12030029 1
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRES.S: 10109MELLOPL CONTRACTOR:AVA CONSTRUCTION PERMIT NO: 12030029
OWNER'S NANIE: N.ARAYANAN HARIHANAN S AND SUJATHA V .20689 FORGE WAV UNIT 202 DATE ISSUED:031062012
OWNER'S PHONE: 5082528117 CUPERTINO,CA 95,014 PHONE NO:(408)387-0999
I
❑ LICENSED CONTRACTOR'S DECLARATION [ ❑ r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clots— Lie.9 9 41 !5e-) r r r
M1IECH RESIDENTIAL COMMERCIAL
Crnu2ctor�yA_�png�Ir��Date� - 6 - ► Z
1 hereby affirm that 1 can licensed under the provisions of Chapter9 •JOB DESCRIPTION:REPLACING INSULATION IN ATTIC,FLOOR&.WALL
(commencing with Section 7(100)of Division 3 of the Business&Professions
Code and that m) 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 cert ificale of consent to self-insure for Worker's
Compensation.as provided for by Section 3700 of the Labor Code,for the
performance of Ilse work for which this permit is issued. Sq.Ft Floor Area: Valuation:58000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die wort:for which this
percuk is issued. APN Number:36905031.00 Occupancy Type:
APPLICANT CERTIFICATION
(certify dna I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and sate Imus relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above meatiooed property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indenmiN and keep harmless the City of Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,anti expenses which may accrue against said City in consequence of the
grinning of this permit. Additionally,the applicant understands and will comply /J/
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: /�9�✓ /IADate: 3 - 7• /,P—
9.13. n
Signature s ate
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall to inspected prior to anv roofing material heimg installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from lite Cmuracmr's License Law'for one of inspeclion
tine following two reasons:
h as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant: Date:
mill do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I.as owner of the proper,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044.Business&Professions Code).
1 hereby aftirin under penalty of perjury one of the followinggdmree HAZARDOUS MATERIALS DISCLOSURE
deciaradous: 1 have read the hazardous materials requirements under Chapter 6.950f the
1 have and will maimain a Certificate of Consent to self-insure for Worker's California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for die compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
performance of the work rix which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will i ainlain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which each hazardous air
Section 3700 of the Labor Code,for tine performance of the work for which this coutaminants as defined by the Bay Area Air Quality Management District I will
pennil is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and(tie
Health&Safety Code Sections 25505.25533.and 25534.
I certify that in the performance of due work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to(tie Worker'sOwner o•authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I /��t�
become subject to the Worker's Compensation provisions of the labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRITC.-HON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I cenify that I have read this application mid state that the above information is Lenders Name
correct.I agree to comply with all city mid comity ordinances aid state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of'Cupenino against liabilities,judgments. ARCHITECT'S DECLARATION
costs.and expenses which may accrue against said City in consequence of the
granting of this Permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source reeulatiois per the Cupertino Municipal Code,Section
218. Licensed Professional
Signature Date
1
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRES.S: 10109MELLOPL CONTRACTOR:AVA CONSTRUCTION PERMIT NO: 12030029
OWNER'S NANIE: N.ARAYANAN HARIHANAN S AND SUJATHA V .20689 FORGE WAV UNIT 202 DATE ISSUED:031062012
OWNER'S PHONE: 5082528117 CUPERTINO,CA 95,014 PHONE NO:(408)387-0999
I
❑ LICENSED CONTRACTOR'S DECLARATION [ ❑ r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clots— Lie.9 9 41 !5e-) r r r
M1IECH RESIDENTIAL COMMERCIAL
Crnu2ctor�yA_�png�Ir��Date� - 6 - ► Z
1 hereby affirm that 1 can licensed under the provisions of Chapter9 •JOB DESCRIPTION:REPLACING INSULATION IN ATTIC,FLOOR&.WALL
(commencing with Section 7(100)of Division 3 of the Business&Professions
Code and that m) 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 cert ificale of consent to self-insure for Worker's
Compensation.as provided for by Section 3700 of the Labor Code,for the
performance of Ilse work for which this permit is issued. Sq.Ft Floor Area: Valuation:58000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die wort:for which this
percuk is issued. APN Number:36905031.00 Occupancy Type:
APPLICANT CERTIFICATION
(certify dna I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and sate Imus relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above meatiooed property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indenmiN and keep harmless the City of Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,anti expenses which may accrue against said City in consequence of the
grinning of this permit. Additionally,the applicant understands and will comply /J/
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: /�9�✓ /IADate: 3 - 7• /,P—
9.13. n
Signature s ate
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall to inspected prior to anv roofing material heimg installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from lite Cmuracmr's License Law'for one of inspeclion
tine following two reasons:
h as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant: Date:
mill do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I.as owner of the proper,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044.Business&Professions Code).
1 hereby aftirin under penalty of perjury one of the followinggdmree HAZARDOUS MATERIALS DISCLOSURE
deciaradous: 1 have read the hazardous materials requirements under Chapter 6.950f the
1 have and will maimain a Certificate of Consent to self-insure for Worker's California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for die compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
performance of the work rix which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will i ainlain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which each hazardous air
Section 3700 of the Labor Code,for tine performance of the work for which this coutaminants as defined by the Bay Area Air Quality Management District I will
pennil is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and(tie
Health&Safety Code Sections 25505.25533.and 25534.
