10070194 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10490 SAN FELIPE RD CONTRACTOR: DHARTI AND CHIRAG PERMIT NO: 10070194
PATEL
OWNER'S NAME: DHARTI AND CHIRAG PATEL 10490 SAN FELIPE RD DATE ISSUED:07292010
OWNER'S PHONE: 4089103220 CUPERTINO CA.CA 95014-3978 PHONE NO:
❑ LICENSED CON'I'R,%CL'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT (- PLUMB r
License Class Lic.q
\IEC{1 RESIDENTIAL AINIE RCLAL
Contractor Dale
hereby affirm that I am licensed under the provisions of Chapter 9 •JOB DESCRIPTION:NEW T P'
(commencing with Section 7000)of Division 3 of the Business& Professions
Code mid that nay license is in full force and effect. O`
1 hereby affirm under penalty of perjury one of(lie following two dcehtrmions:
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 pemtit is issued. Sy. Ft Moor Ar v V valuation:55000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 oflhe Labor Code,for the performance of the work for which this
permit is issued. ANN Number:34244023.00 OccupancY T pr.
APPLICANT CERTIFICATION
I cenify that I have read this application and state that the above intra nation is
correct. l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property fur inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the bty of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this pemtit. Additionally,the applicant understands and will comply -1
with all non-point source regulations per the Cupertino Municipal Code,Section Issued I Date-L ee-A'U
9.18. 1
Signature Date
RE-ROOFS:
OWNER-BUILDER DECLARATION All roots shall be inspected prior to any roofing material being installed.If roof is
installed without first obtaining an inspection,I agree to remove all new materials for
hereby affirm that I am exempt from the Contractor's License Lary for one of inspection.
[lie following txvo reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sm.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed cnactors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETPER
construct the project(Sec.7044,Business S.Professions Code). Or
-
1 hereby affrru under penally of perjur one of the folloxring three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read Ilse hazardous materials requirements under Chapter 6.95 of
I have and will maintain a Certificate of Consent to self-insure I'or 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 the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
performance of the work for which this pemtit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Qualiy Management District 1 will
Maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. health&Safety Code Sections 2q505,1553 and Y 34.
I cenify that in the performance of the work for which this peril is issued,I shall
not employ any person in any manner sons to become subject to the Worker's Owna for .ed ei
ns7 v� /!1
Compensation laws of Cali fomia. If,after staking thiscener ificateofexempu ,I e. V
_Dat -/
become subject to the Worker's Compensation provisions of the IaborC I rust
forthwith comply with such provisions or this pemtit shall be deemed r o zCONS'IRUCI'ION LENDING AGF.NCI'
I hereby affirm that them is a construction lending agency for the performance of work's
APPLICAN F CERTI F'ICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and slate that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep hamtless the City of Cupertino against Iiabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCIHTECF'S DECLARATION
granting of this peril Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records,
with all non-p so me regulations per the C -vino Municipal Code, eelimn
9.18. Licensed Professional
Signalu c Date t
IA-
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APPROVED
IN ACCORD, NCf WITH THE CITY OF
OL"L-G-Af.�.eRDWANCES---
• DATE—
SIGNED
ad-speefficatiams-MUST—
be kept on I a job alall times and it is
unlawful to met i ny c4"es or altbratjons_
the Building DEa]"Injem,City Of Cupertino.
The stamping o !!j!jLjI,,n aO&specdj,4,tjOs
-
-SHAEC F1tT held to pemil or to be an
approval of in( violation of any Provisions
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CL a 0490 SAN FELIPE ROAD, CUPER�T.INO; 404p10
i.i Ld NELSEN ENGIN
p a ¢ SEPTEMBER 2008
u w w
10300 Torre Avenue
Cupertino, California 95014
Telephone: .(408) 777-3308
FAX: (408) 777-3333
COMMUNITY DEVELOPMENT
CUPERTINO
1
FENCE APPROVAL
ATE)
I am an adjoining property owner of
AME) n QA/�
Whose property is located at �b �� 1 l �Z • V �1 �� QA
(ADD )
I appr
o
ve
(per Section 16.28.040 of the Cupertino Municipal Code) the allowance of a
�'`'t foot high fence facing my property.
(8 Fr.MAXIMUM) .
