12090122 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 1090 1IUNTERSTON PL CONTRACI'OR: ROYAL SERVICES PERMITNO: 12090122
OW'NER'S NAME: UTTAMCIIANDANI SANDEEP M 2253 MAYWOOD AVE DATr IssurD:09/13/2012
OWNER'S PHONE: 713623 1419 SAN JOSE, CA 95128 PIIONE NO:(408)972-2452
❑ LICENSIi)CONI'RAC`FOR'SDECLARATION
BUILDING rl:Rw'r INFO: RLuc r Ell l.eL T r PLUME,r
License Class Lic.H ❑ r r
MEcr RESIDENTIAL COMMERCIAL
Contractor Date
I''
1 hereby affirm that turn licensed under the provisions of Cha pier 9 .IOB DESCRII'ION: REBUII.D CIiIMNEY PROM SIIOUI,Dr-R UP
(commencing with Section 7001)of Division 3 of the Business S Professions
Code and that my license is in fall foree:md effect.
1 hereby affirm under penally 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 I-abar Code,for the
performance of the work for which this permit is issued Sq.Ft Floor Area: Valuation:$3500
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this �\I��•Number:36222036.00 Occupnnev'I'ypc
permit is issued.
APP LIC\N'I'CERTIFICATION
I certify that l have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to comply with all cityand county ordinances-,old state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (11'e)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City ol'Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this pcmiit. Additionally,the applicant understands and will comply Issued by: Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RF.-ROOFS:Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ O\\'NJc.k-IS1111.D1?H DECLARATION
hereby:dTirm nt ti1 am exengn from the Contractor's license La. far one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVE,R INGS TO BE CLASS"A"OR BE'IT R
I,as owner of property,or my employees with wages a;their sole compensation,
will do the work,and the structure is not intended or offered for sale(See.7044,
Business Y Prolcssions Code)
I,a;owner of the properly,am exclusive[),contracting with licensed contractors to HA7,ARDOBS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business R Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safely Code,Sections 25505.25533.and 25534. I will
1 hereby affirm under penally of perjure'one of the fallowing three maintain compliance with the Cuperlino Municipal Code.Chapter 9.12 and the
declarations: l le:lth S Safe[),Code.Section 25532(1)should I store or handle hazardous
I haveand will maintain a Certificate of Consent to self-insure Ibr Worker's material. Additionally,should 1 use equipment ur devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino M unicipaf Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by [tic Health S Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Owner or authorized agent: Date
I certify that in the performance of the work for which this permit is issued.I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califrmia. If,after making this certificate of exemption,I CONSTRIICIION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby a@rn that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
A I'1'L1C\NI'CERTI FICAIION Lender's Address
I certify that I have read this application and state that the above infomntion 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 ,\KCI I I'1'FCI"S DECLARATION
and keep harmless the City of Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1090 Hunterston PI DATE: 09113/2012 REVIEWED Bl': Sean
\ APi,N: 6PN: 'VALUATION: IS3,500
`PERMIT Tl'PE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY SFD Or Duplex PENTAAIATION 1CHIMNEY
USE: PERMIT TYPE: it
NYORK ' Rebuild chimney from shoulder up.
SCOPE
Alech, Man Check H...fb. Plan Cheek' Clee.Plan Cheeck
Merit.Pennit'Fwe: l'lanh.Permit Few: Elec.Permit Fee:
Other,18rh./mp. Othe•r Plumb Imp. Other Elec. /asp.
,blech. hisp.Few: Phanh. htrp. Fee: Elec. Insp. Fee:
NOTE: This csrintate docs not ineludefees due to other Departments(i.e. Planning, Public II'arkts, Fire,.Sanitap•Server District,School
Di.mricr,etc.). These feev are based on the prefindnan•information available and are onli-an estimate. Contact die Der for ad/ln7 info.
