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15020024Z CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR: UNIK HOMES INC PERMIT NO: 15020024 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARA.I SUSHM 15185 ALONDRA LN DATE ISSUED: 04/09/2015 OWN S PHONE: 3108490146 SARATOGA, CA 95070 PHONE NO: (650) 240-8483 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL License Class ass4 1 q 33-7 4 CONSTRUCT TWO STORY RESIDENCE (1ST FLOOR -2270 SQFT) AND (2ND FLOOR -1667 SQ FT); ATTACHED — GARAGE (689 SQ FT); PORCH AREA (426 SQ FT). Contractor Date :5-Zp I hereby affi m that I am licensed under the provisions of Chapter 9 DEF #1 - TRUSS CALCULATIONS - ISSUED 5/20/15 (comtnenci 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: $550000 pe formance of the work for which this permit is issued. 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: 32608028.00 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 O)F-DERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon die above mentioned property for inspection purposes. (We) agree to save 180 DAY 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 ,tomb—clbcs-- Date: J granting of this permit. Additionally, the applicant understands and will comp) Y with all non -point source reg# tions per the Cupertino Municipal Code, 9 18. _ 2� 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, 1 agree to remove all new materials for inspection. ❑ NER-BUILDER DECLARATION Signature of Applicant: Date: 1 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) 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 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 Mun' ipal 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,/Ind 2553 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 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 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. 1 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 CL1RTINO NEW CONSTRUC' CION CONSTRUCTION PERMIT APPLIGAiF4 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)cupertino.org ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # J'50,2 00 s �� PROJECf ADDRESS/1} .Q/—� APN � OWNER NAME f , "-�I �' `� PHONE E-MAIL STREET ADDRESS /' '� CITY, STATE, ZIP FAX CONTACT NAME � _ PHO E C. E-MAIL p u 1 STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME, �. �` LICENSE NUMBERC CI/ LLcENSETYPE BUS. LIC k COMPANY NAME��. !' _M f ( 6 FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # 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 i TOTAL DECK/PORCH ARE GARAGE AREA: DETACH []ATTACH I K DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? No ADDITION? []NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF PLANNINGAPPL'O IS THE BLDG AN YES rf S<.'(nAilti31�,f i#�,y TOTAL A ION: [:)NO PLANNING APPROVAL LETTER EICHLER HOME? []NOR);ECEIVE ' r �- By my signature below, I certify to each of the following: I m the -property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provide ave red the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to nbt+ gtion. authorize represent sof Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO TION REQUIRED l�for demolition permit for New SFD or Multifamily dwellings: Apply existing building(s). Demolition permit is required prior to issuance ofbuilding e%,i` i „a 5a .1t ti 4{ i -a tit 3dw xeraM� y# r°} Iry OYER THI COUNTER ern rF 4dp,ds. Iltv+,A t It 1a ry4+� ; ty BUII.DING PLAN REVIEW permit for new gbuildin .❑ EXPRESSv w P xi a rS�. �PLANN f Commercial Bldgs: Provide a completed Hazardous Materials Disclosure `� ❑ EUBLICzWORK$�ca ('�i4 ��S form if any Hazardous Materials are being used as part of this project. a � i'�`eJl It 1 ;C.b�l A 4J''.iajd?�7i4,'�I ?�' �4 SLSy� iS t5 ',.