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12020031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20292 NORTHCOVE SQ CONTRACTOR:SRINIVASA YAKKANTI PERMIT NO: 12020031 OWNER'S NAME: SRINIVASA YAKKANTI 20292 NORTHCOVE SQ DATE ISSUED:02/08/2012 OWNER'S PHONE: 6502485446 CUPERTINO,CA 95014 PHONE NO: 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r IF-MECH:' RESIDENTIAL ' COMMERCIAL ' Contractor Date. I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TOWNHOUSE REMODEL,REPLACE THREE(3)SLIDING (commencing with Section 7000)of Division 3 of the Business&Professions D(X)RS Code and that my license is in full force and effect. &ONE(I)WIN DOW.REPLACE TUB AND SHOWER ONLY IN TWO BATHROOMS;NO ELECTRICAL,LIGHTING OR MECHANICAL 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 f6r which this permit is issued. I have and will maintain Worker's Compensation Insurance,,ts provided for by Section 3700 of the Labor Code,for the pert6rinance of the work for which this Sq.Ft Floor Area: Valuation:$5500 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31641073.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments. PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued bjr---� Date: 0- OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work.and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,as.owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&-Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Conipensatiom,as provided for by Section 37•00 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 [have and will maintain Worker's Compensation Insurance,ate 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(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that In the performance of die work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not em.ploy any person in arty manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safet•y Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent forthwith comply with such provisions or this permit shall be deemed revoked. ate. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and.keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulati(xis per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. ✓ I understand my plans shall be used as public records. Signature Date Licensed Professional RESIDENTIAL, PROJECT COVER SHEET Assessors Parcel Number: :.: Name of owner. Project address. ,NJ Contact person. v Y' ,> y, , Phone. > (71 Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: PMENT DE O ENT TOTAL: BUILDING DI1lI`a10 APPS Are there at least two 10 foot b 20 foot clears aces inside the garage? d rifications MUST be'kept a anat y Y P lads an FIs sot of'P la durinel construction. itsameaor to deviate 1q,b- Official. Is privacy protection planting required for the project? Y N&ar,'-�es or aiteraticnosat from the Building tt+errvtro►n,without app "oval and specifications SHANOT Build it Green Total Points Tr. �r �,� it of this approval of ttie violation r to hFn ' tate Law• mit o a3�� Cit Crdina ce or S ;ons of 1 ` , On what floor(s) is work being done? -- �' �'' -•� f Brief description of work. Code editions: 2010 CBC ( - N)2010 CFC (Y - N)2010 CMC (Y-N) ' t 1�, 2010 CPC (Y -N)2010 NEC (Y-N) s M,,K U l�t.Y L* L) ,� q C- California Green Building Standards Code 2010 Effective 1/0 1/11 i G-r �� r • ter=-� �ec^-a':_,�` ,L411. 6 G v Plan Review Process Work Book Page-8- Revised 12/21/10 PIT� 7 9 '5t,PT i j { v � i � 4 � j 1 ! 1 t •�� G 1 J S � t i a s f i ' Y t O r d .S r` r f 'r c� A ti' c` r i s" CIO v ..-f dNW.. l �4 J i3 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31641073 .00 DATE ISSUED. . . . . . . : 021/08/2012 RECEIPT #. . . . . . . . . : BS000015953 REFERENCE ID # . . . : 12020031 SITE ADDRESS . . . . . : 20292 NORTHCOVE SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SRINIVASA YAKKANTI ADDRESS . . . . . . . . . . : 20292 NORTHCOVE SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SRINIVASA YAKKANTI CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : SRINIVASA YAKKANTI ADDRESS . . . . . . . . . . : 20292 NORTHCOVE SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 500 .00 2 .00 0 .00 2 .00 0.00 1BSEISMICR VALUATION 5, 500 .00 1.10 0. 00 1.10 0 . 00 1STINS-P UNITS 2 .00 520 .00 0 .00 520 .00 0.00 1WINREP EACH 8 4 .00 392 .00 0. 00 392 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 915 . 10 0.00 915 .10 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 915 . 10 VISA --------------- TOTAL RECEIPT 915 . 10 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20292 northcove sq. DATE: 02/08/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: $ 0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration [' Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK townhouse remodel replace 3 sliding doors a one window. Replace tub and shower only in two SCOPE bathrooms, no electrical, lighting, or mechanical. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the erelinina information available and are o2iE an estimate. Contact the De glLor addn'l in o, FEE ITEMS 4, _.y£ t FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1= # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. 