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13050123 CONSTRUCTION PERMIT APPLICATION l� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O CUPERTiNO (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org NEW CONSTRICTION ❑ ADDITION ❑ ALTEnRATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ` l Cj f r r 11t , �� 7APN# %q 2-15 1 - 0 2R OWNER NAME .. M e (��1 p y-1 /\ /I�( L L n f PHONE v v� (' E-MAIL OE uco J1 C�4((Ir t. J STREET ADDRESS 1, fl`J it 'v \J I`ll V a4C CIf�TATE,ZIP C vA, [:I_f'T-' 7 FAX 1 Tz I e!` CONTACT NAME PHONE,4 o� G7 q ?-33 3 E-MAIL /� �,�^�/,Pw A (IQ�` J�lI LOM STREET ADDRESS 1 CI Y,STAT ZIP f, FAX l '"� V at h .50,0 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 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 LICENSE NUMBER BUS.LIC# COMPANY NAME �� J E-MAIL (� k 9�P `t Or(vI C. t- (J0f \ FAX m 7 STREET ADDRESS (6 3 j ` °�[1' (Q,�r c- G� �,� CITY,ST�I�. `n �j L��rM �i PHONE 4-ay(0� L333 DESCRIPTION OF WORK V *Oe W s�7S v--u 6 - c �eco -I!- VIA EXISTINGUSE PROPOSED USE CONSTR.TYPE #STORIES ` 2 USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR 2�7 DEMO TOTAL AREA AREA_2a:66 7 AREA 1 '-]/ NET AREA BATHROOM KITCHEN I OTHER REMODEL AREA REMODEL AREA REMODEL AREA .PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EJ DETACH L ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION OYES IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES (tECEIVE $ 3y;C; TOTAL VALUATION: PLANNING APPL# ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized ge o act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description of Work and v ify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to bu ing constructio 1 authorize representatives of Cupertino to enter the above-identified pr �rty for inspection purposes. Signature ofApplicanUAgent: Date: SUPPLEMENTALTTNFPRMATION REQUIRED „ p � ioiiaAi 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. P _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDAtD n >� O a form if any Hazardous Materials are being used as part of this project. ` G 4� E` _Copy of Planning Approval Letter or Meeting with Planning prior to ��� submittal of Building Permit application. aviA�ox ' '�r" � fls r� xY MdgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10518 E ESTATES DR CONTRACTOR:MANA GENERAL PERMIT NO: 13050123 CONTRACTOR OWNER'S NAME: HYMANAND NELLORE 1839 TAMPA WAY DATE ISSUED:08/12/2013 OWNER'S PHONE: 6505044276 SAN JOSE,CA 95122 PHONE NO:(408)375-4288 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL (� CONSTRUCT ATTACHED GRANNY UNIT 373 S FT License Class Lic.# L� �® / Q t In (f Go q 'Date 2,113 **SEE NOTES** Contractor � 1 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. Sq.Ft Floor Area: Valuation:$50000 AA 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:36925029.00 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 DA F OM LAST CALLED IN SPE TION. 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 Issued by: Date: with all non-po' t source regulations per the Cupertino Municipal Code,Section 9.18. 2L13 RE-ROOFS: Signature Date7JJAll 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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(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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.I2 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 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, y rs 2 5,25533,an 25534. Section 3700 of the Labor Code,for the performance of the work for which this 1 Z �3 Owner or authorized agen Date 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,1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 O (408).777-3228• FAX(408)777-3333•building(@cugertino.org \3 CUPERTINO ` NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDkESS1051 g f. t$ APN# OWNERNAME J O PHO SO 4 E-MAIL 2 •c STREET ADDREI S CI ZIP Q �F () CONTACT NAME PHONE J Xre E-M�aria JOX)ry Q14 7— AR II •. tb TREE TAD r CITY,STA ZIP CA w S60 AX 11 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT / ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARC /ENGINEER NAME r LICENSE NUMBER BUS.LIC# r COMPANY NAME E- L� FAX 66 STREET ADDRESSAr C ,STAT ,ZIP PHONE y DESCRIPTION OF WORK � 7 EXISTINGUSE PROPOSED USE CONSTR TYPE #STORIES .it i 73 �s_L1i 7 r USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG �-/"'4 NEW FLOOR DEMO TOTAL AREA t 174 AREA aft9 AREA -7(4 'ARBA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: r3DETACH _ . F�TATTACH - #DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY 7❑]YES BEING ADDED? nNO ADDITION? ❑NO PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REQEI }( fid:` TOTAL VALUATION: PLANNING APDL# ❑'NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO k, By my signature below,I certify to each of the following: I am the property owner or authorized ageit to act on the property owner's behalf. I have read this application and the information I have prodded 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 build' g construction. I authorize representatives of Cupertino to enter the above-iden'fred property for inspection purposes. Signature of Applicant/Agent: Date: o SUPPLEMENTA RMATION REQUIRED ��� � ' �� r` fix' a PLAN CHECK TYPE, itOIITING$I IY �k New SFD or Multifamily dwellings: Apply for demolition permit for `Q�,OVER-TH>•<COUI!i1'ER �Q,BDIL*D G PL ItE existing building(s)...Demolition permit is required prior to issuance of building " permit for new building. �lxPSs b K R G�LN,iir E _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure forma ST , ARD „UBLI k o if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to gr r a MA70R © ARY SEVI ERbIST T submittal of Building Permit application. -,� ��� ,^���:>. t „" � .� ENVIRUN11ENTAL":�ALTH,•� �� BldgAppjOl 1.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10518 E ESTATES DR DATE: 05/15/2013 REVIEWED BY: MENDEZ APN: BP#: VALUATION: $50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes 0 No PENTAMATION 1 R3SFD2ND USE: PERMIT TYPE: WORK CONSTRUCT ATTACHED GRANNY UNIT 373 SQ FT SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 373 $2,468.00 IR3PLNCK $1,549.00 IR3INSP TOTALS: 373 $2,468.00 $1,549.00 Pkn Lie., PE17-- � EI<)i�x,• . . . Ifi.>'(, i) .._ f'r r r"i> Li fI/I 'ttG, irr�/,. {�t NOTE: This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 UL 7%1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,468.00 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. 0 OT TOOT hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee-0 Reg. 0 OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 #i new Construction Tax: IBCONSTAXR 1 units $641.96 �t 113111 f.4"ti':711'vc 1'cc 0 Work Without Permit? 0 Yes 0 No $0.00 E) Advanced Planning Fee: IPLLONGR $48.49 Select a Non-Residential 0 7rc�°,�1 Doc'rs3rrr3rt�rli�tr, f�' �s: Building or Structure 0 i Strong Motion Fee: 1BSEISMICR $5.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTQTALS: $4,714.45 $0.00 TOTALFEE: $4,714.45 Revised: 04/29/2013