I certify that in the performance of due work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to(tie Worker'sOwner o•authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I /��t�
become subject to the Worker's Compensation provisions of the labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRITC.-HON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I cenify that I have read this application mid state that the above information is Lenders Name
correct.I agree to comply with all city mid comity ordinances aid state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of'Cupenino against liabilities,judgments. ARCHITECT'S DECLARATION
costs.and expenses which may accrue against said City in consequence of the
granting of this Permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source reeulatiois per the Cupertino Municipal Code,Section
218. Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10109 Mello Place DATE: 03/06/2012 REVIEWED BV:
APN: BP#: "VALUATION: $8,000
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE:
WORK
SCOPE
Aferh. Pbn;Chick Plumb. Plan Clrack Flew Plan Check
: ftch. Permit 1•'6e. Plunih,Parton Fee. F_hc. Permh Fte:
ofhe,-It-vil.Irnp. tither Phunh Grsp. Li I Ofher Floc Imp. Li
41,h /ny. Fee, Plumb.Insp.Per. Flee.Inyr.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public(Yorks. Fire,Sanituy Sewer District,School
District,etc.). These fees are based on the prelininan iu ornafion available and are onk an es inale. Contact the De t oraddn'I info.
FEE ITEMS (Fee Resolution 11-053 ER 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: G) Reg. Q OTFO-OThrs $0.00 or Element of a Building
PN4E Plan Check: $0.00
Permit Fee: Hourly Only? Q 1'es E) No $0.00
SuppL Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax
Adnlimismatire Fee- O
Work Without Permit? O Yes (j) No $0.00 (D
Advanced Planning Fee: $0.00 F1 hours Inspections 0
Tr.nul Documentation Fees $130.00 ISTiNSP Inspection, Hourly
Strong Motion Fee: IBSEISHICR $0.80 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 1ADA17N
SUBTOTALS: $1.80 $171.001 TOTAL FEE: 1 $172.80
Revised' 1/19/2012
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36905031.00
DATE ISSUED. . . . . . . : 03/06/2012
RECEIPT #. . . . . . . . . : BS000016204
REFERENCE ID # . . . : 12030029
SITE ADDRESS . . . . . : 10109 MELLO PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NARAYANAN HARIHANAN S AND SUJA
ADDRESS . . . . . . . . . . : 10109 MELLO PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AVA CONSTRUCTION
CONTRACTOR . . . . . . . : KAMRAN ASLANPOUR LIC # 32078
COMPANY . . . . . . . . . . : AVA CONSTRUCTION
ADDRESS . . . . . . . . . . : 20689 FORGE WAY UNIT 202
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 387-0999
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ------—-- ---------- ---------- ---------- —--------
-ADMIN HOURS 1 .00 41 . 00 0. 00 41 . 00 0 .00
1BCBSC VALUATION 8, 000 .00 1 . 00 0 .00 1 .00 0 . 00
1BSEISMICR VALUATION 8, 000.00 0 .80 0 .00 0 .80 O .b0
1STINSP UNITS 1 .00 130 .00 0 .00 130 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 172 .80 0. 00 172 .80 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------
CASH 0 . 30
CHECK 172 . 50 #2934
---------------
TOTAL RECEIPT 172 .80
Prescriptive Certificate of Compliance: Residential CF-IR-ALT ,
Residential Alleralianc Pu e 1 of 5)
Project Name: A� Climate Zone q H ofStories
General Information
Site Address: Enforcement Agency:(r.P,e�Trn/0 1
Dau: 3. b .
Building Ty Single Family ❑Multi Family Circle the Front Orientation:NC S,W,or degrees
Conditioned Floor Area(CFA): Prgiect Type: Alterations nvelope Fenestration Roo( HVAC
Re lacemem or Chance Out Duct Replacement Water Heater
NOTE: This form is not m be used for Neu,&Constructed Buildings or Additions
Insulation P'aluet'For Opaque Surfaces(for Furring use the Alass and Furring Strips Construction table below)
Assembly Alteration
❑Opening of fraaud cavity alone-Alterations that involve the opening of the framed cavity ofa mall,ceiling,orfloor must install the
umndawri,minimum insulation valueper§/i0for the altered assenhbhv Fill in Column A-C andenter mandatary insulation value in Column H.
❑Replacement of entire assembly-Replacement ofan entire mall,ceiling,orfloor assembly requires the installation of Component
Packa e-D insulation vahaes in Table 191-C. Fill in Colanns A-J.
O ague Surface Details For the furred porlioned of Mass)Valls see Furring Stri s Construction Table below'.
