11120089 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21537 ROSARIO AVE CONTRACTOR: ' PERMIT NO: 11120089
OWNER'S NAME: BHATT HASIT H AND SWATI ATE ISSUED: 12/14/2011
ER'S PHONE: 4086465918 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class&Et?. (�2 Lic.0 0'P
8 26(2 r r r
Contmctorc>4-a r_44*t i rot�IA A&'Ie" 11 MECH RESIDENTIAL COMMERCIAL
I'L-1�-
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: FOURTEEN(14)WINDOWS&ONE(I)DOOR
(commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT;NON-STRUCTURAL
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.
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 Sq.Ft Floor Area: Valuation:$8400
pernit is issued.
APPLICANT CERTIFICATION APN Number:35619026.00 Occupancy Type:
I certify that 1 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 PERMIT EXPIRES IF WORK IS 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 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cino Municipal Code,Section
9.18. l
upe
/ , (l Issued by:/Ii% Date:�2 �
Signature le -
OWNER-BUILDERD ARATION
RE-ROOFS:
1 hereby affirm that I 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,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE,
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 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. 1 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(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify 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&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1 �
become subject to the Worker's Compensation provisions of the Labor Code,I must O err r a thor4iee 11 I
forthwith comply with such provisions or this permit shall be deemed revoked. ate' Z - `\
SJW
APPLICANT CERTIFICATION TI LE15KING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction ending 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
cilknd expenses which may accrue against said City in consequence of the
g g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
wt all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35619026.00
DATE ISSUED. . . . . . . : 12/14/2011
RECEIPT #. . . . . . . . . : BS000015573
REFERENCE ID # . . . : 11120089
SITE ADDRESS . . . . . : 21537 ROSARIO AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BHATT HASIT H AND SWATI
ADDRESS . . . . . . . . . . : 21537 ROSARIO AVE
CITY/STATE/ZIP . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : STOCKTON SCREEN WIN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 8,400.00 1.00 0.00 1.00 0.00
1BSEISMICR VALUATION 8,400 .00 0.84 0. 00 0 .84 0.00
1WINREP EACH 8 15 .00 522.00 0. 00 522 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 523 . 84 0. 00 523 .84 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 523 .84 #1280
---------------
TOTAL RECEIPT 523 .84
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
•CUPERTINO (408)777-3228• FAX, (408)777-3333•buildingIEDc_ u�perdno ora
❑NEW CONSTRUCTION ❑ ADDITION VLf ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROLEADDRESS
i
OWNERNAME PHONE . E-MAIL
w
STREEf ADDRESS CITY, STATE,ZIP '- FAX
S �— tNocA ctSO1
COMA NAME PHONE E-MAI.
'T - 2. o SgC AAS
STREEL ADDRESS .�.+ O IIP J (_ e It S�Q FAX ' N -t
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ""CONTRALTOR ❑CONTRACrORAGEN' ❑ ARCHTIECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO CTOR NAME 0 LI SE NUMBER U SE TYPE BUS.LIC#
UA lA r-t AJ
CD= L>4cc'v-� 0 S F, FAX
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ADDRESZ_- C♦ -# C-I CIT
Y._'TA7Ty ZIP . _ PHONE -Z Z
ARCHCTECr/ENOINBER NAME UCENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ESCRIT71ON OF WORX i 4 A-4
O `t _ l e ZolD
ae v DACE pcl- _i__Q til el.A into 0fslecVo
E%LSTING USEF PROPOSED USE CONSTILTYPE I #STORffS _
USE TYPE OCC. SQFI'. VALUATION(s)
EXLSTO NEW FLOOR DEMO TOTAL .(
AREA AREA AREA NErAREA 3 I-CO 6
BATHROOM =HEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCHAREA DaB�G
TALDECK/PORCHAREA GARAGEAREA DETACH
ATTACH
#D WELLP'G UNM: ND UMT YES SECOND STORY YES
DED? []NO ADDITION []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDC AN _ff YES RECEIVED 13 TOTAL VALUATION:
PLANNIN'GAPPL# []NO PLANNING APPROVAL LETTER aICHLERHOME? ❑NO (TAL Oo
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 halve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply withall applicable local
ordinances and state laws mlatiag building construction,
I au repres atives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: / Date: `Z
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVEH TBE-COUNTER .@—H�mc PLAN REVIEW,
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
fbTrunal
m if any Hazardous Materials are being used as part of this project. ❑ LARGE ElF>%DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑
MA.IOR of Building Permit application. ..SANITARY SEWER nlsrRlcr
❑ ENVmOKMZNTAL HEALTH
B/dgApp_1011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 21537 rosario ave. DATE: 12/14/2011 REVIEWED BY: bob s.
