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11060119MY OF CUP']EllRUNO BUff LDffNG P ERMR7 BUILDING ADDRESS: 10387 LAS ONDAS WAY CONTRACTOR: SIERRA STRUCTURE INC PERMIT NO: 11060119 OWNER'S NAME: JOSHI VARSHA 2435 SHERWOOD WAY DATE ISSUED: 04/06/2012 OWNER'S PHONE: 4082342978 d MEADOW VISTA, CA 95722 PHONE NO: (916) 275 -1971 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION. RESIDENTIAL COMMERCIAL License Class U Lic, # -7-7162f, A D1[D17C10N- Klf7CC7E EN/,NOOX &FAlb'l[I[1LY(185SQ FT) & Yl 5�t"✓ 4 7 REMODEL Contractor el-" 4 y•e— Date 7 Z ➢CITC H[1EN(&85SQ II') & REPLACE 1EXIS7f RNG I[2OOlF(24SQ FT) 1 hereby affirm that I am licensed under the I isio s of CLpter 9 (commencing with Section 7000) of Division 3 of the Business & Professions a Code and that my license is in full force and effect. c 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: $70000 performance of the work for which this permit is issued. 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: 36929039.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES 11 YORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN ��� ®� �ylE�� �������� ®� 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 IlDA OM LAST CALLED )( qS PIEC') EON. 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 'on , the applicant understands and will comply Issued by: Date: 7 with all non -point e r ulation per the Cupertino Municipal Code, Section 9.18. Signature Date RE- ROOFS: 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 here 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. 1 will 1 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 1 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 uality Management District R performance of the work for which this permit is issued. will maintain compliance with the Cuperti uni pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 55 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater �'7' % 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, I CONS RUCTION 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. 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 9.18. Signature Date CITY OF CUP E]( TINO BUILDING PERMIT BUILDING ADDRESS: 10387 LAS ONDAS WAY CONTRACTOR: SIERRA STRUCTURE INC [PERMIT NO: 11060119 OWNER'S NAME: JOSHI VARSHA 2435 SHERWOOD WAY DATE ]ISSUED: 04/06/2012 OWNER'S PHONE: 4082342978 MEADOW VISTA, CA 95722 PHONE NO: (916) 275 -1971 ❑ LICENSED CONTRACTOR'S DECLARATION License Class D �t-Lic. # —7-7 9 6 2 1. Contractor �J�/ /A /t�vCfLy(Z Date O 2 I hereby affirm that I am licensed under the provisions of d1pter 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: 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. 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may acc gainst said City in consequence of the granting of this permit. Ad ' ' y, pplicant understands and will comply with all non -point so a re ions per t e Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: ]BLDG F ELECT r PLUMB r IMIECIIII r RESIDENTIAL r COM M[IERCl1AL r— ,JOB DESCRIPTION: ADDITION- KITCHEN/NOOK &FAMILY(185SQFT) & REMODEL KITCHEN(185SQFT) & REPLACE EXISTING ROOF(24SQFT) 8/30/12 - REV #1 - REVISE STRUCTURAL C14ANGES AND WINDOW CHANGE OUTS - 8/30/12 REV #I ISS'D Sq. Ft Floor Area: I Valuation: $70000 APN Number: 36929039.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED EIID WITHIN MO DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date: RE-ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 11 will maintain compliance with the Cupertino Municipal Code, Chapter 9.1.2 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Dote: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona CITY ®IF CUP ERTINO BUILDING IFIERMI<T BUILDING ADDRESS: 10387 LAS ONDAS WAY CONTRACTOR: SIERRA STRUCTURE INC PERMIIT NO: 11060119 OWNER'S NAME:.JOSHI VARSHA 2435 SHERWOOD WAY DATE ISSUED: 04/06/2012 OWNER'S PHONE' 4082342978 MEADOW VISTA, CA 95722 PHONE NO: (916) 275 -1971 D LICENSEID CONTRACTOR'S (DECLARATION .YOB DESCRIPTION: RESIDENTIAL El COMMERCIAL T License Class Lic. # I "% ��i Z (p AIIDIIDIITION -KITCH EN/NOOK &1FAMff LY(R85SQ Tj.& Contractor, �(er/'V, ��✓ilC%�IIdte� — REMODEL . , . 