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14030180CITY OF CUP EIEt'1<INO BQJII[.,1<DING PERMIT BUILDING ADDRESS: 1062 NOVEMBER DR CONTRACTOR: BG PERMIT NO: 14030180 CONSTRUCTION INC OWNER'S NAME: MEHTA SUDHIR AND NEELU 850 W SUNSET BLVD DATE ISSUED: 07/07/2014 OWNER'S PHONE: 4082187509 HAYWARD, CA 94541 PHONE NO: (510) 432 -6249 LICENSED CONTRACTOR'S DECLARATION r— )� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # 6 TD-1 9 1-1 r r �- V% MECH RESIDENTIAL COMMERCIAL Contractor,G t o �t t�t-� tC10� ,Date 7—;?- 1011 JOB DESCRIPTION: CONSTRUCT ONE STORY ADDITIONS (TOTAL 808 SQ FT); FRONT PORCH (40 SQ FT); REAR COVERED PATIO (52 SQ I hereby affirm that I am licensed under the provisions of Chapter 9 FT); INTERIOR REMODEL OR EXISTING RESIDENCE (1506 (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 Sq. Ft Floor Area: Valuation: $2000 performance of the work for which this permit is issued. 1 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: 36216035.00 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 EI(D correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1�0 DAYS OF IPIE]E8>bI[I« 1«�UAIYCIE ®)� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PIECTI[ON. 180 DAYS FROM (LAST CA><..]L.IEI(D 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 , ° � �,y� granting rmi . Additionally, the applicant understands and will comply Issued by: e �1 Date: ® wit non -point source regulations per the Cupertino Municipal Code, Section 9.1 . �^t Signatur Date ( �' ?01 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: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 1 have and will maintain a Certificate of Consent to self- insure for Worker's material. Additionally, should I use a ui ment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as def a Bay Area Air hality Management District I performance of the work for which this permit is issued. will maintain com .nee with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safe Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized t: Date: permit is issued. IQ 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 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 K Ed CITY OF CU PIERTINO BUILDING PERMIT BUILDING ADDRESS: 1062 NOVEMBER DR CONTRACTOR: BG CONSTRUCTION INC PERMIT NO: 14030180 OWNER'S NAME: MEI -ITA SUDHIR AND NEELU 850 W SUNSET BLVD DATE ISSUED: 07/07/2014 OWNER'S PHONE: 4082187509 HAYWARD, CA 94541 PHONE NO: (510) 432 -6249 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] License Class_ Lic. # 6 90 S 11 L' REV# 1 - ADD BAY WINDOW TO GUEST ROOM -1SSdD r� �� � i `��• � — t�' 2 �) ( 8/4 /14TERIOR REMODEL Old EXISTING I[�ESI DENCE(1506 Contractor 11.E Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Profes 'ors Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarah 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: $2000 performance of the work for which this permit is issued. 1 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: 36216035.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN J«® ���� ®� PERMIT �������� ®� 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 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 Issued by: Date; granting of this permit. Additionally, the applicant understands and will comply with all no er the Cupertino Municipal Code, Section 9.18. _ —Z RE- ROOFS: Signature — Date — t All roofs shall be inspected prior to any roofing material being installed, If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Scc.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. 1 will 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 l 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 performance of the work for which this permit is issued. will maintain compliant ertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety ode, Sections 25505, 23533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen : t_9 Date: q '?Ut� 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 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 I Lender's Address 1 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 ERTINO BUILDING PERMIT BUILDING ADDRESS: 1062 NOVEMBER DR CONTRACTO PERMIT NO: 14030180 OWNER'S NAME: MEHTA SUDHIR AND NEELU (� A � �� DATE ISSUED: 07/07/2014 OWNER'S PHONE: 4082187509 , PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECgI r— RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: CONSTRUCT ONE STORY ADDITIONS (TOTAL 808 SQ FT); (commencing with Section 7000) of Division 3 of the Business & Professions FRONT PORCH (40 SQ FT); REAR COVERED PATIO (52 SQFT) INTERIOR REMODEL OR EXISTING RESIDENCE(1506 Code and that my license is in full force and effect. 