SIGNED: 7N
Name: A//C
_ I
Address:
GAP1aMingWppformTencelFence Apprwol Form.dao Updmed 713/1007
II
I
0
10300 Torre Avenue
Cupertino, California 95014
Telephone: .(408) 777-3308
FAX: (408) 777-3333
COMML MTY DEVELOPMENT
CUPERTINO
FENCE APPROVAL
U(DA" �IE?, 9vl,
I am an adjoining property owner of TA I 6 JCI, ?PCT
(NAME)
whose property is located at 6_"o sg�� Fti dj
04
(ADDRESS)
° Sat4
I approve (per Section 16.28.040 of the Cupertino Municipal Code) the allowance of a
Tfoot high fence facing my property.
(8 Fr.I aIAXM ,4)
SIGNED:
Name: •RA1,0-70 V
Address:
G.1P1.mbWUppfomWe=e1Fmee Approval Fwm doc Updated 7W--007
10300 Torre Avenue
Cupertino; California 95014
Telephone: .(408) 777-3308
FAX: (408) 777-3333
COMMUNITY DEVELOPMENT
CUPERTINO
FENCE APPROVAL,
2 ti
(DA )
I am an adjoining property owner of-CH I I/
/ �1 p�
(NAME) ifYL71✓u CA
whose property is located at to l l
(ADDRESS) 'Fro I L�
I approve (per Section 16.28.040 of the.Cupertino Municipal Code) the allowance of a /
foot high fence facing my property.
(8 Fr..MAXIMUM) .
' l
of rr�Q-�
SIGNED: ; n '
Name: ZZ 9q�Y
Address: ZZ A
(avww-4im(D rg, (7I V�
G:V1am mgUppfo mVCncelFeace Approvo!porm.doc Updamd 7/312007
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 'VALUATION: $5,000
*PERMITTYPE: Building Permit PLAN CHEICK•TYPE: Alteration /Addition /'Repair
PRIMARY SFD or Duplex OVER THE APPLICATION !GENRES
USE: COUNTER. O Yes � No "I VPE: d
MECHANICAL Q Yes Q No 13LUMBINC: Q Yes Q No ELECTRICAL Yes No
rY L
0
U
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE 11) BP FEES BP FEE 11)
CONSTR. (s .fl.)
TOTALS: 0 $0.00
,Llech.Plan Cherk Plumb.Plan Check Dec. Plan Check
Adech. Permit Fee: Plumb. Permit Fee: Elce.Permit fee:
Other Me& Insp. Other Plumb.hup. Other rhm./ncp.
NOTE: These fees are based on the prefitninarl,information available and are atrlp an ectittmte. Contact the Dept for addit'I in o.
FEE ITEMS (Fee Resolution 09-OSI LT 7111091 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 0 11.f. Fence
Suppl. PC Fee: e) Reg. O OT 0.0 its $0.00 $0.00 Fence, Non-Masonry>6'
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. O O'1' 0.0 1 hrs $0.00
PME Unit bee: $0.00
PML Permit Fee: $0.00
Construction Tax
Acoustical Fee: Q Yes Q No $0.00 Q
Work Without Permit? Q Yes (' No $0.00
Planning bee: $0.00 Select a Non-Residential
'!'ravel Dwu nteantation bees: Building or Structure
Strong Motion Fee: 18SEIS,VICR $0.50 1.0 [its Standard Hourly Rate
Bldg Stds Commission Fee: PRCRSC $1.00 $126.00
SUBTOTALS: $1.50 $126.00 TOTAL FEE: $127.50
Revised: 7/27/2010
.��/�r-
- --
'
OWNER-B0lLDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT^BUILDING DIVISION
103O0TORREAVENUE^CUPERT|N0. CA35814'3255
(*V8)77T'3228^ FAX (408)7T7'3J3J"
CUPERTINO �
DeuProperty[)wmer($: listing rse|�as�ho�hui|dero�UhePruP".`'
Aoapp|ina�onfor abuilding permit has been submi8odinyour namonnQyu�
improvements specified at:
OWNER 1111E OINER,,A�WESI -/4/0
VVua«uproviding you with an Owner-.Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilitieshmay
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form tousaour\ official address indicated. Anagent ofthe owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.OWNER'S ACKNOWLEDGMENT AND VERIFICATION
F INFORMATION
(D7RETIONS:Please read and initial each statement below to sightly you understand or venry this information.)