�X1 S t r�y� 1;ARCy'>E�.m� �,,:ng'°+'�yA,.,�°k�y��jy'x���� ❑ v�IRE�,AEPx li ri M Wo- YA6*1 p`+t '' � ax ! _ Copy of Planning Approval Letter or Meeting with Planning prior to i'1,ye'�'if� ` submittal ofBui[dingPermi[application. C1�aMnabRiatiIf;�OgSA1VITARYSEwERDISTRrCT l' t�`$�w ilKMRrn� lri ��r„ENVIRONMENT.AI.HEALTI3tr ;'d . J•r,+3,? ,"ti2 «?.;:":. nt �._::' BldgApp_201 1. doc revised 06/21/11 J fn -i CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 10585 Flora Vista Ave DATE: 04/17/2015 REVIEWED BY: Sean !'iru„h. l'tcu7 C'hY;ck APN: BP#: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: f:7t1'ts,• h3ec.. /,is o.LJ L PENTAMATION 1 GENRES PERMIT TYPE: A WORK Deferred Submittal #1: Truss calculations. SCOPE Suppl. Insp. Fee:Q Reg. Q OT 2 i'• I11 5p L If�pP4'4l l( 4�{y"�1�. �p1'll il£ .+ks'41,''Z is 1�1 }F{Yf y4Y{ $ _ X41 �1}k ':,> 1 f•'y Y�ly�n�4 'IF ISl 1 �� 5 4' ,�y,,1 �,N4 N.( i .'1�lh+ll kF :�1 4uYR 1F 1 ✓ �['`i III -r 4 fl 1 �f alec:l7. 1'IY:rr� (:'Ytc�c.'k !'iru„h. l'tcu7 C'hY;ck Ktez'..l'h;.Yr7 C::hc�ck _llech. Pc>rnrit hc7�: F'7anr771. Pcrrr7;it i�;�e: I•;h-:c. Y��,�rni7 T'e�r C)finv' '� lCc•17. h7sp r;hh• P wilb 111sp. f:7t1'ts,• h3ec.. /,is o.LJ L f>ir'ciz. 1;Isp. !'r .. /'/7111111. ITIS/). I''C : /:lea.. It7s1:I. / 'e NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 U 7.2113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Deferred Submittal $286.00 IDEFSUBM Supp/. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.:r�rtst,'uctizx-i T�r.l: :Qc�l111Y1(Sl'/'c71rCd 1'l?c`:': O Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 i Travel Doc `✓r.,o<7aalion ,''c><s: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 9 �{11 G 7 1� ��..I 4' A 1 �b k • Y l J Sr' UBIUTALS 1 ` $0.00 1Y � 1 Ft �1 a GIF rC} Y �„ $286.00 $286.00 Revised: 04/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR: UNIK HOMES INC PERMIT NO: 15020024 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARA.I SUSHM 15185 ALONDRA LN DATE ISSUED: 04/09/2015 OW ER'S PHONE: 3108490146 SARATOGA, CA 95070 PHONE NO: (650) 240-8483 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] License Class_ Lic.4 OJ J� 7 CONSTRUCT TWO STORY RESIDENCE (1ST FLOOR -2270 SQ FT) AND (2ND FLOOR -1667 SQ FT); ATTACHED GARAGE Contractor._ 9 ^i 6 NES Date 6�_ (689 SQ FT); PORCH AREA (426 SQ FT). 1 hereby affirm that I am licensed tinder 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. 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 Sq. Ft Floor Area: Valuation: $550000 of the work for which this permit is issued. Performance ave 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 permit is issued. APN Number: 32608028.00 Occupancy Type: 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 to building construction, and hereby authorize representatives ofthis city to enter WITHIN 180 DA RMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F M 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. Addition lly, the applicant understands and will comply Issued by: Date: with all non -point source regula ns 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: 1 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). 1 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 Cupertit Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code,=?^^� ��� 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 Califomia. 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 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. l 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 CUPERTINO n NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION i COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION n6 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buifding(c Cupertino.org �v ❑ ADDITION ❑ ALTERATION /TI ❑ REVISION/ DEFERRED C`RIGINAL PERMIT k PROJECT ADDRESS I DSFj I5 r V'il`.A V l s A AJ E P U,G ! 