1 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $2000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36216035.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK 15 NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 1180 DAYS OF PERMIT ISSUANCE OR granting ofthis permit. Additionally, the applicant understands and will comply 180 DAYS FROM (LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued by: Date: Signature Date OWNER- BUILDER DECLARATION RE- ROOFS: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, iness & Professions Code) Signature of Applicant: Date: owner of the property, am exclusively contracting with licensed contractors to P construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self - insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will rtify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's health &Safe Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must Owner or a r' ed agent: f( Date: J forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regu ions per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUP E][ TINO BUILDING PERMIT BUILDING ADDRESS: 1062 NOVEMBER DR CONTRACTOR: BG CONSTRUCTION INC PERMIT NO: 14030180 OWNER'S NAME: MEHTA SUDHIR AND NEELU 850 W SUNSET BLVD DATE ISSUED: 07/07/2014 OWNER'S PHONE: 4082187509 HAYWARD, CA 94541 PHONE NO: (510) 432 -6249 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 10/10/14 REVISION #3: REMOVE AND REPLACE (10) RR License Class 1J Lic. # (� �b S t� a� WINDOWS Aj'd1D INCREASE HEIGHT. -- I FSUeCA "i fL0 Contractor �C'p�a�....c} C .lrDate 0- ZCJ4 o iq 1 hereby affirm that I am licensed under the provisions of Chapter 9 -A (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. a r I hereby affirm under penalty of perjury one of the following two declarations: 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: $2000 performance of the work for which this permit is issued. 1 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: 36216035.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT ]Ei XPIFREi S jai' WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating ���� Ili® ���� ®� PERMIT �������� ®� 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 INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses v crue against said City in consequence of the, lssued by: gp� Date: grand is permit. Additionally, the pplicant understands and will comply w all non -point source regulations per the Cupertino Municipal Code, Section 9 18. /^ RE- ROOFS: Sign Date 'I()- IG- ZCb 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. ❑ OWNER - 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. 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 l 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 contaminan ine by the Bay Area it Quality Management District 1 performance of the work for which this permit is issued. will maintain ompliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & ty Code, Sec • 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ages 2 l Date: 1f�' t0� 8094 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, l 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. 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 l IT CI'T'Y OF CU PE][t' INO BUILBING PERMIT BUILDING ADDRESS: 1062 NOVEMBER DR CONTRACTOR: BG CONSTRUCTION INC PERMIT NO: 14030180 OWNER'S NAME: MEHTA SUDHIR AND NEELU 850 W SUNSET BLVD DATE ISSUED: 07/07/2014 OWNER'S PHONE: 4082187509 HAYWARD, CA 94541 PHONE NO: (510) 432 -6249 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class_ Lic. # ��,� 8/27 /2014 - REVISION #2- CHANGE ROOF STRUCTURE TO `�(�(ta �� TRUSSES; RAISE PLATE HEIGHT TO 10 FT; ADD SINK ID`s �CIR(, - Date 1'��- Contractor �^ 4 LAUNDRY ROOM. 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 Sq. Ft Floor Area: Valuation: $2000 performance of the work for which this permit is issued. 1 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: 36216035.