�c,l/if�r;';;,2��t'tZtxtt€>rs l°<rc's': �
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.00 $139.00 ISTINSP Inspection,Hourly
.T $0.00 $278.00 TOTAL FEE: $278.00
Revised: 01/15/2014
O ` 4 e`er
01
Existing
window
4Vx ZY'
I tt/'3
..m Closet
Fan
Ceiling Lights
New header
rDoor2T 4"x10"x3'
Pocket door 2'T
New header 4"x10'x8'
on new 4"x4"posts J
4'k 4"D.F. 4"x 4" D.F.
COM
Proposed bathroom project: �pR 'UD�i'��
RE�� ea eyVA ki
Residence:Shanmuganandam Sougournarargev�e�
Phone:408 973 0346
Address:21053 Christensen Dr. Cupertino.CA 95014FFIC
�EI v ED
Scope of work:Remodel and reconfigure existing master bathroom 123 sq.ft. MAR 1 82014