6o f' APN # :�' IQ _073 - OL,(J l OWNERNAME GOP[rW(YA,5WA"f PHONE . c � E-MAIL 90F —0me-. C^,n STREET ADDRESS CITY, STATE, ZIP FAY CONTACT NAME CHP -IS VVIM" ; ff p PHONEft �v50 � 3�ti E-MAIL �r IS � C —0 -0 E-MAIL -%,5 , v I STREET ADDRESS ^ 0t3l AA t� CITY, STATE, ZIP FF G 1 i{v ven � e, MPS ❑ OWNER ❑ 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 GINEER NAME 4C4-I'R�j fitly 1p LICENSE NUMBER BUS. LIC # COMPANY NAME C11 A A1 �,n�G I`)1 wri E-MAIL GI _ r `SQ a��-`�p ►c�. FAX STREET ADDRESS 2a Q 9 tj AV `, ,(Yjr V renuc, (J CITY, STATE, ZIP PHONE �� O n L. DESCRIPTION OF WORK tiEW LSOR (DENS kjtT" �a`1`r EXISTING USEPROPOSED USE CONSTR. J TYPE �f191- # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EK1STG NEW FLOOR DEbIO + t-1-7 TOTAL (} AREA AREA IAuP (KITCHEN AREA ± IOC NET AREA <I� I �J'i yl,,�,�n • -/ v'K `J/0 G BATHROOM OTHER REMODEL AREA REMODEL AREA REMODEL AREA n qfwe, PORCH REA ^�A- DECK AREA TOTAL1 DECKIPORCH AREA GARAGE AREA: DETACH ATTACH � tl P1(v_ '. '-1 J-l� /A•LY.`C �(/`� '. # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDS YES / BEING ADDED? ONO ADDITION? []NO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME? NO jtECj;j ' TOTAL VAL An. r t 12D A I -o „ By my signature below, I certify toe fmf the following- the property owner or authorized agent t et o e property owner's behalf. I have read this application and the information I h e prowl ed is co pct.e read the Description of Work and verify it is accurate. I agree to comply with all applicable local 7-t ordinances and state laws relating buildingvon ction.honze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:y SUPPLEMEN IN ION REQUIRED ;PLAN CHECK TYPE s, r „�'� ROUTING SLIP . ;, _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER BUILDING PLAN REVIEW' permit for new building. EXPRE PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS:: Form if any Hazardous Materials are being used as part of this project. LARGE FIRE, PFJ'_— _Copy of Planning Approval Letter or Meeting with Planning prior to , ❑ submittal of Building Permit application. MAJOR /ARY SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 061'2I/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: 10585 flora visat ave DATE: 02/04/2015 REVIEWED BY: Mendez IlaADDRESS: APN: BP#: %d D -VALUATION: 1$550,000 PERMIT TYPE: Building Permit PLAN CHECK TYP : New Construction PRIMARY SFD or Duplex USE: 2nd Unit? '> Yes No PENTAMATION 1R3SFDW PERMIT TYPE: WORK construct 2 story sfdwl 1 st floor 2270 2nd floor 1667 attached garage 689 porch area 426 sq ft SCOPE Suppl. Insp. Fee:Q Reg. Q OT0.0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 5,052 $3,358.03 IR3PLNCK $4,159.23 IR3INSP Permit Fee: $4,159.23 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME .Permit Fee: $0.00 Construction Tax: IBCONSTAXR new units $670.76 fdrniraistrcliv r h'rc: 0 E) Work Without Permit? 0 Yes O No $0.00 TOTALS: 5,052 $3,358.03 �tiu ,,���Nx $4,159.23 Jf d.. zry ,amu � .)5 D", Y4kiuttir ... FiS ..r,;` aA'^2 , 1A�..,. RA w 4�16 1lech. Pbcm f'la'ck P!Jiinh. P/cnJ CCex'l, 1./CC. P/1VI C1WC1' Select a Misc Bldg/Structure or Element of a Building F>�,lmb. Perm;/ r��<��: ��;�<«'. t't',-mit l ),,lit r I -Ir ch, irn;rG' Othur Pla�,inh hiss. 010X!' 1 lt.2. Irti�7. Web'?. lliitl: F"c' Permit Fee: wviC: thts 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 nreliminary information availahle and aro nniv an ncti»mata /'nalnrl /bn T►ont f :add., �l ;.. f FEE ITEMS (Fee Resolution 11-053 E .' 711.113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,358.03 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,159.23 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME .Permit Fee: $0.00 Construction Tax: IBCONSTAXR new units $670.76 fdrniraistrcliv r h'rc: 0 E) Work Without Permit? 