1[CII Il C1H[lEl\`I(Il85SQIF II ) & I[BlElP1C,AClE EXISTING l(NG I hereby affirm that I am licensed under the provisions of Chapter 9 1[ OO F(24 SQ FT);1PAN E1L UPGRADE 200 AMT? (commencing with Section 7000) of (Division 3 of the Business & Professions REVISION #2 ENG CHANGE-REVISE STRUCTURAL ]PLANS AND Code and that my license is in full force and effect. (1-30 - -ZO 14 CALCULAT90NS 4/16/2013 IISS'IID 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: $70000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the L'aboi Code, for the performance of the work for which this 4PN Number: 36929039.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ? ERMy 7 EXPM ES IF FORK I(S N07 STARTED correct. I agree to comply with all city and county ordinances and state laws relating �1j�11�I� ��® ���� ®� ��� 1jSS�AI�ICE ®� 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 FROM (LAST CALLED 1 NSIPIE =ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, art&expenses which may acct�rt id City in consequence of the granting of this permit. Additigrrdlly, the applic t understands and will comply Issued by: Date: with all non= point source.. r -per the C pertino Municipal Code, Section 9.18. J" 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- BUILIDER (DECLARATION Signature of Applicant: Date: I here b , affirm that I am exempt from the Contractor's License Law for one of the following two reasons:' 1, as.owner, of the property or my. employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BET'T'ER will do'the'work,'and the structure is not intended or offered for sale (Sec.7044, Business' &Professions Code) I, as owner, of the: am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sect 7044, Business & Professions Code). T 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 es which emit hazardous Compensation; as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Quality anagement District T performance of the work for which this permit is issued. will maintain compliance with the Cuper ' o unicipal ode, Chapter 9.12 and I have and -will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 3, and 534. Section. 3700'of the Labor Code, for the performance of the work for which this 1 1! Owner or authorized agent: Date: - 6 permit is• issued.' . I certify that in the performance of the work for which this permit is issued, I shall /RUCTION 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, 1 CONS LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l 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 CIERTIFICATION Lender's Address I certify that I haye'read this application and state that the above information is correct I agreeao 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 Cupert ino 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 sourcelregulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature: Date I CITY OF tCU P]ERTINO BUILDING P EIEgMff T I BUILDING ADDRESS: 10387 LAS ONDAS WAY OWNER'S NAME: JOSHI VARSHA OWNER'S PHONE: 4082342978 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor Date I hereby affirm that I am licensed under 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: 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. 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 permit is issued. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date OWNER-BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date �Z CONTRACTOR: JOSH) VARSHA 10387 LAS ONDAS WAY CUPERTINO, CA 95014 PERMIT NO: 11060119 DATE ISSUED: 04 /06/2012 PHONE NO: BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB r MECH F RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ADDITION- KITCHEN/NOOK &FAMILY(185SQFT) & REMODEL KITCHEN(185SQFT) & REPLACE EXISTING ROOF(24SQFT) Sq. Ft Floor Area: I Valuation: $70000 APN Number: 36929039.00 1 Occupancy Type: PERMIT ]EXPIRES IF WORK IS NOT STARTED END WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYSf FROM ]LAS'S CALLED INSPECTION. Issued by: / % &7 Date: N (P- RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or a itho ed agent: Date: t; CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional j4 I ccl CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (40x8)777-3228•FAX((4008)777-3333•building(a)cupertino.org ElTI NEW CONSTRUCON L9)7ADDITION LVJ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS 103 o APN a -03 — OWNER NAME ) errs �:\ Lbow -Zs'-, -%9 - STREET ADDRESS ,O s CrrY STALATE,ZIP Y b C 1 FAX CONTACT NAME PHONE E- V, 2 - i •LONA STREET ADDRESS CITY,STATE,ZIP CA 12-1 FAX t• co ❑OWNER ❑ OWNER-BUQ.DER 10 OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARcmECT ❑ENOMEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC b c�a . COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGBdEER NAME LICENSE NUMBER BUS.LIC a CO . FAX STREET ADDRESS CrrY,STATE,Z[P PHONE O PS NOF WO a —n OUSTINGUSE PROPOSED USE CONSTR.TYPE r STORIES Sv-(L 5 V a_ UAnON 31 EXISTG NEW FLOOR DEMO TOTAL Z54-2 AREA AREA AREA NET AREA J BATHROOM KITCHa, Z.SS OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREADECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:11 DETACH fJ ATTACH M DWE 11NC UNUS: IS A SECOND UNEP ❑YES SECOND STORY ❑YES 1 EEElGAMM" NO ADiDPP/ON7 NO PEE-APPLICAMON ❑ YES IF YES,PROVIDE COPY OF PLANNERS NAME: RECEIVED BY: PLAN19M ADPL E NO PLANNING APPROVAL LErrER 1 By my signature below,I certify to each of the following: I am the property owner or authorised 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 budding I es of Cupertino to enter the above-identified property for inspection purposes. SUPPLEMENTAL INFORMATION REQUIRED PLAN CEMCK TYPE HOUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for © OVER-THE:CotrlaMR 24METMA MAN RZV1XW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ G MAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Attu 11PUXJC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE 'FMZ DM _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ &&MARY SEWER DWMCF submittal of Building Permit application. ❑ ZNMOMWUAL HMTR BldgApp 2011.doc revised 03/16/11 ga'°fj COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 C U P E RTI Rf 0 (408) 777 -3228 ^ FAX (408) 777 -3333 o building(cDcupertino.org i ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI N MODIN EFERRED 3 ORIGINAL PERMIT # i� —DCodI 1 PROJECT ADDRESS APN # OWNER NAME PHONE E -MAIL LA STREET ADDRESS CITY, STATE, ZIP FAX (O LaS Ovl On , CA 95 cI CONTACT NAME 2A PHON E -MAIL ce r U 2 -. I h l b STREET ADDRESS CITY, STATE, ZIP FAX Saci S. Ck rw Sa Cie ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. L1C # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTlENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME —� E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR- TYPE #STORIES SF a— e5-R- e5- n -- �16 ID, USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR 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 SECOND STORY ❑ YES BEINGADDED? ONO ADDITION? ❑NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY:: TOTAL VALUATION: PLANNING APPL# ENO PLANNING APPROVAL LETTER EICHLER HOME? 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 buildi ction. I a ize-representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED rinxcgECxTYPE "ROUTING SLIP PLAN New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building VER THE-COUNTFR ,. Vii, BUILDING REVIEW permit for new building. Q EXPRESS 0.. PLANNINGPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD' PU13LICtVORKs ' _ form if any Hazardous Materials are being used as part ofthis project. "� " -• ._. LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ".0 _ SANITARY SEWER I)iSTRICT submittal of Building Permit application. ,rnaoR ENVARONAIENTAL REALT9 B1dgApp_2011.doc revised 06/21/11 �gtraro CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 (408) 777 -3228 o FAX (408) 777 -3333 o buildino okupertino.or0 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I TI V REVISION / DEFERRED ORIGINAL PERMIT # _JJ ® 6 © U P g PROJECT ADDRESS � � � � APN OWNERNAME A PHO ®� o V EMAIL STREET ADDRESS 0 �( CITY, STATE, ZIP FAX CONTACT NAM I 477 PHONE 4 -2 -1 sr_ ®"Z�l D EMAIL 130el b STREET ADDRESS /y he CCTY, STATE, ZIP p i e4 '73- -72 FAX '�'G t*1 f1 , l v�Y ❑ OWNER ❑ OWNER - BUDDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMB�$� LICENSE TYPE BUS. LIC # ®C // COMPANY NAME ��1, ���� c,y E- MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ro ji1 4 UYJ U V R,0645 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I 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 TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? []NO ADDITION? NO PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THEBLDG AN ❑ YES D B TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO o By my signature below, I certify to each of the followin th perry ner, or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is co ct. read the scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin c ' authonz presentatives of Cupertino to enter the above- identified property for inspection purposes. Signature of ApplicanUAgent: Date: it SUPPLEMENT FO ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER- THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamil dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD El PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. El LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121111 MY OF cCUPERTff NO FEE ESTIMATOR — BUILDING DIVISIGN ADDRESS: 10387 las ondas I DATE: 04/04/2013 1 REVIEWED BY: larrys APN: BP #: *VALUATION: L *PERMIT TYPE: Building Permit PLAN CHECK TYPE: 4W4440a PRIMARY SFD or Duplex PIENTAMATIION USE: PIERMDT TYPE: woRK revision to structural SCOPE 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 preliminary information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11 -053 Ef. 711112) ]FEE QTY/ EE, IO' ESC 11TIEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT hrs PME Plan Check: ISUPP Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative .Fee: Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 Travel Doc�unentutinn Fees: Strong Motion Fee: $0.00 0 # Revisions $0.00 IREVSFDWL SFDWL BldgStds Commission Fee: $0.00 SUBTOTALS: $266.00 $0.00 TOTAL. FEE: $266.00 Revised: 04/01/2013 ,f'1TrRI'R7 A -'t,7m if ITr TTMTr7i7Trrr'rk\r?T Revised: 07/01/2012 '1Iji it 11 � U1P 1l1lUlr iCjin ll J11N\1.0 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10387 las ondas way. DATE: REWEWED ]BY: bobs. APN: 1BP #: �j� / *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise structural changes and window change outs SCOPE i -.J J Meek Plon Check lwch. Penn it Fee: Orlrer Afech, Insp. ;1 -kxh. Insp. Fee: Plumb. Plan Check /Imb. Permit Fee: Other Plumb Insp. Plumb, Insp. Tee: Elec.. Plan Chuck ielec. Permit Tee: Other Elec. Insp. Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Eire, Sanitary Sewer District, School District, etc.). These Lees are based on the prelimina information available and are onl an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11 -053 Elf 7/1/11) FEE QTY/1FE]E MISC ITEMS Plan Check Fee: Hourly Only? (j) Yes O No $0.00 2 hours Plan Check, Hourly $266.00 ISTPLNCK Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. ® C 0.0 ws $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiniction :Tax: Administrative .Fee: Work Without Permit? O Yes (9 No $0.00 Advanced Planning $0.00 Select a Non - Residential Building or Structure Travel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.00 TOTAL FEE: $266.00 Revised: 07/01/2012 CITY OF CUPIEIEB'Ir11NO FEE ESTIMATOR - BUILDING DI[Vff SIION IWNADDRESS: 10387 las ondas way (DATE: 06/14/2011 REVIEWED BY: bobs. PC FEE ID APN: 1BP #: *VALUATION: 1$70,000 *PERMIT TYPE: Building Permit kAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes o 0 No OTC. 0 Yes E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Psfd 7add kitchen /nook family, remodel kitchen and replace exisiting roof. SCOPE hrs OCCUPANCY TYPE: TYPE OF CONSTR. F LR AREA s.f. PC (FEES PC FEE ID ]BP (FEES BP IFEE IID R -3 (Custom) II- B,111- B,IV,V -B 185 $965.00 JADDPLCK $934.00 IADDINSP Suppl. Insp. Fee-.0 Reg. C OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (D No $0.00 Q 0 Work Without Permit? 0 Yes (D No $0.00 Planning Fee: PLLONGRNGR $24.05 TOTALS: 185 $965.00 Strom Motion Fee: IBSEISMICR $934.00 Select an Administrative Item MIECH, HOURLY , 0 Yes 0 No PLUMB, HOURLY 0 Yes E) No IEILEC, HOURLY Yes (D No ;. r,'i �.. f t_<•; l.ri<'::':;. Plan Check Fee: :Y iti(;fi, f'`vrjijti }''E.Y' :': L;7?....f'n!'; �i ?i I� {. t.. l;i c. �. f�i'!'i3.. %; !'p. r;• 7 r!lt('i' i4: �d, fidS ". (�� %td'Y tai 1611:£; ;l Zit). � }`i•!!'i % -.' �7. fil S'; ). Permit Fee: $934.00 Suppl. Insp. Fee-.0 Reg. C OT NOTE: These fees are based on the Preliminary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (lee Resolution 09-051 ff. 7/1"10) FEE QTY/FEE MffSC ITEMS Plan Check Fee: $965.00 = s.f. Remodel, Kitchen (< =300 sf) $570.00 IREMRESx T Suppl. PC Fee: E) Reg. COT 0.0 hrs $0.00 PME Plan Check. $0.00 = s.f. Re -roof $312.00 IRER00FRES Permit Fee: $934.00 Suppl. Insp. Fee-.0 Reg. C OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (D No $0.00 Q 0 Work Without Permit? 0 Yes (D No $0.00 Planning Fee: PLLONGRNGR $24.05 Select a Non - Residential E) Building or Structure 0 G, Strom Motion Fee: IBSEISMICR $7.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTAL S: $1,933.05 $882.00 TOTAL FEE: $2,815.05 Revised: 04/2912011 I L— A s I ] Oil 9 A P a i /11/z lo ate, ?� ,� e-.;.&., ten, _ T �/',, s 4A . I 0 w yr ter' o f P.ei',,,,, rT 1106011 9 try ( -ea r e U eSfv,.-7. r� i 4 J-0 -Co •1 -t-44-c- °f u 57 vtie -'t�� ` -,*S O v, 4,45E c-✓,4 �v� 4/4i •2 c li