'
. | understand 6frequent practice cfunlicensed persons is tuhave the property owner obtain onownur
»u/mebuilding permit that erroneously implies that the property owner is.providing his or her own labor and material
pe/s"/
a||y | as maybuhe|d |iab|�andsubieu\1nuohouo�finanuia| riak{urunyinjuhossuatoinodhy
an unlicensed" puronnandhisorh'remp|uyoonwhi|owurkingonmyprupoAy. yWyhonnenwne/oinsurance nooynu�
pioI am acting as an Owner-Builder and am aware of the limits of my `
ins r:nce coverage for injuries to workers on my
I understand building permits are not required to be signed by property owners unless they are responsible for
Zonstruction 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
rmit filed in his OF her
otect myself from potential financial risk by hiring a licensed Contractor and having the pe
Ina a instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
nbers on permits and contracts.
5. 1 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 m6terials, I may be
co n sHered an ..employer. under state and federal law.
46. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
fedral 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
a )serious financial risk.
7. 1 und erstand under California Contractors' State License Law, an Owner-Builder who builds single-family
re
re idential 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
med under contra
Owner
if| sell the property for v/mc
any finanumorpersonal r�v//� � nnnmpunm�u /u^uxu, / ../u� v� ..�~ """.^ .".
~^~ ~` `�i -��s�sustained���nndbyunysubsequon�m*nor(n)Uhatresu|thnmany|atontuonnhnction
defects inthe workmanship nrmaterials.
5�,�8x/��,��,n,_J01V&ncno�oJ0�Y4V0
_---- __ `- -`
{ l/ u | understand | may obtain more information regarding my obligations "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)ori www.cslb.Ga.gov for more information about licensed
-41 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
m 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
y I applicable laws and requirements that govern Owner-Builders as well as employers.
2. 1 agree to notify the issuer of thisform immediately ofiany additions, deletions, or changq�toany of the
i for ation I have provided on this- folrm. Licen'seid' contractors"are�egiulgted by laws desi�ned to protect the public.'If
you contract with someone who does not hdve a license, he Contractors'StatetLicense Board may J&unable to
assist you with any financial losi�you may'sustain as a re'sult of a complaint. Your only rem�d'y ag'ain'st unlicensed
Contractors may be in,civjI'c`06rt:It is also'important for you to understand th5t if e[nunficensed 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 whether or not
those Contractors are ponporlworkers' coververifyingage.
CONSTRUCTION LFNDING AGENCY
(u'ncC//O/vu:Pnauocomplete the following construction lending agency/hfjnnahonj
I hereby affirm that there is a construction lend6g agency for'the performance of the work for which this permit is issued
(Sec 3087Civ.)
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 6f 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 sign t 4
Property Owner's Signature: Date: 141
--- — -��--' --''- —�--'ti-o-n--F--o-
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(AK)7�� Thnb�0o*�kJAu0/on�a0Unfnnn/� ukn��ob----'�----' ---- -' - --'-- '�--� ---�'�---''—�—
/eq oxon.p�AyUby�hopn�pc�yowmernn/y*hondo�pne�noan---
agent
of the pn��o�yowner toapply for aoonsbouhonpermit for NoO*nopDuVoe�, ling
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Exclu'ding the Notice t6 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
0wner'Dui|derPennit for nnyproject. � '
Scope ofConstruction Project(or Description nfYVurk):
Project Location urAddress: '
�
Name pfAuthorized Agent: TelNo `
Address ofAuthorized /\gent:
| declare under penalty ofperjury that | anothe property owner for the address listed above and | personally fi||edout the
above infbrinaiionand certify its accuracy. Note:Acopy ufthe dyer's driver's license, /h pota�zabUoo/other
ve�Toationuooap[ah/eto /hoo�y/naybe/equ�ad/nbepnn�o �by .whon �hnpe0n/�/t/�ouod�ovo�` the po9�e�yowner's
signature.
^ _ ,,.�
Property Owner's GiQnatu Date:
CITY OF [0O70I
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN # 2 „ / , / 2, 3 Date: Z p 2-ol 0
Building Address:
a41 f o �S ,✓ F��,P� /20, C4. fly
Mailing Address (ifdifferent from building address):
Are hazardous Materials being used as part of this project? Yes ❑ No
HOA: Exterior work only Yes ❑ No IX If ves, provide letter from HOA
Ow er's NPhone #:
U tp-ame: iD 1108 - 910 - 3ZZo
Contractor: Phone: 4-10e — z/N 727�
Fax:
Contractor License #:
Cu ertino Business License #:
Contact: Phone:
Tax:
Residential Commercial ❑
Job Description:
zn , 7 '_ FEN GE.
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mcch ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ II/III 13, W414. V-B v 3
Valuation: C(� Square Footage:
Project Size: Express �tandard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEER Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditZLi:U .or
Revised 07/14/09