0 Yes O No $0.00 Advanced Planning Fee: IPLLONGR $707.28 Select a Non -Residential E) Building or Structure 0 Travel Docwne?7101ior1 1'e es: Strong Motion Fee: IBSEISMICR $71.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $22.00 ,K"SO 3TOTAL $8988801 $Q.00 1 t "1'tt j����`'"``�TOAY,FEE%$8,988 i+ri fi tlnl.,Y.:r kbi .i )i. i, n%).)iY hioY .80 Revised: 01/06/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR: UNIK HOMES INC PERMIT NO: 15020024 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARA.I SUSHM 15185 ALONDRA LN DATE ISSUED: 04/09/2015 OW ER'S PHONE: 3108490146 SARATOGA, CA 95070 PHONE NO: (650) 240-8483 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] License Class_ Lic.4 OJ J� 7 CONSTRUCT TWO STORY RESIDENCE (1ST FLOOR -2270 SQ FT) AND (2ND FLOOR -1667 SQ FT); ATTACHED GARAGE Contractor._ 9 ^i 6 NES Date 6�_ (689 SQ FT); PORCH AREA (426 SQ FT). 1 hereby affirm that I am licensed tinder 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. 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 Sq. Ft Floor Area: Valuation: $550000 of the work for which this permit is issued. Performance ave 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 permit is issued. APN Number: 32608028.00 Occupancy Type: 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 to building construction, and hereby authorize representatives ofthis city to enter WITHIN 180 DA RMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F M 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. Addition lly, the applicant understands and will comply Issued by: Date: with all non -point source regula ns 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: 1 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). 1 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 Cupertit Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code,=?^^� ��� 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 Califomia. 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 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. l 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 CUPERTINO n NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION i COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION n6 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buifding(c Cupertino.org �v ❑ ADDITION ❑ ALTERATION /TI ❑ REVISION/ DEFERRED C`RIGINAL PERMIT k PROJECT ADDRESS I DSFj I5 r V'il`.A V l s A AJ E P U,G ! 6o f' APN # :�' IQ _073 - OL,(J l OWNERNAME GOP[rW(YA,5WA"f PHONE . c � E-MAIL 90F —0me-. C^,n STREET ADDRESS CITY, STATE, ZIP FAY CONTACT NAME CHP -IS VVIM" ; ff p PHONEft �v50 � 3�ti E-MAIL �r IS � C —0 -0 E-MAIL -%,5 , v I STREET ADDRESS ^ 0t3l AA t� CITY, STATE, ZIP FF G 1 i{v ven � e, MPS ❑ OWNER ❑ 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 GINEER NAME 4C4-I'R�j fitly 1p LICENSE NUMBER BUS. LIC # COMPANY NAME C11 A A1 �,n�G I`)1 wri E-MAIL GI _ r `SQ a��-`�p ►c�. FAX STREET ADDRESS 2a Q 9 tj AV `, ,(Yjr V renuc, (J CITY, STATE, ZIP PHONE �� O n L. DESCRIPTION OF WORK tiEW LSOR (DENS kjtT" �a`1`r EXISTING USEPROPOSED USE CONSTR. J TYPE �f191- # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EK1STG NEW FLOOR DEbIO + t-1-7 TOTAL (} AREA AREA IAuP (KITCHEN AREA ± IOC NET AREA <I� I �J'i yl,,�,�n • -/ v'K `J/0 G BATHROOM OTHER REMODEL AREA REMODEL AREA REMODEL AREA n qfwe, PORCH REA ^�A- DECK AREA TOTAL1 DECKIPORCH AREA GARAGE AREA: DETACH ATTACH � tl P1(v_ '. '-1 J-l� /A•LY.