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 ���� Off PERMIT �������� ®� 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 INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, tses w rich may accrue aga d City in consequence of the sting of this permit. Additionally, the applicant t derstands and will comply ��yy Issued by: 6�° �f��� Date: with all non -point source regulations per the Cupertino Municipal Code, Section 18. �� RE- ROOFS: Signat c� 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 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 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 hazardous I have and will maintain a Certificate of Consent to self- insure for Worker's material. Additld I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contain' it by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will ma' ain coith the Cupertino Municipal Code, Chapter 9.12 and !99 1 have and will maintain Worker's Compensation Insurance, as provided for by the He th &Sa 05 25533, and�25534. Section 3700 of the Labor Code, for the performance of the work for which this Q�G,p permit is issued. Owner or aut �^° Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I t 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 CONSTRUCTION PERMIT G PPLIC A ll 1OH �IU COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 0 Ci9PERT9aV® (408) 777 -3228 • FAX (408) 777 -3333 - building(akupertino.org ❑ NEW CONSTRUCTION ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS Q(a Noo emyj ^Q� 4'1�Iv� APN# OWNER NAME G Av)1y* me1�k� 14,! !✓ PHONE Ab% _21 15� EMAIL���Iryq ' o -1901rM'9. STREET ADDRESS 1/1 CO2. p 104 ^M�� T T i1 q e CITY, STATE, ZIP � o t n A Ojob fj q FAX CONTACT NAME \lJ , Pw A s c� PHONE /j o�� ^��,�V`.'�i /^� 1 y 1 E MAIL�YprTJOSlICL 1 F� STREET ADDRESS �.An -eet CI ,.STA�E`�ZIP ��� 12- FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ¢+ ARC *q%cy ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME /'�, .(Im� _ 1� LICENSE NUMBER BUS. LIC # COMPANYNAAME✓Q/�.en E -MAIL �pp�S1 FAX STREET ADDRESS`%' ^i� CITY, STATE, ZIP n,� ,/' CTG41 27 PHONE 4 -2C1?_^3B00 DESCRIPTION OF WORK %08' S+ A M OiA N � 52- � Y& r l l L�� CV TVV11 UQ�� `o c� p 4 80 601 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 3 r- � QF� USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL (� AREA AREA AREA NET AREA VK BATHROOM REMODEL AREA ,_I I b 6DECK KITCHEN I REMODELAREA�O OTHER �An ysf REMODF.LAREA C/�/_/WJ PORCH AREA AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: ISA SECOND UN IT 13 YES SECONDSTORY ❑YES B BEING ADDED? 1P NO ADDITION? PNO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS TILE BLDG AN ❑ YES R;ECEry' v BY: - TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO C/ By my signature below, I certify to each of the following: I am the property owner or authorize ent to act o e property owner's behalf. I have read this application and the information I have provided is correct. 1 have read the Description of Work d verify it is acc ate. I agree to comply with all applicable local ordinances and state laws relating to building c n lion. I authorize representatives of Cupertino to enter t e above -id ntified p operty for inspection purposes. Signature of Applicant/Agent: Date: ����� t� SUPPLEMENTAL INFVYAIATION REQUIRED "; PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for [] OVER - THE - COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. El EMPRESS PLANNING PLAN 'REVIEW N _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PUBLIC WORK$ form if any Hazardous Materials are being used as part of this project. ❑ LARGE PUM DEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 11 MAJOR SANITARY SEWER DISTRICT ❑ F.NVIRC1NAfENTAI,�HVAI..TH- BldgApp_201 ].doe revised 06/21/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT_ DEPARTMENT . BUIEDIt\I QJ 10300 TORRE AVENUE • CUP ERTINO, CA 95014 -Z 1"l ��lJl`✓JllV 0 — (408) 777 -3228 ^ FAX (408) 777 -3333 ^ buildinana cuaertino.ora El NEW CONSTRUCTION 71 ADDITION El ALTERATION/71`1 9 REVISION / DEFERRED ORIGINAL PERMIT 4—{ b a 3 01"x" C , I ^ `` PROJECT ADDRESS �O�n� w I/ it APN0 '?)U2-- ll V Y 1 V Y U W PHONE 2- t --12 M.AIL ONER NAME r h, ]r I CITY, ST TE, ZIP STREET ADDRESS k (0— 0 l t t FAX ` (A1 I.* PHONE E -MAIL CO hCT NA ,]VIE �d �i'�l X111 STREET.ADDRESS 372n •� CITY STATE, ZIP ��qOL�� F.<X OWNER ❑ OW NEk- BTJT1Za ❑ OWNER AGEI` -r ❑ Co1,-IRACTOR ❑ CON7'R4CT0-R ACG.ENIT `qr ARCHYTECT Q ENGINMTR ❑ DE\TLOPE ❑ T -.NANT CONTRACTOR NAME I LICENSE NUAGER LICENSE TYPE I BUS. LTC + COMPANY N.hbrL E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP Jvrit&E � ARCHITECTIENGINEER NA--ME �1 YOU LICENSE NMSER . C I BUS. LIC N COMPANY N.4A4E /t (� GUl CZ`IP' FAX STREET ADDRESS 7'n- 5-�►- CrrY, STA Ca pt s k� 2 HONE -o8 -2a 2..