B-2017-2082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2082
21078 MANITA CT CUPERTINO,CA 95014-5074(362 23 048) ALDAN
CONSTRUCTION&
REMODELING INC
LOS ANGELES,CA
90048
OWNER'S NAME: CHUPPALA RAVI S AND SHETTIGAR VINEETHA K TR DATE ISSUED:12/05/2017
OWNER'S PHONE:650-906-1315 • PHONE NO:(818)652-7290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class B Lic.#1030243
Contractor ALDAN CONSTRUCTION&REMODELING INC Date 08/31/2019 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
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 j, '
license is in full force and effect. JOB DESCRIPTION:
2ND FLOOR BATHROOM REMODEL-(110 SF)
I hereby.• irm under penalty of perjury one of the following two declarations:
1. ave and will maintain a certificate of consent to self-insure for Worker's -
ompensation,as provided for by Section 3700 of the Labor Code,for the II.
performance of the work for which this permit is issued.
12. 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: Valuation:$12000.00
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 362 23 048
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 "PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against" 'd C'Ay in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the api
.nt t derstands and will comply with all non-point
source rer lationst • upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature. / Date 12-05-2017 Issued by:'Kim Dunbar
Date: 12/05/2017
OWNER-BUI..l ER DECLARATION
•
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. I,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(Sec.7044,Business&Professions Code)
2. 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: 12-05-2017
I hereby affirm under;penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 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.
z. 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
California Health&SafetyCode,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this
•
permit is issued. maintain compliance'with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)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 equipment or devices which emit hazardous
air contaminants as defined by the Bay Are it i'I ality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuperf M . ' ipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety' ode,Seer/ s 2 .0.,25533,a , 25534.
Labor Code;I must forthwith comply with such provisions or this permit shall '
be deemed revoked: Owner or authorized agen
APPLICANT CERTIFICATION Date: 12-05-2017
I certify that I have read this application and state that the above information is CONSTRUC'IN LENDI G 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,•end expenses;which,may accrue against said City in Lender's Address
consequence of the granting ofitliis permit. Additionally,the applicant understands '
and will comply with all non-pointisource regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 12-05-2017
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
•
10300 TORRE AVENUE • CUPERTINO, CA 95014-325 •
5
S�trm (408) 777-3228 • buildin c cu eI tino.orgPEMIT*B-2° ( F -7/V g 2
CUPERTINO REVS DEFS
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 07. 4tttl�-0. C(4. APN A 3( 2-
a 3—0 f
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OWNER NAME owl .Skaankct PHOt�13d.,wo6 I E-MAIL
STREET ADDRESS _ • CITY, STATE,ZIP
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®CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
STREET ADDRESS „ TAT ZIP A -
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E-MAIL viii® Gteeet4sfY' h•Cd PH 90ONE
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• 0 ARCHITECT 0 OWNER ❑OWNER AGENT Vi CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
•
CONTACT I9 ,�wrV E-MAIL ®
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STREET ADDRES� CITY,57ATE,ZIP a PHONE
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DECRIPTON bCtpt9.0~ 'A-GeAtignie.44V
•
rialNGLE-FAMILY/DUPLEX ' D MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF [DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF/491° SF SF SF 0 DETACHED
EXISFIREIS SPRINKLERS 0 NO EICHLER O'YES SECOND STORY ADDITION DYES
NO
DWELLING SECOND DWELLING (]yES 0 ATTACHED❑DETACHED OTHER
UNITS4 UNITADDITON: ❑NO SF
POOLSI ❑FIBERGLASS D VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF
RE.,.. VE TAL VALUATION:
Convuerrial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval a s X1/2-voco,d•)
RE-ROOF EXISTING ROOF TYPE: O BUILT-UP ROOF E ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD El 1/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES 6 OF LAYERS THICKNESS❑5/8" OTHER Doss ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER -
*Provide a signed copy of the Cupertino's Tear-Off Policy SF :of SQUARES •
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 informatio .have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordina -•. a d state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for ii : : ti. purposes. I acknowledge and authorize all information contained on this application form
to be made available for public r-cord.
of Applicant/Agent: Date: t( �,/
SUPPLEMENTAL INFORMATION;IQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a'completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
Bldg,4pp_2017.doc revised 08/01/17