0 OT ®.Q 1 hrs $0.00 $392.00 1 UNREP Replacement PME Plan Check: $0.00 Permit Fee: Hourly Only? Yes 0 No $0.00 Suppl. Insp. Feer Reg. Q OT Eil hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 F-1 0 Work Without Permit? 0 Yes Q No $0.00 x ��z Ektn r .._. $0.00 2 hours Inspections ..._.._.w Y $200.00 I STrNSP Inspection,Hourly IBSE��s'�KC Select an Administrative Item IBCBSC $1do SUBTOTALS: $1 $652.00 TOTAL FEE: $653.50 Revised: 1/19/2012 NQRTHt OINT HOMEOWNERS ASSOCIATION PROPERTY MODIFICATION NOTICE Please indicate'below which modification(s) are planned for your property. Provide bmchure(s) if possible and a copy of any proposal(s), Including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval, Satellite Dish Installation has a separate form to be completed and submitted for approval. Noii coign 8e$tr1gt12ns aniRehr m!Rntss Air conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property, There will be no part of the unit visible to common areas. Installed by a licensed contractor. -v/ Replacement window/ ----- Must be same size aperture and Sliding door location of existing window or sliding SQ-m 5a door. Any necessary touch-up pai6ting is the responsibility of the Homeowner. Installed by a license contractor. Garage door Must be windowless and in conformity with general architectural style of the complex, Repainting to conform to exterior color scheme is responsibility of the Homeowner. Installed by a licensed contractor, Any damages caused to property as a result of modifications will be the homeow e ' responsibility. n r s p ty All prohibitions, restrictioms, conditions, and rights of the Association enurnereted under Article V of the amended and restated Covenants, Conditions and Restrlotions of the Northpoint Homeowners Association are applicable to modifications Contained herein, City permits may be required, Pp � Please Print in Homeowners Name(s); t 1 V Kti rJ J l Property Address: —,CL �_,� Ai,-)4-t& C„�c s 1 Phone; 6- Date of Notification:, 7��1 ._.._ Date of Completion: Homeowner has 6 months to complete the designated m � ificati nc�t..';in lt>ar�a ement u on project completion, °� ons and is responsible for 0 ce Use Only Notlfiaation received by., Corn� I � � D ' petion verified & a v ate;� . p ped �y. Data; Form adopted 8/10/1999 Revised 5/00 �t �l OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building(alcuoertino.orq CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS � J 2`1 Z N<,;c 1 [.0�� _y t.=-_ APN •.� �� 1 � BP# OWNER NAME _ OWNER ADDRESS DESCRIPTION OF WORK: r We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) i'�. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 12. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3' 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5r I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"under state and federal law. -4 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. i ` 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. � 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. 014,ne1'BuilderFo7-771 2010.doc revised 04/14110 I 9. I understand I may obtain more information regarding my obligations as an employer' from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that am t party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: "�— Date: 2-.7 y --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 0-wnei Buildei-Fonn 2010.doc revised 04/14/10 I CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333- building cDcupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION 2 ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# [ �� 1 4l y OWNER NAME �p•1 AOA PHONEC� i� 7 E-� 1� �!� 1c Qt N'i 2. STREET ADDRESS CITY, STATE,ZIP_, ` FAX Nr CONTACT NAMI��I N�i j I,I� �� l� .i.1- PHONE /- � E-MAIL y,A K KA tj STREET ADDRESS CITY,STATE, ZIPFAX 61 4 J VT ❑OWNER tA 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 N E-MAIL tN FAX STREET ADDRESS CITY,STATE,ZIP N, PHONE �1 DESCRIPTION OF WORK bah* S M'_. A 4.3.3�.1�► ill J�••�..LYa�Aw�r ri EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL bb �-• AREA AREA AREA -i J NET AREA A3 $ l 00 0 BATHROOM KITCHEN C'r OTHER ^� J Z500t , O REMODEL AREA,�f REMODEL AREAdl REMODEL AREA �"'� o�J PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA LJDETACH AATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED? WO ADDITION? 0 PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE IVED$y; Tr VALON: „w PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 5 O By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prppperty owner's behalf. I have 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 with all applicable local ordinances and state laws relating to bufldinA,construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: f 1 Date: 2- SUPPLEMENTAL SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition pe or OYER_THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to' ance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a c eted Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLic woRKs form if any Hazardous Materi re being used as part of this project. ❑ LARGE ❑ FMDEPT Copy of PI pproval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of I ding Permit application. . ❑ ENVIItONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11