- 30 - DESCRIPTION OF WORK K�hn EXISTING USE PROPOSED USE CONST&ITE STORD?S I USE TYPE OCC. I SQ.FT. VALUATIONS) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCd AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE A. DETACH ATTACH m DA'ELLLNG UNITS: IS A SECOND UNIT 0IBS SECOND STORY ❑ YES BEING ADDED? El NO ADDITION? oNO 1 -- PRE- ARPL-ICAiiON— D-Y -ES T-�frS,- P-ROYIDECOPY_OF _]S�FIE BLDG AN „) -. + - ,. :' TOTAL VALUATION: EICNLERHOME? NO PLAINNINGAPPL: ❑NO PLA.'�`N111'G APPROVAL UTTER By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac property oumer's behalf. I have read this application and the information I have provided is c ect. I have read the Description of Work and verify rs accurate. I agree to comply with all applicable local ordinances and state laws relating to building constrl]c au rize. representatives of Cupertino to enter the above -id Itified r(operty� for inspection purposes, S ignature of App) icant/Aeent: Date: SUPPLEMENTAL INFO MATI . t REQUIRED w.. :3'LA\CH✓CKT,0E ��'BUIIkbi�GPLtzzEty` or} TxcounR�� 1\e w SFD or Multifamily d\vellin s: Apply ror demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingQ permit for new building. F,xI-gPti ^ass - 1'I A%iI11GPL'tT�I?�T>'e g 4�i2 vim'..FsY ^x ssS f+i Commercial Bldg: Provide a completed Hazardous Materials Disclosure �uBtIC\YOlti s- i� _ form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior toxj _ � ❑ 3�i.4J0� �� � � �zx P L�,��nTT',�RI SE{i�R DISTRTCT� � �.. submittal of Building Permit application. 5 tom€ yam{ BldgApp_2011.doc revised 06/21!11 tCUPERTI O CONSTRUCTM PERfM11 If APPLIICAT11 01M COMMUNITY DEVELOPMENT DEPARTMENT ^'W. @8ffl-0 10300 TORRE AVENUE > CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildin cu c hlk9or ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI M REVISION /DEFERRED ORIGINAL PERMIT # PROJECTADDRESS CoUd? „°, 1 APNN (30Z m IQ -035 OWNER NAME q PHONE g e2 _T; E -MAIL STREET ADDRESS ^ ( {� CITY, STATE, ZIP (� �j (� CONTACT NAME I � PHONE r � r1T E -MAI _ ,� ,C d a `ayy�dV U STREET ADDRESS (pe.�/� �p� CITY, STATE, ZIP 1 (24 4,1 t 2- FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT Rf ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ''. CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT /ENGINEER NAME / A (h� 0 y� LICENSE NUMBER BUS. LIC # �A E -M COMPANY NAMEaf7 I� FAX STREET ADDRESS s. CITY, CITY, STATE, ZIa t p n �p N�vet") � PHONE *w oa, DESCRIPTION OF WORK t EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH 9 DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY OYES BEING ADDED? ONO ADDITION? ONO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES RECEIVE Y: TOTAL UATIO N: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ONO / 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 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to co p)y with all applicable local ordinances and state laws relating to building constru ion. horize representatives of Cupertino to enter the above- identif d prope ty for 'nspection purposes. Signature of Applicant/AgenC Date: SUPPLEMENTAL INFO ATI N REQUIRED PLANCHECKTYPE ROUTING SLIP ❑ OVER- THE - COUNTER 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. ❑ EXPRESS PLANNING PLAN REVIEW fPUBLICWORKS Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD __ form if any Hazardous Materials are being used as part of this project. ❑ 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 11.doc revised 06 121111 / S d" TrIPM7 ATI" d-1Tr TTrb- "7MrTPIrTTA'T x.11 1L ll %Ujr %- ku lr 1L11� ll. ILIA %Y 7� FEE ESTIMATOR - BUIDLBI G WVIMN ADDRESS: 1062 November Dr DATE: 10/10/2014 REVIEWED BY: Sean APN: BP4: O *VALUATION: 11,500 'PERMIT TYPE: Building Permit PLA CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #3: Remove and replace 10 Windows. SCOPE Suppl. Insp. Fee :Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i onstruclion !ci : Adiniitiwreati�,e I t e: G Work Without Permit? 0 Yes E) No $0.00 Advanced Planning? Fee: $0.00 1 hours Inspections $143.00 ISTINSP Inspection, Hourly ®a �i ^cnei Ctrintrita�i Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $286.00 TOTAL FIEF: $287.50 Afech. I !Iaq Chet k it %C''.