07080066 CITY OF C",UPERTINO
BUILDING DIVISION PERMIT
PERMIT NO,
BUILDI1y�i,�4nQ{ 1:MC CLELLAN RD RAM NAMITA 07080066
L�J PERMIT ISSUE DATE
OWNER'S NAME:
RAM NAMITA 1 20681 MCCLELLAN
SANITARY NO. CONTROL NO.
IE:
BUILDING PERMIT INFO
ARCHITECTfFNGINEEX: BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION Job Description
O
� I hereby affirm that I am licensed under provisions of Chapter 9(commencing /
L) with Section 7000)of Division 3 of the Business and Professions Code,and my license is CONVERSION OF l E) 1/2 BATH TO FULL BATH
in full force and effect.
z License Class Lic.N
Date Contractor
ARCHITECTS DECLARATION
l understand my plans shall be used as public records
U
yLicensed Professional
a OWNER-BUILDER DECLARATION
2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
to following reason.(Section 7031.5.Business and Professions Code:Any city or county
Ii which requires a permit to construct.alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Ll 4 O O O
m (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.2 that he is exempt therefrom and the basis for the alleged exemption.Any violation of A Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 916 0 0 9 . V
not more than five hundred dollars($500).
D I,as owner of the property,or my employees with wages as thew sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvement are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.)
;`� owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors L-
cane Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am ext under Sec ,B&P C for this reason
Owner _Date
1 1104
I iP.E
WOR KFRS CONSATION DECLARATION
I h!reby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
D I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person i any manrtr f�q abt apo}subject to the Workers'Compensation
Laws of Califomi arc r 11�1 / 1(..� II
Applicant
NOTICE TO AP alYcr ma' g this Ccrtiliwtc of Exemption,you should
become subject o c Worker's Compensation provisions of the Labor Codc,you must
Oforthwith comp with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
4 I hereby affirm that there is a construction lending agency Cor the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
7 QLender's Name
4 Z Gender's Address
Q 1 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
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments,costs and expenses which may in any way accrue against said City - 3
Z in consequence or the granting of this permit. Date
►� APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued 1)y:
SOURCE R UL,tT ONS.
cF- Re-roofs r
Signature f pplioant/Contractor Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)7 All roo Fs shall be inspected prior to any roofing material being installed.
DYes If a rocf is installed without first obtaining an inspection,I agree to remove
Ut
Will the applicant or future building occupant use equipment or devices which
nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? .
D Yes u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building _
does not.currently have a tenant,that itismy responsibility to notify the occupant of the Date
rcqu' mens which must be met prior w issuance of a Ceniftcale of O r S ignatt re of Applicant
11—AAll roof coverings to be Class"B' or better
O n or authorized agent Date
CITE' OF CUPERTINO
c rroF PERMIT APPLICATION FORM
CUPEkTINO
Date:
PN4 - , clr
- 1C
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
(1 CJ'-' -� Z� `12- 4 �,
License #
Contact: S 1 Phone: Cupertino Business License#:
,a�-t ►C(�n H Fax: �r4 Z S E1 _(tS_
Building Permit Info:
Bldg L3'� Elect L' Plumb CA— Mech ❑
fz
Job Description: (_C "A v�-�r,-\, f� .fix �� f , ,�� � i��-:.Gt%�
Commercial ❑
Residential
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
4C �.c 3
Type of Construction: Please check this box if the project is a
El
second-story addition:
roject Size: Standard 10' Large El Mai or ❑
Quantity Fee ID Yee Description Fee Group
BAPPLOTHER Cther Appliances MECHANICAL
BBOILERI Boi.er<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boilei > 1M to 1.75 M Btu MECHANICAL
BBOILER5 Bailer> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH lintel and Motel BUILDING
BCONSTAXR Cor.stax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
/ BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
SC- a_
Project: Conversion of/2 bath on ground flocr to a full bath.
Location: 20681 McClellan Road, Cupertino,C;A,95014
se currently has 2 full baths and a e2
Description: The houbath
ealize that i nssaferon the grourforSince
we have parents and grandparents visiting us,ill the time
them to occupy the ground floor bedroom instead of having tbo g Thean'w bathroom will
This would
require us to change the 1/2 ba m ana he existing hallwafloor to ay.
be accessible from the bedroom
The bath is a standing shower. All the compo sents�of the shower
1lare prefab to save time e
and problems. The floor will be repl"ove.-I M ' �•"'i
tile will be laid out on 1/4 inch thick wonderbc and until 5' height. On the floor the tile will
be laid out on 1/z inch thick wonderboard.
To make space for the bath two closets are boing removed. There are no main beams or
joists that are supported by these closets.
ASSESSOR CO , �,
Ilk
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CD
ajUw A y
Project: Conversion of V2 bath to full bath
Address: 20681 McClellan Road Cupertin,),CA,95414
Existing Layout
9 tt
30
o `lL c,4 cl-low
L7 d`Y� ih
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CD
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t
60 etA�,
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Project: Conversion of 1/2 bath to full bath
Address: 20681 McClellan Road Cupertir.o,CA,95014
Proposed Layout __�
�GGQ a- a
Project: Conversion of 1/2 bath on ground floor to a full bath.
Location: 20681 McClellan Road, Cupertino,CA,95014
Description: The house currently has 2 full baths and a %2 bath on the ground floor. Since
we have parents and grandparents visiting its all the time we realize that it is safer for
them to occupy the ground floor bedroom i astead of having to go upstairs. This would
require us to change the 1/2 bath on the ground floor to a full bath. The new bathroom will
be accessible from the bedroom and the exl'sting hallway.
The bath is a standing shower. All the com_)onents of the shower are prefab to save time
and problems. The floor will be replaced b� bile a.:d 91.1-v:µ=.:,::i=:::..►.c Clic%."A- 5'. T".c
tile will be laid out on 1/4 inch thick wonderboard until 5' height. On the floor the tile will
be laid out on %2 inch thick wonderboard.
To make space for the bath two closets are being removed. There are no main beams or
joists that are supported by these closets.
ApPRO V 1 L)
tN RCCORDA ANDE WITH TO
OR
COPERTINO COO"
?
DATE .�.._..--•-----•".__. � �. ,�'
J
This sel a{ gin'.; !'
ve pr cn x.
lawful to
_�
rsn same r'. , , {'' V r:t '; l , },13 VV ]
the bur', l,g 4;.rt., -' ni ,ti+
The stamP(Iy, rr,t ,;r t� t'
SHALL NOT to '-" t p�
viclatu;;n ofi any t%r'}J
d�proval of the
,,"
it anv City
Pcw�•.
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DID
Project: Conversion of V2 bath to full bath
Address: 20681 McClellan Road Cupertin o,CA,95014
Existing Layout
S y
30,,
to-Ait
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.ti
az
t .qI(Ac
l 1 Q f¢0(,
L
Project: Conversion of/2 bath to full bath
Address: 20681 McClellan Road Cupertbio,CA,95014
Proposed Layout Y_�
OWNER-BUILD ER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A ✓All the work authorized by this permit
B. — A portion of the work
C. — None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hir(d to do:
A. _ All of the work
B. — A portion of the o,ork (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(,;) other than my immediate family to perform all or
portions of the authorized work. I understwid that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Perso irnt Address/City Phone Number ;;rerformed
e of work to be
..............................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side). /
Property Owner's Signature:
Date:
' ' I i{�1 L( �C��-,/` Ie vl� i lc�'E?z tZ7 i 1��iPermit#
Job Address: 20 �-
Any changes to the information provided on this form shall be submitted to the City of Cupertino Buil
Department.