`C �(/`� '. # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDS YES / BEING ADDED? ONO ADDITION? []NO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME? NO jtECj;j ' TOTAL VAL An. r t 12D A I -o „ By my signature below, I certify toe fmf the following- the property owner or authorized agent t et o e property owner's behalf. I have read this application and the information I h e prowl ed is co pct.e read the Description of Work and verify it is accurate. I agree to comply with all applicable local 7-t ordinances and state laws relating buildingvon ction.honze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:y SUPPLEMEN IN ION REQUIRED ;PLAN CHECK TYPE s, r „�'� ROUTING SLIP . ;, _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER BUILDING PLAN REVIEW' permit for new building. EXPRE PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS:: Form if any Hazardous Materials are being used as part of this project. LARGE FIRE, PFJ'_— _Copy of Planning Approval Letter or Meeting with Planning prior to , ❑ submittal of Building Permit application. MAJOR /ARY SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 061'2I/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: 10585 flora visat ave DATE: 02/04/2015 REVIEWED BY: Mendez IlaADDRESS: APN: BP#: %d D -VALUATION: 1$550,000 PERMIT TYPE: Building Permit PLAN CHECK TYP : New Construction PRIMARY SFD or Duplex USE: 2nd Unit? '> Yes No PENTAMATION 1R3SFDW PERMIT TYPE: WORK construct 2 story sfdwl 1 st floor 2270 2nd floor 1667 attached garage 689 porch area 426 sq ft SCOPE Suppl. Insp. Fee:Q Reg. Q OT0.0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 5,052 $3,358.03 IR3PLNCK $4,159.23 IR3INSP Permit Fee: $4,159.23 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME .Permit Fee: $0.00 Construction Tax: IBCONSTAXR new units $670.76 fdrniraistrcliv r h'rc: 0 E) Work Without Permit? 0 Yes O No $0.00 TOTALS: 5,052 $3,358.03 �tiu ,,���Nx $4,159.23 Jf d.. zry ,amu � .)5 D", Y4kiuttir ... FiS ..r,;` aA'^2 , 1A�..,. RA w 4�16 1lech. Pbcm f'la'ck P!Jiinh. P/cnJ CCex'l, 1./CC. P/1VI C1WC1' Select a Misc Bldg/Structure or Element of a Building F>�,lmb. Perm;/ r��<��: ��;�<«'. t't',-mit l ),,lit r I -Ir ch, irn;rG' Othur Pla�,inh hiss. 010X!' 1 lt.2. Irti�7. Web'?. lliitl: F"c' Permit Fee: wviC: thts 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 nreliminary information availahle and aro nniv an ncti»mata /'nalnrl /bn T►ont f :add., �l ;.. f FEE ITEMS (Fee Resolution 11-053 E .' 711.113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,358.03 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,159.23 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME .Permit Fee: $0.00 Construction Tax: IBCONSTAXR new units $670.76 fdrniraistrcliv r h'rc: 0 E) Work Without Permit? 0 Yes O No $0.00 Advanced Planning Fee: IPLLONGR $707.28 Select a Non -Residential E) Building or Structure 0 Travel Docwne?7101ior1 1'e es: Strong Motion Fee: IBSEISMICR $71.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $22.00 ,K"SO 3TOTAL $8988801 $Q.00 1 t "1'tt j����`'"``�TOAY,FEE%$8,988 i+ri fi tlnl.,Y.:r kbi .i )i. i, n%).)iY hioY .80 Revised: 01/06/2015 Z CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR: UNIK HOMES INC PERMIT NO: 15020024 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARA.I SUSHM 15185 ALONDRA LN DATE ISSUED: 04/09/2015 OWN S PHONE: 3108490146 SARATOGA, CA 95070 PHONE NO: (650) 240-8483 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL License Class ass4 1 q 33-7 4 CONSTRUCT TWO STORY RESIDENCE (1ST FLOOR -2270 SQFT) AND (2ND FLOOR -1667 SQ FT); ATTACHED — GARAGE (689 SQ FT); PORCH AREA (426 SQ FT). Contractor Date :5-Zp I hereby affi m that I am licensed under the provisions of Chapter 9 DEF #1 - TRUSS CALCULATIONS - ISSUED 5/20/15 (comtnenci 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: $550000 pe formance of the work for which this permit is issued. 