° . We ll 11n1p. F"e: P(:rtnh. Plop 11-7we' Plumb Perm,"" % ec. r1r.m1� F'1row"). fns). I -C, 1.1cc�- Oi;w C7rrc/c Il Ile 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 vreliminary information available and are onhi an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 UL 7 /1/13) FEE QTY/FIEIE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCx Suppl. PC Fee: ) Reg. 0 OT Q,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? (0 Yes (D No $0.00 Suppl. Insp. Fee :Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i onstruclion !ci : Adiniitiwreati�,e I t e: G Work Without Permit? 0 Yes E) No $0.00 Advanced Planning? Fee: $0.00 1 hours Inspections $143.00 ISTINSP Inspection, Hourly ®a �i ^cnei Ctrintrita�i Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $286.00 TOTAL FIEF: $287.50 Revised: 08/20/2014 • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • B" 1 c3 10300 TORRE AVENUE • CUPERTINO, CA 95014 - 255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinq(a)-cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI V REVISION / DEFERRED ORIGINAL PERMIT #—t ti� L0 3 01 '30 PROJECT ADDRESS I © ", !) K r o V bM 66I � f ) , /, /PHONE APN # �j O fi 7 / rj �1 4% OWNER NAME S �p p /4 OA E -MAIL STREET ADDRESS l 06 2 UD.7M _DflV f CITY, STATE, ZIP' FAX , , /vl 1214 CONTACT NAME , !+ / D'4 / H,, V] I /<j� PHONE l� , pl p (r ^] -�^IV pl -MAIL V Qr/ ]ACV I JL STREET ADDRESS C a; 6,_t 'I/ � CITY, STATE, ZIP p� qb� /E�, ` 1A FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHTFECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME AA LICE NSE gMBER LICENSE TYP BUS. LIC # kNJ b S t COMPANY NAME E -1, L c� ( FA VZc, ou _ COusCb �1 Ic tMG�t�� Z i 5,01 STREET ADDRESS P.5-c) LOU. CITY, STATE ZIP c, fplp q3 Z k ` ONE i —4 32 6 Z It ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL figX ry. -- STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK .�ni _. .I6;-1 6l2— U t 4_S on EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ,ADDED? ENO ADDITION? E]NO PRE - APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN [] YES, ,, TOTAL VALUATION: PLANITG APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of th foil ing: I am the property owner or authorized agent to act o property owner's behalf. I have read this application and the information I have provi is c rrect. 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 buildin on ction. I authorize representatives of Cupertino to enter the above- ide/ntti d prop for inspection purposes. V B B Signature of Applicant/Agent: Date: J SUPPLEMENTAL INFORMATION REQUIRED k, ei nN cicx TYPE .° RovTli;c sLiP . )]''ovEx- THE cogrlTER ❑ sUU Du:c PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition pen-nit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. %V7 ❑ PLANNINGPLANREVIFW+ Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PoBLICwOxxs _Commercial form if any Hazardous Materials are being used as part of this project. "Q iAlicE� ' ' n I❑(�`FrxEDFPT _ Copy of Planning Approval Letter or Meeting with Planning prior to Q r�aox sEWER ❑ sAnITARY'DISTRrcr submittal of Building Permit application. r ._E]' ENVIkONMENTALHEALTH BldgApp_2011.doc revised 06121111 CI'T'Y OF CUP Ell$'/ INO FEE ]ESTIMATOR - BUILDING ING DIVISION 1W ADDRESS: 1062 NOVEMBER DR DATE: 03/31/2014 REVIEWED BY: MENDEZ PC FEES APN: BP #: *VAILUATION: $200,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? ° Yes No , a OTC. 0 Yes ® No PENTAMATION PERMIT TYPE: IR3SFDADD d� WORT{ 808 SQ FT ADDITION REMODEL 900 SQ FT THROUGH OUT SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. F1LR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 808 $2,577.00 1R3PLNCK $1,617.00 1R3INSP floc lfl'g5 l_o,. PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee-.E) Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 808 $2,577.00 $1,617.00 MlEC HI, HOURLY Q Yes Q No PLUMB, HOURLY Q Yes Q No 1E1L1EG, HOURLY Q Yes C) No W'ec- r Pion (.'he(..-k PGorrh, P/w., 'herd 'F le, Plait Ch", k PO'Mif 7`ee' Iilrr I'ti;nr! 1 i��. Other Afech. Insn, Other Phun'.b h7sp. 07"N . Lio !rhsp. LA I 1 -t�xh In,p _ 1��pz� Pheiu %,. h1+gr. Fee': floc lfl'g5 l_o,. NOTE: This estimate does not include fees due to other Departments (4e. Planning, Public {forks, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E,ff 711113) FEE QTY/FEE IISC ITEMS Plan Check Fee: $2,577.00 DKI s.f. $558.00 Remodel, Other 1REMRESOTH Suppl. PC Fee: (2) Reg. COT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee-.E) Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswvctior? 