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12100117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10494 MIRA VISTA AVE CONTRAC`fOR: BROTHERS HOME PERMIT NO: 12100117 IMPROVEMENT OWNER'S NAMF-: BHAGWAT MAHENDRA J AND DEEPAVALI 2510 DOUGLAS BLVD DATE ISSUED: 10/162012 OWNER'S PHONE: 4087258727 ROSE.VILLE, CA 95661 PHONE NO:(a08)295-0680 LICENSED CONTRACT'OR'S DECLARA'T'ION r. ELECT I✓ PLUMB I_ License Class e`i Lc W�"�� BUILDING PERMIT INFO: BLDG r r, r Contractor Date A1EC11 RESIDENTIAL COMMERCIAL 1 herehy affirm that 1 am lic oert c provisions of Chapter 9 JOB DESCRIPTION: WINDOW RF-PLACENIENT(4),INTERIOR DOOR(I).NO (commencing with Section 7000) of Division 3 of the Business & Professions EGRESS WINDOWS CHANGED Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the following two declarations: I have mid 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 permit is issued. I have and will maintain Worker's Compensation huurancc, as provided for by Sq. FI Flour Area: Valuation: $3083 Section 3700 of the Labor Code, for the performance of die work for which this permit is issued. AI'NN'umber: 35704029.00 Occupancy Type: APPLICANTCFRTI FICATION 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 to building construction, mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYFjtOM LAST CALLED INSPECTION. with all non -point source regulation> per the Cupertino Municipal Code, Section 9.18. V Iss�u }. f Date: Signature ❑ OWNER-RIIILDER DECLARATION RF. -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beiig installed. Ira roof is the following two reasons: installed without First obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sea7044. Business R 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). ALL ROOF COVERINGS'T'O BE CLASS "A" OR BETTER hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of work for which this peril is issued California Ilealth S Safely Code. Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the CupertinoNlunicipal Code, Chapter 9.12 and the Ilealth & 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. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work forwhich this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, o s 25505, 25533, and 25534. Compensation Imus of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Owmer or h Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCT10N LENDING AGENCY APPLICAN I' CER'TI FICATION I certify that I have read this application and slate that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. 1 agree to comply with all city and county ordinances and slate laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name ' upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments. Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply %RCIIfI`ECI"S DECLARATION with all non -point source regulatiais per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO lye//I FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10494 mira vista dr DATE: 10/16/2012 REVIEWED BY: larrys PC FEE ID APN: BP#: 'VALUATION: 1$3,083 *PERMITTYPE: Building Permit PLAN CHECK "TYPE: Alteration / Repair PRIMARY SFD Or Duplex USE: 2nd Unit? Yes No OTC. OYes E) No PENTAMATION SFDREM PERD11TT1'PE: WORK window replacement(4),interior door 1 exterior door (1). no egress windows changed SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s. f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-8,111-BjV,V-B 0 $0.00 Other Elec. Imp. $0.00 Plumb. Insp. Fee: Elee. Imp. Fee: PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. O OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1 0 1 $0.00 1 $0.00 MECH, HOURLY O Yes O No PLUMB, HOURLY O Yes (F) No ELEC, HOURLY O Yes Q No Mech. Plan Check Plumb. Plan chuck Elee. Plan Check A/ech. Permit Pee: Plumb. Permit Fee: Elea Permit Fee: Other,tlerh. Insp. Other Plumb In p. -Ll I Other Elec. Imp. ,Mech. Imp. rec: Plumb. Insp. Fee: Elee. Imp. Fee: NOTE: This evionate does not includejees due to other Departments (i.e. Planning, Public Works, tire. Sanitary Sewer District, School District. etc.). These fees are based on the Prelitninan, information available and are m h, an estimate Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 [= # $400.00 Window / Sliding Glass Door 1 n'LVREP Replacement Suppl. PC Fee: (D Reg. O OT 0.0hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. O OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consn-action Tux: Administrative Fee: O 0 Work Without Permit? O Yes Q No '$0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) O i T rave[ Dac:umenuttion Ices: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $400.00 TOTAL FEE: F $401.50 Revised: 10/01/2012 IZl vol l-] CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 IC—IU PERTIN0 (4018)1777-3228 • FAX ((408) 777-3333 • buildiinInlqGncupertino.org I I NFWCONSTRt1C8) TION I ADDITION I1AITERATION/TI RFV1S1f1N/nFFFRRF(1 f1Ri(7INAL PFRMITB PROJECTADDRESS IO (,J V^ 10, / If I'' � APNM 213n— o\l lE-ML OWNERNAME HON�2 ,..- ?7AI I 'NONE 2� STREET ADDRESSu n� CITY, STATE.ZIP FAX r V ` / �C YP t WQ C 9 I� CONTACT NAM PHONE E-MUL 2 2, STREET ADDRESS/� Ingly m1ro V rGO CITY, STATE, ZIP t(�INU L -y FAX �// ❑ ❑ ❑ ❑ L� 0\YNER OWNER-BUMDER OWNERAGENF CONTRACTOR CONTRACTOR AGENT ❑ ARC}BTECT ❑ FNGL4EER ❑ DEVELOPER ❑ TENANT CONTRA OR NAM ` LIWENSE NUMBER LICENSETYPf BUS. LIC0 t2a 1 COMPANY NAME E-MAIL E-MAIL FAX G ST ETADDRE S CITY,Sy- (� SOA ZJ PHO n�yE Jr U�C 7S (Z �OO 2�Q3--06 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-NIAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 4 wtN o II % �cl� N wU c ✓a'�r ✓' ♦ c r F- Vic #—�><W(Qt .Aid f14 ✓ nC EXISTING USE PROPOSED USE CONSnLTRE #STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOORDEA10 TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER RENIODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GMi AGEAREA: DETACH ❑ATTACH N DWELLING UNITS: IS A SECOND UNIT Li YES BEIN'O ADDED' [J NO SECOND STORY ❑YES ADDITION! ❑NO nnn PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLAN•NWGAPPLO ❑NO PLANNLNG APPROVAL LETTER IS THE BLDG AN ❑YEs EICHLER HOME' ❑NO :RECEIVE B/ - •� ^` TY{r' S 'fO5QS.MA5ATION: fir•/+ JrS(i / By my signature below, 1 certify to each of the following: I am the property o\, ner or authorized age t ct on the propeny owner's behalf. I have read this application and the information I have provided 1 correct. I -e read the Description of Work, and vcofy it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building nstruct' authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Sienaturc of ApplicaD./AgenC Date: O SUPPLEMENTAL INFORr\ttl(DN FtQUIRED C d'aa.� I' AN,CIiECK;TY'PE ++ r`�c_ROUTINQSEIP , e QO\ TIIE'COU\TER - T sLs�e�`' �$ BUILDING PLAN:RE\'3E\� + New SFD or Multifamily dwellings: Apply for building(s). Demolition is demolition permit forB'I✓' issuance buildln-'c, existing permit required permit for new building.L.0 prior to of REsS 5 © Plr'nm\c I uNNRE\9E\\, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑•❑ STw\DARofi•"A _ To if any Hazardous Materials are being used as pari of this project. . Y' •' s '. _ Copy of Planning Approval Letter or Meeting with Planning prior to�5,, L\AGE A�`L'❑'FIRE ❑OnuJOR\ DEPT'- .lam ®.SAN'ITARI'.SE\\Y'EyA submittal of Building Permit application. £�-. tLt�S. DISTRICT. Y❑�EN\'IRONDIENTAL 'AI;T' •..]tE5'. HE RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Project address. Contactperson. S/CYOGJG�I' �Yl(Kwc� Phone Fax. Net square footage of lot. Existing Square footage: First floor: Second floor: Garage: TOTAL: Proposed Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y Build it Green Total Points 1 On what floor(s) is work being done? Z ),t f ?