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: 32608028.00 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 O)F-DERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon die above mentioned property for inspection purposes. (We) agree to save 180 DAY 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 ,tomb—clbcs-- Date: J granting of this permit. Additionally, the applicant understands and will comp) Y with all non -point source reg# tions per the Cupertino Municipal Code, 9 18. _ 2� 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, 1 agree to remove all new materials for inspection. ❑ NER-BUILDER DECLARATION Signature of Applicant: Date: 1 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) 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 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 Mun' ipal 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,/Ind 2553 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 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 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. 1 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 CL1RTINO NEW CONSTRUC' CION CONSTRUCTION PERMIT APPLIGAiF4 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)cupertino.org ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # J'50,2 00 s �� PROJECf ADDRESS/1} .Q/—� APN � OWNER NAME f , "-�I �' `� PHONE E-MAIL STREET ADDRESS /' '� CITY, STATE, ZIP FAX CONTACT NAME � _ PHO E C. E-MAIL p u 1 STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME, �. �` LICENSE NUMBERC CI/ LLcENSETYPE BUS. LIC k COMPANY NAME��. !' _M f ( 6 FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # 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 i TOTAL DECK/PORCH ARE GARAGE AREA: DETACH []ATTACH I K DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? No ADDITION? []NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF PLANNINGAPPL'O IS THE BLDG AN YES rf S<.'(nAilti31�,f i#�,y TOTAL A ION: [:)NO PLANNING APPROVAL LETTER EICHLER HOME? []NOR);ECEIVE ' r �- By my signature below, I certify to each of the following: I m the -property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provide ave red the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to nbt+ gtion. authorize represent sof Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO TION REQUIRED l�for demolition permit for New SFD or Multifamily dwellings: Apply existing building(s). Demolition permit is required prior to issuance ofbuilding e%,i` i „a 5a .1t ti 4{ i -a tit 3dw xeraM� y# r°} Iry OYER THI COUNTER ern rF 4dp,ds. Iltv+,A t It 1a ry4+� ; ty BUII.DING PLAN REVIEW permit for new gbuildin .❑ EXPRESSv w P xi a rS�. �PLANN f Commercial Bldgs: Provide a completed Hazardous Materials Disclosure `� ❑ EUBLICzWORK$�ca ('�i4 ��S form if any Hazardous Materials are being used as part of this project. a � i'�`eJl It 1 ;C.b�l A 4J''.iajd?�7i4,'�I ?�' �4 SLSy� iS t5 ',.�X1 S t r�y� 1;ARCy'>E�.m� �,,:ng'°+'�yA,.,�°k�y��jy'x���� ❑ v�IRE�,AEPx li ri M Wo- YA6*1 p`+t '' � ax ! _ Copy of Planning Approval Letter or Meeting with Planning prior to i'1,ye'�'if� ` submittal ofBui[dingPermi[application. C1�aMnabRiatiIf;�OgSA1VITARYSEwERDISTRrCT l' t�`$�w ilKMRrn� lri ��r„ENVIRONMENT.AI.HEALTI3tr ;'d . J•r,+3,? ,"ti2 «?.;:":. nt �._::' BldgApp_201 1. doc revised 06/21/11 J fn -i CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 10585 Flora Vista Ave DATE: 04/17/2015 REVIEWED BY: Sean !'iru„h. l'tcu7 C'hY;ck APN: BP#: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: f:7t1'ts,• h3ec.. /,is o.LJ L PENTAMATION 1 GENRES PERMIT TYPE: A WORK Deferred Submittal #1: Truss calculations. SCOPE Suppl. Insp. Fee:Q Reg. Q OT 2 i'• I11 5p L If�pP4'4l l( 4�{y"�1�. �p1'll il£ .+ks'41,''Z is 1�1 }F{Yf y4Y{ $ _ X41 �1}k ':,> 1 f•'y Y�ly�n�4 'IF ISl 1 �� 5 4' ,�y,,1 �,N4 N.( i .'1�lh+ll kF :�1 4uYR 1F 1 ✓ �['`i III -r 4 fl 1 �f alec:l7. 