A B C D E F CII I T J
Pro maed °" Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Ta e,J Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
IDS or Tv ¢ and Size' or Other' factor' Number' R-value R-Value' Row'/Col" U-factor'
r or-7_—Zn/C .0 O
a u5 / 1
3 0 •/
Note:For furred assemblies,accounting for Continuous insulation R-value,see Page JA4-3 and Equation 4-l. For calculating.furred walls use the Alass and
Furring Constmcnon table belom
1.For TagliD indicate the identification rmme that marches the building plans.
1.Indicate the Assembh•Name or rave:RoofiCeiling, (Palls,Floors.Slabs.Creel Space. Doors and etc...Indicate in coliom G the Frame
material and size:Far Ir luml.Afetal:A4eral Buildings.,Nass.enter 2x4,2x6,or etc-.see JA4 for other possible frame type assemblies.
3. Etter the thickness for mass ininches or Spacing benreen finning members enter; 16"or 14*'OC;or Other for all other assembly description
such as Concrete Sandheich Panel,Spandrel Panel, Logs,Strain Bale Panel and etc....
4. Based on the Cliurate Zone;enter the equivalent U factor fmmd in JA4 Table based on the R-I•alue from Table/it-B.C,or D
?. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R-value that is being installed in the wall Cavin,or benreen the framing;otherwise,enter "0".
7. Enter the Continuous Insulation R-value for the prolmsed assembly;otherwise,enter
S.Eater the row and column of the U---ardor•value based on Column F Table Number and enter the Assembly U factor in Column J
9.The Propased Assewbh LI-factor,Column J must be equal to or less than the Standard U-factor in Column E to comph.
Furrin Strips
Construction Table for!`lass Walls Onlv
A B I c I D I E F I G I D 1 .I 1 .h L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
JointAppendix Table 4.3.5.4.3.6,4.3.7 Joint Appendix Table 4.3.13
_ 4 _
G n• C yU, u '�' `o Je � x.2o UCn
u
inalAsembhF
Mass Name or JA4 Table Assemble
Thickness' Tvpe' Number' c - " ' - ' i j = ' U-fnctor'•' Comment
to
Regisuntion A'urnber: Registration DoteuTime: HERS Prnrider:
2008 Residential Compliance Forms Ala rqh 2010
123 0 �zs'
GENERAL PERMIT APPLICATION /
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION M E P �,
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
MI
^ /�
CUPERTINO (`08)777-3228• FAX(408)777-3333• buildinc(cDcuoertino.ora v\ (v'
❑PLUMBING ❑MECHANICAL ❑PTFCTAICAL ❑MLSCELLANEOUS
PROTECT ADDRESS l O {D/��I K//0
P/7acc AINI �l )/��3 f �y�� /•�,.
OWNERNAMZ lrr ►�/aI a aP1nN/1 PRONE(408)V-5-2-1117 E"' na ra a@ PW4 .CAM
==ADD= !O I o ^ /.O //l�C CRY.STAT'E`NZ�G ,K/ `�'1, f J V t FAX
CONTACT NAM.. C (Q ehe, \ PRONE�OC�
-9.5w-966A E� J p,VA—COnSd 10�1-(c,,,
STREErADDRESS No• e!S a Y2,(,Wr216 CITYSTATEzm 6V�erl~r�o95o1 4oa _969- )Gtia
❑ owuEn ❑ Ow -BORDER ❑ 0w, AGENT ❑ CONRAC DR e mwr, CTOR AGENT ❑ ARaarEcr El Evcwm 11ev
DeoPR ❑
CONTRACTOR NAME K4 H1 rAh Ian r LICENSE NLTI 9E (�) LICENSE TYPE nus.LIC'Yr G .
COMPANYM&ME V4 [(415111ZXiC;fial�h
STREITADDRFSJao F� ' vcEnY.rAkT2a.M �@-N7a)vWL-µce►i1
sfi5ru0�14 ;►; 408`-W�6-q--6l5z
ARcutECTiENCDEFa NAME
LICENSE NUMan 6
EUS.uc a
CO..WA.NY NAME' , E-MAE. FAX
SiR..c1 ADDRESS CITY,FATE.ZIP PHONE
USE OF SFO w[1UPIFX ❑ MALT:-FA Y PROJECT IN Wn DLANO ❑ TES PROJECT IN ❑ YEs M THE BLOG AN ❑YES
RUIDWO: ❑OO�Q URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0N ECHLAHO.Nn. 0N
DESCR=ON OF WORK 1-b 1
TOTAL VALUATICN: GODS -- RECErvED BY:
By my signamme below,I certify to each of the fbilowing: I as rhe property owner or autSorized agent to an,on the property owner's behalf. I have read this -
application and Lie information I have provided' cm L�have read the Descpton of Work and verify it is accurate. I agree to comply wid:alI applicable local
ord'mahc:s and sa :laws relating m building constrn on. [author.=represeatauves of Cupertino to enter the above-idea/tilled property for inspection pu4poscs.
Signature of AppEcanUAgenc 6
SUPPLEMENTAL INFORMA-MN REQUIRED OFFICE USE ONLY
m' OVER-THE-COUNTER
F ❑ EXPRESS
Y
U
❑ STANOARo
U
Z ❑ LARGE
3
L ❑ NAJOR
MPPM1re9pp_1011.doc revised 06/21/11