- � cm C-) --r cr ou 9.0 a C m � C3 CDv CD Z a0 Brief description of work. l W 1/ I•ot f riy Oaci Z &X errs ! Doer Code editions: 2007 CBC (Y - N)2007 CFC 2007 C13C (Y - N)2007 NEC Effective l/1/08 (Y - N)2007 CMC (Y- N) (Y - N) Plan Review Process work Book Page -8-Revised 8/05/08 COMMUNITY DEVELOPMENT DEPARTMENI BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the Job site during construction. It Is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. BY I,A2R_I DATE 10 ,1 Q, . 1Z PERMIT NO. 12,1 Oy 1'% V& .a. OfCUPERTINO Building Department Cm __j OCT 15 2012 6� A-- `�EVIEWED FOR CODE COMPLIANCE X '� Reviewed By: o QC KJ— P. P.ti (Iwo Q -_ V1 r V S V v Y o e � s a / V& .a. OfCUPERTINO Building Department Cm __j OCT 15 2012 6� A-- `�EVIEWED FOR CODE COMPLIANCE X '� Reviewed By: o QC uoop agl anoge (SI 1IJ. uerp ia7ew5 aq'1ou pinogs 5uu2d0 agl to wolloq aP 'E'8Z01 § Jed Joolg w0J1146iaH wnwlxeW Mopgw arp :o uuoeiad0 Ieuuou mag 11nsai pings 5wuado jeap 1aAr 16iag Jeap lau wnwruiW . (808)..0ZdO tpp!M reap lau wnwiuiyV cli.mismll s3000 Wows / vei !zu 8v'Ol / g 5 01 Me sau w paonpz aq Aew s5uuado J00y apeu5 azw ESpV g Z Sgo 5uuedo leap 'leoaoeid si li aiauM satouedn000 laeuapisai tau wnumiw e aneq o; aje s5umado an0sai 6e ui s5unlado u3ns 10 uois.uwd puawwooai pue adaase Ajua5iawa 'ZSZo1 § 1ed am inq 'saiouedn000 uiayao m, algeoildde luaw azlS wnwlulW ann5aj sit m, suopdeoxe we ajaui 1-inoo jo weA'�ue ol�gnd ;aa^s oi�gnd e oluo Ap3aiip +CUPERTINO uado m a e asaul.'5upuado enosei pue adnse f , Suilding Department Aouafuawa auo lseal le anew of ale /vols tunol OCT 1 5 2012 aul Molaq sworn 5wdeals pe pue sluawaseg _ sai�uawawa w tau REVIEWED FOR CODE COMPLIANCE -udflad anosaj 7di Timmas-a oiui AeM-e puz Reviewed By: ;uadmoo ail ja; s=o-, 5utd3als !o bio AaM e ap!Awd q aie asau i 'saiouedn0oo eons ui sworn to lno 5wpeal ssai5a io sped leuou m uouppe ui eJe esayl'anasai pue adaose Aouamawa ja sburuado ssw5a anei of 9Z0! § Aq,pa inbai aJ=- salouednaoo (1-p jeuollruesui pue (u) jeguapisau 3dVOS3 A90191:13:ti3 �I JAI J cli.mismll s3000 Wows / vei !zu 8v'Ol / g 5 01 Me sau w paonpz aq Aew s5uuado J00y apeu5 azw ESpV g Z Sgo 5uuedo leap 'leoaoeid si li aiauM satouedn000 laeuapisai tau wnumiw e aneq o; aje s5umado an0sai 6e ui s5unlado u3ns 10 uois.uwd puawwooai pue adaase Ajua5iawa 'ZSZo1 § 1ed am inq 'saiouedn000 uiayao m, algeoildde luaw azlS wnwlulW ann5aj sit m, suopdeoxe we ajaui 1-inoo jo weA'�ue ol�gnd ;aa^s oi�gnd e oluo Ap3aiip +CUPERTINO uado m a e asaul.'5upuado enosei pue adnse f , Suilding Department Aouafuawa auo lseal le anew of ale /vols tunol OCT 1 5 2012 aul Molaq sworn 5wdeals pe pue sluawaseg _ sai�uawawa w tau REVIEWED FOR CODE COMPLIANCE -udflad anosaj 7di Timmas-a oiui AeM-e puz Reviewed By: ;uadmoo ail ja; s=o-, 5utd3als !o bio AaM e ap!Awd q aie asau i 'saiouedn0oo eons ui sworn to lno 5wpeal ssai5a io sped leuou m uouppe ui eJe esayl'anasai pue adaose Aouamawa ja sburuado ssw5a anei of 9Z0! § Aq,pa inbai aJ=- salouednaoo (1-p jeuollruesui pue (u) jeguapisau 3dVOS3 A90191:13:ti3 Building Department City Of Cupertino 10300 Torre Avenue CA n;A1A-1f%CC Telephone: 4108-777-3228 CUPERTINO - Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST ' JOB ADDRESS: MIA Viltr,PERMIT # OWNER'S NAME: PHONE # Z Zr- g7Z7 GENERAL CONTRACTOR: rWV BUSINESS LICENSE # ADDRESS: (Q ya CITY/ZIPCODE: SOA fv ( 9 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION( PILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON ORS 'E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ell 1 am not using any subcontractors: Signatu a Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation, Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date