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13050087I . - CITY OF CUPER'1'l[NO BUILDING PERMIT BUILDING ADDRESS: 7811 LILAC Cf OWNER'S NAME: KRISHNA KILAMBI CONTIUCTOW LUU CONSTRUCTION INC PERMIT NO: 13050087 333 AVENIDA PIN'OS DATE ISSUED: 08/15/2013 OWNER'S PHONE: 4089140567 1 SAN JOSE, CA 95123 1 PRONE NO: (408) 623-7558 1 LICENSED CONTRACTOR'S License Class f3� �I Lic. # �b C t ?� Cx d \ /Y' Contractor 3 � LV—v\ 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 perlormance 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 certil)y 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 ofthis permit. Ad orally, the applicant understands and will comply with all nor _Point soon c lati er the Cupertino Municipal Code, Section 9.18. / Signature Date ❑ OWNER -BUILDER DECLARATION hereby affirm that 1 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, 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 prgjcet (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, aller making this certificate of exemption, I hCOme subject to the Worker's Compensation provisions ofthe Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CF,RTIFICA770N 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the srantin- of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Si�naturc Date BUILDING PERMIT INFO: BLDG (— ELECT r- PLUMB FJ MECH RESIDENTIAL r COMMERCIAL F JOB DESCRIPTION: CONSTRUCT A ONE STORY ADDITION (502 SQ FT). **SEG NOTES** Sq. Ft Floor Area: I Valuation: $120000 APN Number: 35903026.00 1 Occupancy Type: PERMIT IT lEXPIRES IF WORK 1S NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM ]LAST CALLED INSPECTION. Issued by: ��%/� ��9� Date: C/ 3 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 COVF,RINGS TO BE CLASS "A" OR BETTER TER HAZARDOUS MA'T'ERIALS DISCLOSURE 1 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(x) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the IIcalth & Safety Cqe, Sections 25505, 25533, and 25534. Own!=t � t riz cnt: c— �i�a/'~ Date: t! 7 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 Ad ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION a� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ' 10300 TORRE,AVENUE • CUPERTINO, CA 95014-3255 (4QBj .777-3228 • FAX (408) 777-3333 • building a�cupertino.org C U OkIk" l! 8, EI NEW CONSTRi3CTION IL`I ADDITION ❑ ALTERATION /'n ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDkESS APN# OWNERNAME V PHONE®8 _ 1 k .4 , %_J E-MAIL IL ��� �� G� CITY, STATE, ZIP L n k CA q50 (1 FAX O�!�Dlyy[ [ I OweCONTACT NAME PHONE �M°IIK`YA hA STREET ADDRESS ZIP FAk-7 -7-o 12-7 ❑ OWNER .❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONrRACTORAGENT ❑ ARCHITECT )WENGWEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME ' y _ , f / ` I r e LICENSE qA71�� LICENSE TYPE r7 BUS. LIC # COMPANY NAME j t� til Q_UU E-MAILjylA� qlwKe FAX ' STREET ADDRESS.. �{ 1-T3D� W 0-> CITY, STATE, ZI P ARCHTTECTIENGINEE R NAME C �(, e �, 5 .., ICENSE NUMBER BUS. LIC # COMPANY NAME /f C I VI�E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USECON TR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S). tXIS�6 TG' NEW FLOOR DEMO TOTAL AREA . AREA /'_' O t AREA NET AREA . BATHROOM KITCHEN OTHER REMODEL AREA (©:0 REMODEL AREA REMODEL AREA ' .PORCH AREA " . DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH 2�,ATTACH # DWELLINGUNTTS:' IS ASECOND UNIT ❑ YES SECOND STORY ❑YES , BEINGADDED? 0 ADDITION? GXNO .. . PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES CG'f'�`r ❑ ,� ,'t a-��' �l� TOTAL VALUATION: PLANNING APPL # O PLANNING APPROVAL LETTER EICHLER HOME? 0 R ''� �f4u°. By my signature below, I certify to each of the following: I am the property owner or authorized agent act o the p rty.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 a ate. I agree to comply with all applicable local. ordinances and state laws relating to uildi cons ction. I authorize representatives of Cupertino to enter the above-ide tifred roperty for inspection purposes. Signature of Applicant/Agent: Date: O ' r„ a�, ,�' w✓r a_' r s- .�y> .r st, zr -�F- Y er€= ,c.w .�. .cc �f t (:. SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamilydwellings: Apply for demolition permit for IN u� EV, � �� �� � �� t� � C ��rt� � PP Y P F N � OVER THE COUNTER � � � ❑ BUII DING PLAN REV�IEIi l r r � I t existing building(s):, Demolition permit is required prior to issuance of building i .� '�, {$� l permit new building. EXPRESS $ 'l at IAnNlt�PLANREVIEv P g�p.w�5 ivy7"?��� ` _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANuaRD ` d rusfacwoRxs 1 . 5� sw s k irA form if any Hazardous Materials are being used as part of this project. w 1s { > nRCE { Copy of Planning Approval Letter or Meeting with Planning prior to �r SAtIIFARYSEwERDISTRICT� submittal of Building Permit application. aott� w y k=3s ENVI60NMENITAP.-AL'l;H,'. a BldgApp_301I.doc revised 06/31/19 CITY OF CUPERTINO Fm -N FEE ESTIMATOR — BUILDING DIVISION I& ADDRESS: 7811 LILAC CT FLR AREA SX DATE: 0511012013 REVIEWED BY: MELISSA BP FEES APN: 359 03 026 BP#: 0-o0g, �7 "VALUATION: 1$120,000 *PERMIT TYPE: Building Permit $2,468.00 PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: Eke. hull". fee: 2nd Unit? ° Yes No OTC. Yes No PENTAMATION I R3SFDADD PERMIT TYPE: WORK REAR ADDITION OF 602 SQ FT TO CREATE 2 N MASTER BEDROOMS SCOPE PME Unit Fee: $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA SX PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 602 $2,468.00 1R3PLNCK $1,549.00 IR3INSP Eke. hull". fee: $1,549.00 Suppl. Insp. Fee,0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslruelion K.Ix: Adrninistra ive.Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: 602 1 $2,468.00 Trai'el I_)oct,trrac>ratcllion I ees: $1,549.00 Strong Motion Fee: 1BSEISMICR MECH;,HOURLY 0 Yes G No PLUMB, HOURLY 0 Yes E) No ELEC, HOURLY Q Yes (D No tifec:h. h'lrvi Check 1'hunb. Plcrrr C hc;c'k Flec. 1'1an Check Much. Perwil het Phimb. Permit Fee: I:lcec, Permit Fee: Other :L9ech. Insp.. Other Plumb Insp. Lj Other Eicc. Insp. Ll lkeh. Insp. F&v: Mud), Cusp. Fee: Eke. hull". fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,468.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee,0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslruelion K.Ix: Adrninistra ive.Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning F'ee: IPLLONGR $78.26 Select a Non -Residential Building or Structure 0 Trai'el I_)oct,trrac>ratcllion I ees: Strong Motion Fee: 1BSEISMICR $12.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $4,112.261 $0.00 TOTAL FEE: 1 $4,112.26 Revised: 04/29/2013 CUPER70HO CONTRACTOR / SUBCONTRACTOR LEST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # D 5--,C7 0 c9 7 OWNER'S NAME: PHONE # 4- o5-47 GENERAL CONTRACTOR: (A, BUSINESS LICENSE # ADDRESS: -3� v Pj KtC)5CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CU]P]ERTIN` O BUSINESS LICENSE. I am not using any subcontractors: Signature ]Please check applicable subcontractors and complete the following information: Date d SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date 11