1'IY:rr� (:'Ytc�c.'k !'iru„h. l'tcu7 C'hY;ck Ktez'..l'h;.Yr7 C::hc�ck _llech. Pc>rnrit hc7�: F'7anr771. Pcrrr7;it i�;�e: I•;h-:c. Y��,�rni7 T'e�r C)finv' '� lCc•17. h7sp r;hh• P wilb 111sp. f:7t1'ts,• h3ec.. /,is o.LJ L f>ir'ciz. 1;Isp. !'r .. /'/7111111. ITIS/). I''C : /:lea.. It7s1:I. / 'e NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 U 7.2113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Deferred Submittal $286.00 IDEFSUBM Supp/. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.:r�rtst,'uctizx-i T�r.l: :Qc�l111Y1(Sl'/'c71rCd 1'l?c`:': O Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 i Travel Doc `✓r.,o<7aalion ,''c><s: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 9 �{11 G 7 1� ��..I 4' A 1 �b k • Y l J Sr' UBIUTALS 1 ` $0.00 1Y � 1 Ft �1 a GIF rC} Y �„ $286.00 $286.00 Revised: 04/01/2015 ID:24E985B3-EF3D-41A1-9960-179EDF689071 U NIKHr0i"► MES QUALITY LIFESTYLE. November 12, 2015 Cupertino Building Department 10300 Torre Ave Cupertino, CA 95014 Reference: 10585 Flora Vista Ave — Permit #15020024 To Whom It May Concern, In regards to the gas and electric meter release request. Field inspection for both of these 2 items have passed. I, Tom Cao President of Unik Homes, Inc. and Gopi Rangaswamy, the owner of the above referenced project. Both attest that no one will move or live in the property until all required agencies have signed off the finals on the permit. If you have any questions or comments, please do not hesitate to contact me at 408-590-6469. Your help is greatly appreciated. Sincerely, EDocuSigned by: 7F2FB3085=459... Tom Cao Unik Homes, Inc. Ec DocuSlgned by: ePt rav*sw&* 8D9C951DAEC1457... Gopi Rangaswamy Property Owner IX 650-240-8483 ►tea tom@unikhomes.com a; 3790 EI Camino Real #322 ib 650-240-8482 �� www.unikhomes.com Palo Alto, CA 94306 If i CUPERTINO 7� o Good TEMPORARY CERTIFICATE OF OCCUPANCY FORM T' r' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.orq 2t ' APN 31os:-- BP #: O .� ��. 7/2 DATE: _ r� -IS- PROJECT VALUATION: SITE h ADDRESS: �" OWNER'SAM + • , _ PHONE #: (p nn�j' VV FAX #: . .................. MAILING ADDRESS (if different from site address): CONTRACTOR1 'v Ho M _ �� FAX PHONE#:#: ®� - Cl _- (��it f CONTACT: , C, PHONE #: J v -- O FAX #: -r TGeeanRAPV C.PPTIFICATF OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1 % VALUATION(BLDBONDSJ CODE El CHECK El CASH BOND OF BOND: 5K min -10K max $55700 EDITION: 2 ©� TCO EXPIRATION c 1/ oy ?j /� FEE: $286.00/1110 TOTAL FEE: $ 5 bMPOCC] DATE (6 MONTHS MAX): // I USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT .y ..� Fire - J'aL l SCG U ,,t Date Jj. / Pq AP OVED [IAPPROVED WITH CONDITIONS* Signature. ;l:...l � . .................. ..1.,r..... u is Works t� ( 3 APPROVE&40 APPROVED WITH CONDITIONS" ­JM nCnAMTAACAIT 1 At--r-W-V ADDOnVAI C• anning) 5... ❑ APPROVED )PAPPROVED WITH CONDITIONS' Si nature:.. .................... Date:...... .y ..� Fire - J'aL l SCG U ,,t Date Jj. / Pq AP OVED [IAPPROVED WITH CONDITIONS* Signature. ;l:...l � . .................. ..1.,r..... u is Works t� ( 3 APPROVE&40 APPROVED WITH CONDITIONS" Signature:... ................ ............................ Date:...... 0 ...... -Other: ❑ APPROVED APPROVED WITH CONDITIONS` Signature: ........................................................ Date:...................... *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may I e forfeited and the non-compliance may result in avvnforcemeRt action. Owner -�` _ Contractor . Signature:..... Date:.!. 2. 3.).�....... Signature: ............. 4'Al Date:L2. .. This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and similar emerciencies. Buildin Official:. Print.... E'c='..... .....�.....�? .................... Date: ...%..'.-�:-I:...... DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file TempOccForm_2013.doc revised 717114 u'4/