15030066CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15030066
10386 SOMERSET CT CUPERTINO CA 95014 (369 29 036)
(PAB CONSTRUCTION
INC)
CUPERTINO, CA 95014
OWNER'S NAME: SAM VARGHESE
DATE ISSUED: 03/03/2016
OWNER'S PHONE: 650-333-5662
PHONE NO: 408-499-6595
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #980537
Contractor (PAB CONSTRUCTION INC) Date 03/03/2016
_ BLDG —ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH — RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CONSTRUCT ONE STORY ADDITIONS TO THE FRONT AND REAR
I hereby affirm under penalty of perjury one of the following two declarations:
(581 SF); INTERIOR
1. I have and will maintain a certificate of consent to self-insure for Worker's
REMODEL (733 SF); INSTALL NEW WINDOW AND DOOR IN FAMILY
Compensation, as provided for by Section 3700 of the Labor Code, for the
RM; UPGRADE ELECTRICAL PANEL (200 AMP); INSTALL NEW
performance of the work for which this permit is issued.
FURNACE IN ATTIC; INSTALL NEW TANKLESS WATER HEATER;
-' I have and will maintain Worker's Compensation Insurance, as provided for
REMOVE AND REPLACE STUCCO (150 SQ FT).
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Sq. Ft Floor Area:
Valuation: $80000.00
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
APN Number:
Occupancy Type:
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
369 29 036
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-poin source regulations per the Cupertino Municipal
PERMIT EXPIRES IF WORK IS NOT STARTED
Code, Section 9.1
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
-'"
Signature Date 03/03/2016
180 DAYS FROM LAST CAL CTION.
13UIL E DE LARAT
Issued by: MEL
Date: 03/03/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
FS:
compensation, will do the work, and the structure is not intended or offered
All roofs shall be inspected prior to any roofing material being installed. If a roof is
for sale (See.7044, Business & Professions Code)
installed without first obtaining, an inspection, I agree to remove all new materials for
2. 1, as owner of the property, am exclusively contracting with licensed
inspection.
contractors to construct the project(Sec.7044, Business & Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations:
Date: 03/03/2016
1. 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
performance of the work for which this permit is issued.
2. 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
HAZARDOUS MATERIALS DISCLOSURE
this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
s. I certify that in the performance of the work for which this permit is issued, I
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California. If, after making this certificate of
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
exemption, I become subject to the Worker's Compensation provisions of the
air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code, I must forthwith' comply with such provisions or this permit shall
will maintain compliance with the uperti Municipal Code, Chapter 9.12 and
be deemed revoked.
the Health & Safety Co , S fr n 25505, 25533, and 25534.
APPLICANT CERTIFICATION
6S-0-1-16
Jno
I certify that I have read this application and state that the above information is
p-wrier or authorized agent:
correct. I agree to comply with all city and county ordinances and state laws
Date: 03/03/2016
relating to building construction, and hereby authorize representatives of this city
CONSTR T ON 11DING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereby affirm that there is a c struction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in
Lender's Name
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non-point source regulations per the
Lender's Address
Cupertino Municipal Code, Section 9.18.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records..
Signature Date 03/03/2016
CITY OF CUPERTINO
FEE ESTIMATOR — RITILDING IIIVNION
y ADDRESS: 10386 somerset ct
DATE: 03/10/2015
REVIEWED BY: SEan
APN:
BP#:
'VALUATION: 1$80,000
*PERMIT TYPE: Building Permit
120 s.f.
$645.00
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes @No
OTC? 0 Yes (D No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
Construct one story addition 444 sq ft); kitchen remodel 120 sq ft • interior remodel 600 sq ft).
SCOPE
Remodel, Other
IREMRESOTx
Permit Fee:
OCCUPANCY TYPE.: TYPE OF FLR AREAPC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. sJ. 1
R-3 (Custom) 11-8,111-BjV,V-B 444 $1,626.00 IADDPLCK $1,323.00 IADDINSP
t
I TOTALS: I 444 _$1_626_.00$1,323.00 I
:!Meeh. Ilan (':rick I 11,11110_ Plan Caeca I k:lec% Ilan Check
Lleckr. Permit F'ee. Plumb. Permit Fee: Elec.. Permit Fee:
Other ,tleckf. InsI7_ Other Plumb Insp. 01her Elea: Insp, Li
Rech. hisp, Fee: Plumb. Insp. Fee: Fkc. Insp. Fee:
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 for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,626.00
120 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: (E) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00F--6-070s.f.