1LV I dra?drr.:ti tr�rti ve . ee: 0 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: IPLLONGR $113.12 Select a Non - Residential Building or Structure 0 0 d Travel T,.7ocionenturion Fees: Strone Motion Fee: IBSEISMICR $20.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $8.00 SUBTOTALS: $4,335.12 $558.00 TOTAL FE $4,893.12 01/1512014 ,r17rrr1R7 f-1Tr TTrh1M1Mrrr11T Tirh ROTE: 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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Ef 7f !1113) mm mm r�+�i�l.11 llrTII �17Yr1�C �1.7��17J�17��T1G1LQllT�llTlV �lU �T�7 �T IFEE ES ll ll1 A ll OR — l��lJ ffLDff G Dll V' R��®1V Phuuh Plan C)It.c; ADDRESS: 1062 novermber dr DATE: 08/0112014 REVIEWED BY: meiissa T APN: 362 16 035 RP #: 14030180 WALUATION: Iso "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: $0.00 PENTAMATION 1GEIVRES PERMIT TYPE: WORK REV# 1 - ADD BAY WINDOW TO GUEST ROOM SCOPE ROTE: 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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Ef 7f !1113) heel Plan (lw(k Phuuh Plan C)It.c; MISC 1<')<'IEMS We'll. Perotil Fee' Pl,.,;nh pera rr reL. 0 hours Plan Check, Hourly $143.00 ISTPCNCK Other .1lcch. Imp (brie,- Plumb Imp El I 1/,-c /r Imp IV,(. 1,1uulr'. hlw.11(le, Permit Fee: ROTE: 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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Ef 7f !1113) FEE QTY/FEE MISC 1<')<'IEMS Plan Check Fee: Hourly Only? C Yes Q No $0.00 0 hours Plan Check, Hourly $143.00 ISTPCNCK Suppl. PC Fee: (2) Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. COT Q.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C(nistruction Tux: 1, ltnirri�trative Fee: 0 E) Work Without Permit? ® Yes O No $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential E) Building or Structure 0 4 Truvel Docua cc wu/ioa Fees- StronV Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $ 143.00 TOT AL]FIEIE: $143.00 Revised: 07/10/2014 a CUP[i:RTONO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: ( D62 6V0 1/rW K 1 rL- PERMIT # L9,9 - r 010 0 OWNER'S NAME: �i�� / PHONE # ® i( 7-19 `��%� GENERAL CONTRACTOR: HS'T9 &j/DN .- BUSINESS LICENSE # C ADDRESS: ? ;o W St4AIZ J' id,1,t -d, , HPYW40 CITY /ZIPCODE: RPN 6,/4 , K4,1 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING ]FINAL OR ]FINAL OCCUPANCY INSPE ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTOR IMAV E OBTAINED A CITY OF CUPlElE TINO BUSINESS LICENSE. " 97 0 M-2- —&2-1-IJf I am not using any subcontractors: Signature ?lease check applicable subcontractors and comppete the following infformniflon: )[Date A� V SUBCONTRACTOR BUSEN ESS NAME B USRN ESS LffCIENSE # Cabinets & Millwork &rem Ktila t-. ' � , Cement Finishing /V Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating d0� (�- Q Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date 7001 �e P3 53 CUPERTONO TE v�POO RAF?Y CERT F CA E OF UCC FANCY FOR 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 o buildingScupertino.om APN b Z_ 1 b - 0 3� BP #: 1 1f 3 0 j Q� 0 DATE: '.Z. VALLUAT ON: SITE - q,p�� �� f ,� �p ADDRESS: i D 6 2 �vD t/�i�`'�9Ti� �) VG "� �i ��1 N " OWNER'S NAME: _,_ouDfll r %f PHONE #: ogr ZI g )QJ FAX #: MAILING ADDRESS (if different from site address): CONTRACTOR: PHONE #: FAX #: CONTACT: PHONE #: FAX #: TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BORID TYPE: ❑SURETY BOND AMOUNT (1 %VALUATION (BLDBONDS] CODE ❑ CHECK ❑ CASH BOND F BOND: 5K min -10K max EDITION: TCO EXPIRATION FEE: $2$G.00 /1110 TOTAL FEE: $�� [1TEMPOCC] DATE (6 MONTHS MAX): ❑ APPROVED PROVED WITH CONDITIONS USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT 4a-04PROVED ❑ APPROVED WITH CONDITIONS` Work //..�5 ❑ APPROVED PROVED WITH CONDITIONS Si nature:...... Date:. .zZ.(. Other: U APPROVED ❑ APPROVED WITH CONDITIONS' Signature:.......... Date: .�1.:� . �. /. OTHER DEPARTMENT / AGENCY APPROVALS: Planning �rr Signature: ........................... Date:........................ ❑ APPROVED ❑ APPROVED WITH CONDITIONS` ire Signature: .... ... ... ....... ............................... -Ty-blic Date:...,. 4a-04PROVED ❑ APPROVED WITH CONDITIONS` Work //..�5 ❑ APPROVED PROVED WITH CONDITIONS Si nature:...... Date:. .zZ.(. Other: U APPROVED ❑ APPROVED WITH CONDITIONS' Signature:.......... Date: .�1.:� . �. /. *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 be forfeited and the non - compliance may result in a enforcement action. Owner ,L� l Contractor Signature-....., ............................... ..... Date:........................ Signature:............................. ... /.......................... Date:...................... 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 emergencies. r l_ f _ Building Official: °� alb` / ......... .........................Print: It4!!Y °. °.V.. ....:..!- ..9/....... Date:..... �. Imo.,...... DEPARTMENT ACTION: After determination, copies to: 1 }applicant, 2) permit filed kf // R MAXI TempOccForm_2011 doc revised 717114 S�e�1N refe, June 51h 2015 Building Department City of Cupertino Subject: Transfer of Permit # 14030180 from Contractor to Owner We hereby request the transfer of Permit # 14030180 from BG Construction Inc to myself (owner) for the remaining remodeling work at 1062 November Drive, Cupertino CA 95014. BG Construction Inc has repeatedly failed to deliver on the contract, delayed the remodeling by over 5 months, is not engaged at all, does not have any workers and has financially misappropriated funds I have paid on a regular basis. This includes a recent Mechanical Lien for the amount $36,633.32 from Golden State Lumber, the funds for which I had paid BG Construction Inc several months back. I have been forced to pay the Mechanical Lien directly to Golden State Lumber as they threatened to put my house on foreclosure. The contractor had refused to make the payment for the Mechanical Lien. We have been living in an apartment since July 2014 and the delays, poor quality of work, dismal contract management and misappropriation of funds has led to a lot of anguish and sleepless nights for us. I have no choice but to take on the permit onto myself for us to complete the remodeling at the earliest. Thanks, Sudhir Mehta 1062 November Drive Cupertino, CA — 95014 408- 218 -7509 .4> CUPERTIINO COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 o FAX (408) 777 -3333 ^ building(a.cupertino.org — Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS i ! , n oy dr ft - ). k' 1 �b ...... � �01j Ova �%aV'v � I APN.. BP# jI y� � -4.-" 3 OWNER NAME OWNER ADDRESS:, 0 VV VEM �r/f �� � , CAW M DESCRIPTION OF WORK:' M We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner- Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIR CTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. U::�_2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. J-- 3. 1 understand as an "Owner - Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her o n :4. e instead of my own. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license z n bers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be Zconsidered an "employer" under state and federal law. . I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 4L7. I understand under California Contractors' State License Law, an Owner - Builder who builds single- family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �/�-- 8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 \L 9. I understand I may obtain more information regarding m obligations as an "employer" from the Internal Y 9 9 Y 9 Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed I t actors. 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide \� by all applicable laws and requirements that govern Owner - Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have provided on this form. Licensed contractors are regulated by..laws designed to protect the public. If . you contract with. someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint,. -Your only remedy against unlicensed Contractors maybe in civil court. It is also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. , A - i - . I Property Owner's Signature: Y_Jk_ Date: `O( ID I � II -NOTE: - -T--h-e -- folow-ing -- Auth-orza-ti-o-n -- F--o-r-m -- -is- -r-e-q--u-i-r-e-d - -t-o - -b-e -- -c-o-m--p--l-e-t-e-d -- b-y -t-h-e - -p--r-o-p-e--rt-y -- o-w--n-e--r - -o-n-1-y' -w-h-e--n - -d-e--s-i-g-n-a--ti-n--g - -a- r--- agent of the property owner to apply fora construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 CQLCGREEN U3E30Em nftL C HECKWn e 6uGawA Rv yz_ DUCNS COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISIONRECEIVED G{Llif'ff IIIs 1:C ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 JUN I (408) 777 -3228 o FAX (408) 777-3333 o building@Qyoertino,orq W! M p IS-14 -9y The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, we s, dormitories, condominiums, shelters, congregate