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B-2016-2403 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2403 10341 PRUNE TREE IN CUPERTINO,CA 95014-2022(316 33 038) S O D BUILDERS INC ENCINO,CA 91316 OWNER'S NAME: BHIDE MAHESH PAND URMILA M DATE ISSUED:09/09/2016 OWNER'S PHONE:408-807-6525 PHONE NO:(818)616-8377 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#942085 Contractor S O D BUILDERS INC Date 11/30/2017 X BLDG —ELECT —PLUMB I hereby affirm that I-am licensed under the provisions of Chapter 9(commencing _MECH X 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: ONE STORY ADDITION(191 S.R);REMODEL MASTER BATH AND I hereby affirm under penalty of perjury one of the following two declarations: CREATE 1/2 BATH(93 S.F.);REMODEL KITCHEN AND DINING 1. I have and will maintain a certificate of consent to self-insure for Worker's ROOM(250 S.F.). Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. z. 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. Sq.Ft Floor Area:191 Valuation:$75600.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 33 038 Deferred Submittal(R-3),R-3(Custom) 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 a al liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue again aid City in consequence of the granting of this permit. WITffiN 1$0 DAYS OF PERMIT ISSUANCE OR Additionally,the icant understands and will comply with all non-point source:regulatio s er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ,Signature- Date 9/9/2016 Issued by:Kim Dunbar Date:09/09/20.16 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(See.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: /9 9/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2, I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipme or devices which emit hazardous air contaminants as defined by the Bay Are Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper o unicipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Seco 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. &,Owner or authorized agent: APPLICANT CERTIFICATIONDate:9/9/2016 I certify that'I have read this application and state that the above information is CON 1rTVnd$1XMING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued.(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 9/9/2016 Professional itsCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 G4IPERTtNO (408)777-3228•FAX(408)777-3333•bUlding@_ctf erhno.ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATioN l Ti ❑ REVISION!DEFE D ORIGINAL PERMIT PRO'EGT ADDRESS UNC C �N APN II Q3�11 �'R. OWNER NAME Mlkl-tGS('� .Uf^tAiUN- DkA PHONE(1k)16) 6()q— SZ EMAIL ,STREBTADDRESS !0j\�I U TSzC L/�1' CITY,STATE.��ZIIF ��pC`Zr11u f qS�I FAX CONTACT NAME SC�3 J\5T t f�C t..�a N s0 .���.. .,PxONIE E-MAIL ttR1 fits Y+b 'P1>:cert. ty�,i l•to STREETADDRESS 0 A5"tWaT,)0 A k f 4��o C1TY,STAT-ZIP £k� �`/ �S-� FAX r_ ®.OWNER 13 owNutt-BUILDER 13 OWNE�RIAGHNNT E3 CONTRACTOR ONTRACTOOR AGENT k 3 ARICIIITECCT ❑ENGINEER © DEVELOPER ❑TENANT CONTRACTORNAME {�0 " T- k AJLICH E NMBER i�l��� G•L1U5S .1LiICuENeSEtsTY.PcEutiYl BUS.LIC Y �7 COMPANYNAME FAXL16/ JT, / r,`( : .qZU 131 rbP'J STREET ADDRESS k'�ry-3 t veti1l-1xvaRA S1; :JbLl aTY,sTATE,ZIP G\,�L 1 Q 0,, L& C�l3 f j PHONE(JbC 1J,k01_32_7 3Z-7 a ARCHITECTlENGINEERLAAME G gh&_r IAN ALF6a t� LTC IINSE NUMBER BUS.LIC# COMPANY11 IC(v t� &MAIL s t FAX kbi tiGS��7N `�� VtcS ai�5i tnsc�r�JSS@. w�Itl�cb STREET ADDRESS 1 y«�1. warm. W 15\A I a TQO ?\ 6A,110 CITY,STATE,ZIP (to ST- PHONEC9 0 Z 8-1DESCRIPTION Of? A-Dsf _ w _i-- - las'r MoI�C-L J_/IYC0C— To iP6o�_, CT?PTl (N) 1,010A 60 Ar-0, . W3S,F tzlvNlol7G-i MM'TE?-.13AJH 'TO 0�M CDP- (A)) '/Xgh-1fit,CM) 'FtxAvJZcS 110 '51-iH EXISTING USE PROPOSED USE GONSTR.TYPE lk3TORtES 4 NSR ` USE TYPE OCC. SQXT. VALUATION(S) BXISTG / ,�� NEW FLOOR + DEMO TOTAL i1 o AREA 1 W AREA i AREA fU NLT AREA BATHROOM KITCHEN OTHER n REMODBLAREA RIMODELAREA 9` REMODELAREA - PORCI�AREA DECK�AREA TOTALDECKIPORCRAREA. GARAGE AREA: DETACH-6s 1,1-L 22> `•I`c Z ATTACH tIDWELLING UNITS: IS A SECOND UNIT YBS SECOND STORY YES { Ii'INOADDFD? NO ADDITION? NO ME-APPLICATION 13YEs IF YES,PROVIDE COPY OF -IS TRE BLDG ANYES .RECE TOTAL VALUATION: - PLANNING ADPL A Wo PLANNING APPROVAL LETTER 'PICHLER HOME? A1NO By my signature below,l certify to each of the following: I ain the property owner or authorized a act on a pr y owner's behalf. I ha a road this application and the information I have provided is correct.I have read the Description of Work and verify it' •ate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to Io above-identified property for inspection purposes. Signature of ApplicanVAgent: Date: 1 I SUPPLEMENTAL INFOM4ATION REQUIRED Q PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forvEtt mtlE COUNTER UILDING PIAN RFYIEW existing building(s). Demolition permit is required prior to issuance of building permit fornewbuilding, E.] ExPREss i—NINGMAN REVIEW _Commercial 13Idgs: Provide a completed Hazardous Materials Disclosure E3 STANDARD I] PUBLIC WQRxs form if any Hazardous Materials are being used as part of this project. El LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Maeting with Planning prior to 0 MAJOR E SANITAIRY SEWERDISTRICT submittal of Building Permit application. - 1 ENVIRONFKTALHEALTR Bldg�4pp_M Ldoc revised 06121111