$503.00
Remodel, Other
IREMRESOTx
Permit Fee:
$1,323.00
Suppl. Insp. Fee:Q Reg. 0 OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
AdministrativeFee
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee: IPLLONGR
$62.16
Select a Non -Residential
Building or Structure
E)
0
Travel C' vel DocZdt12C?nl a11Urt 17ees:
Stro.m4 Motion Fee: IBSEISMICR
$10.40
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$4.00
_U
$3,025.56
$1,148.00 x
$4,173.56
Revised: 02!14.12015
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • building@cugertino.org
❑ NEW CONSTRUCTION ® ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED
r
wsld
0? A- vo
s
ORIGIRAL PERMIT
PROJECTADDRES'S 10386 5omeroet Court
APN9 369-29-036
I
OWNERNAME Sam & 5eema Varoheoe
PHONE 650-313-5662/
E- 5am.vareheoe@gmaiI com
sTREETADDRESS 10386 li 5omeroet lou
CITY, STATE, ZIP Cupertino, Cil 95014
FAX
CONTACT NAME Daryl Harris
I PHONE530-268-3055
E-MAIL, dvh.rha55oc00lrlai1.com
I
STREETADDRESS 22867 5unoet midge Drive
CITY STATE, ZIP Auburn, CA 95602
FAx 530-268-2027
1
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 129 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
h r)
"1® A
COMPANYNAME
E-MAIL U I I I I I Pil.
FAX
STREET ADDRESS
CITY; STATE, ZIP
PHONE
ARCHITECTIENGINEERNAME Pa ryl Ha rrl o
LICENSE NUMBER C 25(�` 31
BUS. LIC #
COMPANYNAME pH Aooociateo
" dvh.rha000c@gmail.com
F`x530-268-2027
STREETADDRESS 22867 5unoet Kidge Drive
CITY, STATE, ZIPAuburn, CA 95602
PHONFJ30-268-3055
r+ a
DESCRIPTION OF WORK
A kvm t
EXISTING USE
PeSidentiale5idential
PROPOSED USE CONSTR
TYPE # STORIES
`�
USE
TYPE
OCC.
SQ:FT.
VALUATION($)
EXISTGNEW
AREA 2,218
FLOOR
AREA 592
DEMO
AREA 0
TOTAL
NET '2,810
BATHROOM
REMODEL AREA
KITCHEN -OTHER
REMODELAREA 10 1
REMODEL AREA 563
PORCH AREA
DECK AREA
TOTAL DECKNORCHAREA
GARAGE AREA DDETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
1
BEINGADDED? ®NO
ADDITION? ®NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:TOTAL
VALUATION:
PLANNING APPL # El NO PLANNING APPROVAL LETTER
EICHLERHOME? ® NO
By my signature below, I certify to -each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUMG SLIP
❑ OVER-THE-COUNTER
1 l BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
17711 EXPRESS
❑, PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
0 STANDARD
❑ PUBLICwoBKs
form if any Hazardous Materials are being used as part of this project.
El LARGE
1-1 FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ mAJoit
❑ sAWARY SEWER DISTRICT
submittal of Building Permit application.
ENVIRONMENTAL HEALTH
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(40,8)3777,3,225 -_FAX (408) 777-3333 - buildinclacupertino.org
CUPSIRT1140"
NTW-QQNTRtZGTIQN ADDITION,, „ ❑-ALTERATION / T!, REVISION /-DEFERRED ORIGINAL PERMIT 4
' I'
PROJECT ADDRESS1038L
APN 4
OWNERNAME'I-
E-M'AIL
—J
STREET ADDRESS
CITY; STATE-, ZIP FAX
CONTACTca�G1i�PHONE.;�
2S 4..c) l 4gt E-MAIL 4i Vi
STREET,kiDRESS 7
, CITY; STATE;
y
FAY,
-11,OWNER, , El O-WNE-kiBUILDER'-_* ❑ `OSt>TTER AdLNT ff'CONTRACTOR �--�:ElCONTRACTOFAGENT ,-.-,n ARCHITECT ,[],ENGINEER ,f],DEVELOPER ..,--EITEIIANT-'
CoNtRACTORNAME
5J
LICENSE NUMBER '3 &6 2 2—LI
LICENSE TYPE
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS )j56,42, 01,a510n '3>1Va
CITY, STATE Z11_ c:(
PHONTE
ARCIETECTIENIGINTEER. NAME
LICENSE NUMBER
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Sr�e A44
EXISTING USE PROPOSED USE ONSTI�a�E
PIP—S C V13
4S TORIES
1 P-
USE
TYPE
OCC.
SQ.FT.
VALUATION
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA 17oof4:2
✓BATHROOM
AREA 11olel
AREA
NET AREA
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL EDCKRORCH ARE
GTJL�AGEAREA�. DETACH
.43 5f-
I
I A 3
1 E]ATTACH
9 DWELLING UNITS:
IS A SECOND UNIT El YES
SECOND STORY []YES
I
BEING ADDED? [.NO
ADDITION? []NO
PRF -APPLICATION [71 YES IF YES, PROVIDE COPY OF
PLANNING APPL 9 r_1 NO PLANNING APPROVAL LETTER
IS THE BLDG AN [] YES
EICHLERHOME? El NO
1NAN
A PIN
g
M
TOTAL VALUATION:
R,
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t building construction. I authorize representatives of Cupertino to -enter the above -identified property for inspection purposes.