residences, employee-thwousinn, factory -bull housin and other types of swellings with sleeping accommodations and new acres W.. ings associl�Sa- o uses. Existing site and landscaping improvements that are not otherwise d d are no11 -1,ubj t9 goo, requirements of CALGreen. Project Name: MEHTA RESIDENCE X062 NOVEMBER DR. t � LIARi�Ls Project Address: Revit'ned -- Project Description: ADDI-n ION /RE MODEL ' a�— Instructions: U� 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall Initial COW= 2 of this checklist, sign and date Sec don I - OaWgrn Waffle. -Man at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete C aW mn 3 and sign and date Seadon 2 - Wpts menft lan Mefflaaldon at the end of this checklist and submit the completed form to the Building Inspector. 4.108.2 Storm avatar drainage and reterntlon during construction. A plan is developed and implemented to manage storm water drainage during ® [] construction. 4.903.3 Grading and paying. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how If -91 site grading or a drainage system will manage all surface water flows. of CalGreen 2014.doe revised 01115114 1 Page 5 _ 4.201.1 Low -rise residential buildings shall meet or exceed the minimum 4� standard design required by the California Energy Standards. 4.303.1 Water conaewing plumbing ftum and flings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ® 4.303.1.3.2 Waiter Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA 1WaterSense Specifications for Tank -type Toilets. ® 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ® 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ® 4.303.1.3.2 Nultlplis Showerheads zerving one zhwer. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be ® [� designed to allow only one shower outlet to be in operation at a time. ® 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ® 4.303.1.3.2 Lavatory faucets In common and public use aram. The maximum flow rate of lavatory faucets Installed in common and public use areas (outside of dwellings or sleeping units) In residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ® 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ® 4.303.1.4.4 lKitchen faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at.60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fflatures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the f R1 California Plumbing Code. Page 2 of 5 CalGreen_2014.doc revised 01115114 A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY A4.5 ENVIRONMENTAL QUALITY 4.504.2A Verification. Documentation shall be provided to verify that. compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low - emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde emission standards. 4.505.2 Concrete slab foundation. Required vapor retarders and capillary breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building materials used in wall and floor framing is checked before enclosure. 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. 10 1 11 1 4.507.2. Duct systems are sized and designed and equipment Is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 2. Size duct systems according to ACCA 29 -D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36S (Manual S) or equivalent. 702.1 Installer training. HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the 13 discipline they inspect and verify. 703.1 Documentaflon. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 . CalGreen_2014.dx revised 01115114 Project Name: Project Address: Project Description: CALOG°3IEEH VOMA URE DDIECLG°Q° 700MO MEHTA RESIDENCE 1062 NOVEMBER DR. ADDITION /REMODEL SECTDOM it e DDGSW dEW�CA7POO H Complete all lines of Section 9 -'Design Verification" and submit the completed checklist (Columns 9 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by Q City of Cupertino. i Owmees Signature / Date Ownees Blame (Please Print) Design Professional's Signature Date afess nars fume (Please - Print) of License Professional responsible for CalGreen compliance Date Nam f License Professional responsible for CalGreen compliance (Please Print) Phone 1- 701&W\ I y � NA 69 %Qefc-L Email Address for License Professional responsible for CalGreen compliance Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project Identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2093 Califomia Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone compliance Page 5 of 5 CalGreen_2014.doe revised 01115114,