FEE ITEMS (Fee Resolution 11-053 FJT 71111!) FEE QTYIFEE MISC ITEMS
Plan Check Fee: $0.00 = # Chimney I Chimney Repair
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 5534.00 ICHMINESR Chimney Repair
RME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.S Reg. 0 OT p,p hrs $0.00
PML" Unit FCC: S0.00
PME Permit Fee: $0.00
Cansnvcrian 1 us:
AdIniniclrative_Fee: 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced planning rec. 50.00 Select a Non-Residential !�
Tnmel Dacumenmtiun Fu•a':
Building or Structure 0
Strong iMotinn Fee: ISSEISAHCR $0.50 Select an Administrative Item
Bldg Sids Commission Fee: IaCeSC $1.00
SUBTOTALS: $1.501 $534.001 TOTAL FEE: $535.50
Revised: 0710112012
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION _ 1
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ` /•./- (j 1
CUPERTINO (408) 777-3228• FAX (408) 777-3333• building Qccuoertino.org 1�l�VVL
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ RFVISIONYDEfERRED ORIGINALPERPUTO
PROJECTADDRESS 1^0,.' 0 rrE/ e im tl -- I APAY /
•
OWNER NA\IE � PRONE/I Y/ . -I�'9E F.-MAIL
VL2
STREETADDRESS
CITI', 5T,\TE ZIP FAX
.JWP"�S q �1�4✓�k .nil.,!- n t•-r 5-3ti
CONTACT NAME��y1,1 I y PRON�1\n q � EAIAIL
STREGLAODRFSS IoV�(v AL1 /IYr`D �v CITY,STATIE ZIP S�•-. FAS
❑OWNER ❑ OWNER-BUILDER ❑ ON:NERAGENT CO.NTRAMOR ❑CONrRAC URAGENT ❑ ARCHITECT Cl ENGINEER ❑ DEVELOPER ❑ TENANT
CO\TRACTOR NAS I n 610ENSE NUSIOER LICENSE T\'Pii RAS:LIC p
COSIPANYNAME CvLyLANIAL FAX
STREFr ADDRESS /l/) CITY,STATE.ZIP PHONE
ARCI II'I'ECI'IENGI.NEER NAME LIC6CSE NUMBER BUS.LIC e
COMPANY NASIE. E-SIAIL FAX
STREET ADDRESS CITY,$TATEZIP PHONE
DESCRIPTIONOF\VORK /„//
Uf /NY f u oc Ot cn
EXIST 'GUS PROPOSE USE DRIES
USE TYPE OCC. SQ.fT. VALUATIONS)
ESISTG NEN•,FIAOR r9t0 IOTAL
AREA AREA AREA NET AREA /m w, (f V{2 fJ
BATHROOM KITCHEN D11ER ,Y �•'
RFAIOOEL AREA REMODEL AREA RMIOOEI.AREA
PORCH AREA PECK ARBA TO AL DEC"'ORCII ARG GARAGE ARG: DETACH
ATTACH
•OWELLLNG UNITS: ISANErO SI)ILNTT O\'FS II:CUSn NIORY C]VES
IDDNf.AOal:nr 0 N AMITIOSI ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF LN 1'111:mACdS ❑YES RECEIVED 8 'i- - TOTAL\' LUATION;
PLANNING APPLe ONO PGNNING APPROVAL LETTER EICIILf:R IIII.I C' ❑NO 16�\
By my signature helo\v.I certify to each of the f/11,11i'n am the plopcnyo%%ner or aathnrized agent lona on the propertyo\ ner's behalf. I have o adthis
pplication and the information I have providedI have read the Inscription ofWork and verify itis accurate. Iagree1 comply.cilhullapplicablebeat
ordinances and 5tatp la\\'s miming m b I wtoI ulhoriic rcprVsenmlis'cs ofCupertinoto enter the abort-i mif• 1 <m'for in5peelion purpascs.
Signature of Applii:=/AgaH: \ Date: - f —
SUPPLENIBNTAI.INFORMATION REQUIRED TERN cnl:cx'n'rL` kowrisc swF
New SFD or(Multifamily dwellings: Apply for demolition pcnnit for deelr'1'nP:cauNn;x ;�uUii,tii�G Piu,v,u'evlF;Av
CNisting building(s). Dclnolit ion pcnnit is rcyuired priorlo issuance of building / -
permitfornewbuilding• ❑ I:xr RESs ❑..PEAS •i.'c 14aN REVIEW
_Comnxrcial Bldgs: 1'rovide a comPICled I I;Irardous iMalerin I5 Di5CI0Sure YrA NINA It 11 - ❑' PU turn C.AVUPNS
form if any Hazardous-Mnterials are being used as pnn or this Project. '!
_Copy of I'lanning Approval Letter or Meeting with I'lanning prior In
Suhluittal of Building Permit application, ❑ SLAJUII ❑-$,1N1'1',Ax It5EVY1:R'OI$'TxICn
.❑ r:vrlxoN.li;ll\Ii IIF.VISII__
OldgApp_201 Ldoe reviser/06121/11