Signature ofApplicant/Agelit:, Date: 10.4 1 !c
SUPPLEMENTAL INFORMATION REQUIRED . mm�xwl
i
LTA CHECK A
NINE
. . . . . . . . . . . . . . .
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition pennit is required prior to issuance of building
permit for new building.
Commercial Bldgs- Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.LI LARGE. '•IRE DEPTto
^s t
ggp
Copy of Planning Approval Letter or Meeting with Planningprior to
ERDiSTRICT Ems'
submittal of Building Permit application. ES
BldgApp_20'1 1. doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10386 Somerset Ct
DATE: 12/23/2015
REVIEWED BY: Sean
APN:
BP#:
"`VALUATION; Iso
4 -PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFDor Duplex
USE: P
2nd Unit? 0' Yes � No
OTC? YesNo
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
CONSTRUCT ONE STORY ADDITIONS TO THE FRONT AND REAR 581 SF); INTERIOR
SCOPE
REMODEL (733 SF); INSTALL NEW WINDOW AND DOOR IN FAMILY RM; UPGRADE ELECTRICAb
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
(s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
11-B,111-B,IV,V-B
581
$2,654.00
IR3PLNCK
$1,666.00
1R3INSP
$0.00
PME Plan Check:
$0.00
200 amps
$48.00
Electrical
1BELEC200 Services
Permit Fee:
$1,666.00
Suppl. Insp Fee:Q Reg. Q OT
0,0
hrs
$0.00
1� # Plumbing
$29.00IPRWHEATR Water Heater
PME Unit Fee:
$0.00
PME Permit Fee:
$144.00
# Mechanical
$143.00 1MFR=<100 Furnace, Forced -Air
TOTALS:
581
$2,654.00
$1,666.00
MECH, HOURLY O Yes r No PLUMB, HOURLY 0 Yes ;0 No TEL HOURLY Yes, Q"No
Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check OA 1 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: 1EPERMIT
Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Insp. 0.0 hrs $48.00' Other Elec. Insp. 0.0 hrs $48.00.
'� iii8t:'. f ,S i n<;'
NOTE, This estimate does not include fees due to other Departments (I a Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict.. etc.). These fees are haved on, the nreliminary information availadhle and are only an estimate. Contact the Dent for addn'1 info
FEE ITEMS dI-c<e Resolution I1-053. `ff. 7 1.':131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,654.00
733 s.f.
$575.00
Remodel, Other
1REMRESOTH
Suppl. PC Fee: Q Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
200 amps
$48.00
Electrical
1BELEC200 Services
Permit Fee:
$1,666.00
Suppl. Insp Fee:Q Reg. Q OT
0,0
hrs
$0.00
1� # Plumbing
$29.00IPRWHEATR Water Heater
PME Unit Fee:
$0.00
PME Permit Fee:
$144.00
# Mechanical
$143.00 1MFR=<100 Furnace, Forced -Air
7Cf.
#
$431.00
Window 1 Sliding Glass Door,
1WINREP Replacement
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannrina Fee:
IPLLONGR$81.34
Select a Non -Residential_
Building or Structure
0
r
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$4,593.34
$1,226.00
TOTAL FEE:
$5,8.19.34
Revised: 10/01/2015
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
6MADDRESS:
10386 somerset ct
DATE: 03/10/2015
REVIEWED BY: SEan
PC FEE ID
1 APN:
BP#:
"VALUATION: 1$80,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes .' No
I OTC. 0 Yes 6) No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
Construct one story addition 444 sq ft); kitchen remodel 120 sq ft); interior remodel 600 sq ft).
SCOPE
F-600-1 s.£
$503.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
444
$1,626.00
IADDPLCK
$1,323.00
IADDINSP
{lslec.
"'o
$0.00
F-600-1 s.£
$503.00
Remodel, Other
IREMRESOTH
Permit Fee:
$1,323.00
Suppl. Insp. Fee -.0 Reg. ® OT
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
444
$1,626.00
$1,323.00
MECH, HOURLY 0 Yes ) No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
MISC ITEMS
Plumb. Plan C`hrrtA
Elec. Plan (::heck
! , : _
Plumb. P� . ,...
/;lac. Permit 1 ..
C?tJrer i h;, hr Insf)
other Plumb lnsfr.
E1__L_
ltdzer�
ET
Insp.1,cc
hrs
t
v) V -v
{lslec.
"'o
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 relimina information available and are only an estimate. Contact the De t or addn7 in o.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,626.00
= s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Supp/. PC Fee: Reg. ®OT0.0
hrs
$0.00
PME Plan Check:
$0.00
F-600-1 s.£
$503.00
Remodel, Other
IREMRESOTH
Permit Fee:
$1,323.00
Suppl. Insp. Fee -.0 Reg. ® OT
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee: 1PLLONGR
$62.16
Select a Non -Residential
Building or Structure
0
0
�
Y
rr'La1 t l ',frtc rr�r.c�yFltxtXCrp t`'eee":
Strong Motion Fee: IBSEISMICR
$10.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$3,025.56
$1,148.00
TOTALFEE:
$4,173.56
Revised: 02/14/2015