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13010128 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10517 SAN FELIPE RD CONTRACTOR:LAMIA CONSTRUCTION PERMIT NO:13010128 OWNER'S NAME: DHIRAJ MALLICK 14771 BRANHAM LN DATE ISSUED:0124/2013 OWNER'S PHONE: 4086231060 SAN JOSE,CA 95124 PHONE NO:(408)594-1401 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL11 License Clas__5L_ Lie.# L REMODEL(E)HALL BATH TO ADD TUB/SHOWER& RELOCATE Contractor[A-M�i� s�eji ¢ G�am 1� (E)LAUNDRY AREA TO DOWNSTAIRS HALL CLOSET I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect.. 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 for which this permit is issued. Sq.Ft Floor Area: Valuation:$5500 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34222072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter ST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 18 indemnify and keep harmless the City of Cupertino against liabilities,judgments, 2 / costs,and expenses which may accme against said City in consequence of the I Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source re collation ern the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date_ih� ?j 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or 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 Cuperti o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 ,2 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued, 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm 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 APPLICANT CERTIFICATION Lender's Address 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,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used w 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: 10517 san filipe rd DATE: 01/24/2013 REVIEWED BY: MELISSA APN: 342 22 047 BP#: 'VALUATION: $5,500 *PERMIT TYPE: BuildingPermit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORKREMODEL E HALL BATH TO ADD TUB/SHOWER & RELOCATE E LAUNDRY AREA TO SCOPE DOWNSTAIRS HALL CLOSET ibfech. Plan Check Plumb, Plan Check Elec.Plan Check Meeh. Permit Fee: I Plumb. Permit Fee: I Elec. Permit Fee: Other He,h.Insp. Other Plumb Insp. Lj Other Elec.Insp. FT ,h/ech.Insp. P'ee: Plumb. hisp. Pee: Elec,Insp. Fee: NOTE:This estimate doesnot include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District School District,etc). These fees are based on the prethnWdna in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: Q Reg. Q OT FO.0 I hrs $0.00 $600.00 IREMRESBAT PME Plan Check: $0.00 9 s.f. Remodel,Other Permit Fee: $0.00 $400.00 IREMRESOTH Suppl. Insp,Fee:Q Reg. Q OTr0_01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tire: lldininisiralive lee: Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0,00 Select a Non-Residential t) Travel Docwnerntation Fee : Building or Structure i Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $1.551$1,000.00TOTALFEE:; $1,001.55 iKILF GYbG.e+e.. Revised: 10/01/2012 1st Floor , { P Made xAth Me icFbn NEW BATH --EXISTING BATH n Elf u�,OZAL- ttFF PLA'r PtAAb cxEcxEn BY VATE li3 LOIC—E 00 bODL R' JO P UNI G DEPT. Leib i � $v Ji �� �# 41.11 ii kms• ATE �t,I)f. DF;7pr uk n z u n c i z EXISTING BATH EXISTING LAUNDRY_ L n �w 0 P z ` G�F�r rr✓c� 00 CONSTRUCTION PERMIT APPLICATION 0\� B COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION M�\ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \ ll (408)777-3228•FAX(408)777-3333•building@-2 DertinG 0r9 CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGIN7AL�PrERMIT# PROJECT ADDRESS �/ I , E AIN# PHO NF�I /i / `, EMAIL V OWNERNAME Q �� CITY,STATEPFAX L STREET ADDRESS PHONE E-MAIL CONTACT NAME FAX CITY,STATE,ZIP STREET ADDRESS ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT XCONTRACTOR. ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT LICENSE NUMBER �p_ � O LICENSE TYPE BUS.LIC# CONTRACTOR NAME / I 'I'(J 1 EMAI Nf F CJ COMPANY NAME 1 " STREET ADDRESS STATE,ZIP! I-S( r P BUS.LIC# ARCHITECT/ENGINEERNOME UCENSENUMBER _ FAX E-MAIL COMPANY NAME PHONE CITY,STATE,ZIP STREET ADDRESS DESCRIPTION OF WORK Ff�i- 4ez o✓ l�2.1�C,� EXISTING SE PROPOSED SEM CONSTR TYPE #STQ USE TYPE OCC. SQ.FT. VALUATION($) NEW FLOOR ' TOTAL AREA, AREA AR p NETAREA AREA BATHROOM �/ KIfCHIN OTHER REh10DEL �I"r REMODEL AREA REMODEL AREA AREA PORCH AREA DECK AREA TOTALDECIC/PORCH AREA GARAGEAREA: ❑ATTACH ISASEADDE ❑YES SECOND STORY ❑YES #DWELLA'G UNNS: NU ppDIT10N? r7N0 BEING ADDED? I YES RECErVEDBY TOT��LUATION: PRE-APPUCATION ❑YESWYESTROVB)ECOPYOF �2.0 x PIANN�'G ADPL# 0 PLANNING APPROVAL LETTER EICIILER NOME? s ,,,4,, " By my signature below,I certify to each of olio g: I am the property owner or authorized agent o act on the property owner's behalf. I have read this ly with all application and the information I have pro is I he Description entativ s of Cupertino to erner the abI verify it is ovto c mpl r e en wed propfor inspecionrpa�" ses . ordinances and state laws relating to b authorize 3 Date: Signature ofApplicanUAgenCROUTING SUPPLEMENT INFORMATION REQUIRED P[,pNCAECKTYPE r P oVF.RTHECOUNTEH E 1 BBn.DINafLANREviEw New SFD or Multifamily dwellings: Apply for demolition permit for *f. existing building(s). Demolition permit is required prior to issuance of building ❑ EXYxessf s H "l ;rLANmtu+c rLAN REv>EW` �` permit for new building. > ❑-PUBL ,s Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �� si�NDAIm Y r'r IC WORKS " To if any Hazardous Materials are being used as part of this project. ❑ LAtcE ❑ FIRE DEPT ❑ MA70R t 4 t '� SANITARY SEWER DISTBT�T Copy of Planning Approval Letter or Meeting with Planning prior to ;, submittal of Building Permit application. �� ❑ ENVIRONMENTAL HEAT.T'jr,4-' BldgApp_201 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION Ea ADDRESS: 10517 san filipe rd DATE: 01124/2013 REVIEWED BY: MELISSA APN: 342 22 047 BP#: `VALUATION: $5,500 *PERMIT TYPE: BuildingPermit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1R3SFDREM USE: SFD or Duplex PERMIT TYPE: WORK REMODEL E HALL BATH TO ADD TUB/SHOWER& RELOCATE E LAUNDRY AREA TO SCOPE DOWNSTAIRS HALL CLOSET sum i r a Xf ch Plan Check Pbnnb. Ptun Check Elect.,Plan Check Mech. Perini!Fee: Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. Other Plumb Imp Other Elec.Insp. Nlcch. Insp. Fee: Plumb. Iny Fee: Elec.Insp.fine: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the relimina in ormation available and are onl an estimate. Contact the Dept or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 65 1 s.£ Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $600.00 1REMRESBAT PME Plan Check: $0.00 9 s.£ Remodel,Other Permit Fee: $0.00 $400.00 IREMRESOTH Suppl. Insp.Fee:D Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax. Ci Administrative Fee: Work Without Permit? ©Yes 0 No $0.00 Select allon-Residential E)Advanced Planning Fee: $0.00 Building or Structure i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bide,Stds Commission Fee: IBCBSC $1.00 u, , $1.55 $1,000.00 TOTAL FEE; $1,001.55 Revised: 10/0112012 1st Floor 0 JAN 2 4 2013 g z DINING KITCHEN/FAMILY12 0 r u LL w a COMMUNITY DEVELOPMENT PARTMENT z BUILDING DIVISION-CU RTINO - APPROVE a APPROVE This set of plans and specifications UST be kept at the job site during construction. It is uwful to make any. BEDROOM 3 changes or alterations on sam .4r TfAMILY' z therefrom,without approval from t 'Building Official,' z J The stamping of this plan and specif #ions 7 be held to permit or to be an a t I of any provi y City Ordinane r L < v i r DATE / Z PERwi IT NO. O O 1 2F _ N E)C.MASTER BED j� 0 Z � Z 6 O Z 6 OF" WF 00 0 ¢ �� 1y ¢z as 1 L� �w 0' 4' 6' 12' 16' gl17L RO C-011 u CAl -