APN: BP#: "VALUATION: $8,400
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTAMATION 1 GENRES
USE: PERMIT TYPE:
WORK 114 window 1 door replacement non structural.
SCOPE
Ifeck Pian Check Pluu,b, i'Irrn Check Elec.r?nq Chsck
;Lfech. rerun:i',x: Plun:h.Permit Pee: &ler. Perrin Fee:
1.'77hia ;l f,.•h.hap, 014")11/-vurh G;..p. Other Elea Lrsp. El
Mech.lnep. Fee. Plumb. fndp.L-'rr: Liles.Le,cp. 1'ee:
NOTE: This estimate does not include fees due to other Departments(le. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the relhrina information available and are onlv an estimate. Contact the De t or addn7 into.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/1 U FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 57 # Window/Sliding Glass Door
Suppl. PC Fee: (E) Reg. OT 0.0 hrs $0.00 $522.0011 WINREP IReplacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
('I,enWrnotiun nix:
Adminisirali1v Feet: �
Work Without Permit? O Yes (E) No $0.00
Advanced Plannine Fee. -Residential$0.00 Select"NonE)
Trdve l Domunenfatirm Fees„ Building or Structure
Strong Motion Fee: IBSEISMICR $0.84 Select an Administrative Item
• Blde St ds Commission Fee: IBCBSC $1.00
t! i o iii v SUBTOTALS:
$1.84 $522.00 TOTAL FEE: $523.84
Revised: 12/04/2011
RESIDENTIAL PROJECT COVER SHEET
Assor's Parcel Number:
,
Nairofowner. -1AS�� a SWAM ��Af�
Prof;#ct address. 2 1 - 6 y C C (L-4 t ti o CA , C( S o t 4
Contact person. F�4 r � r��^ Phone. 2 a q - L( Z_ _cc��n"� v
Fax. 2 o Q
Net square footage of lot. m
Existine Proposed O
Square footage: First floor: n
Second floor: z
Garage: CA
TOTAL: _
Are there at least two 10 foot by 20 foot clear spaces inside the garage? C —4 r
Is privacy protection planting required for the project? Y N m T
Be it Green Total Points \ O N i
zo �T
On what floor(s) is work being done? 0
Brief description of work.W tt,3 bou-;> d- o o(L_R.c p�I ac F rJ { L{ ww rJc�,�
Nct� L,+(L-Ork0 = I gcNP-cbAA 4nt-F�,J '? otn Cu a..-mac, C0E . v
r (LP?otJ
Code editions: 2010 CBC N)2010 CFC (Y-N)2010 CMC (Y-N) p1
2010 CPC (Y-N)2010 NEC (Y-N)
California Green Building Standards Code 2010
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO -
Eif'ective 1/01/11 APPROVED
This set of plans and specifications MUST be kept at the
lob site during construction. It is unlawful to make any � n
changes or alterations on same,or to deviate L��n
therefrom,without approval from the Building Official, RJ -
be
The stamping of this plan and specifications SHALL NOT Fjl!
held to permit or to be an approval of the violation v
Of any provisions of any City Ordinance or State Law, C �1 10BY ��2.�j D��
DATE
PERMIT NO.
Plan Review Process Work Book Page-8- Revised 12/21/10
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