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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
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/ �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
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P.
P.ti
(Iwo Q
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a
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V&
.a. OfCUPERTINO
Building Department
Cm __j
OCT 15 2012
6�
A-- `�EVIEWED FOR CODE COMPLIANCE X '�
Reviewed By: o
QC
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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
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g 5 01 Me sau w paonpz aq Aew s5uuado
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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
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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=-
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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
