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11090054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20352 GILLICK WAY CONTRACTOR:-T .Uk PERMIT NO: 11090054 OWNER'S NAME: ANJALA MANGAL1�y � DATE ISSUED:09/07/2011 NER'S PHONE: 4082758595 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Al Lie.# 44 REMODEL 100 SQ FT TO 2 BATHROOM NON- STRUCTURAL Contractor E_Aip, ✓E -�.J6�%rr� Date '7 *SEE NOTES* 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:$15000 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:36936010.00 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 authoriz epresentatives of this city to enter upon the above mentioned property for ins ion purposes. (We)agree to save 180 DAY R LAST CALLED INSPE TI N. indemnify and keep harmless the City of ertmo Inst liabilities,judgments, costs,and expenses which may accrue nst sai ity in consequence of the �f granting of this permit. Additionally applic t understands and will comply Issued by: �- Date: with all non-point source regulatio er the pertino Mu icipal Code,Section 9.18. Q RE-ROOFS: Signature '✓ ate < 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. OW R-BUI ER DECL RATION _. Signature of Applicant: Date: I hereby affirm t /It 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 1,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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 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,S tions 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cu ino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 2 (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 a equip ent or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b e Bay a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wi the Cup r . ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co e, ctio ,25533 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or auth ed ag t: � Date D 2 f 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affi hat 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 w ich 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 lemnify and keep harmless the City of Cupertino against liabilities,judgments, .s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,.anting 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 PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPiRTINQ' (408)777-3228• FAX(408)777-3333• building(8cupertinG.org PROJECT ADDRESS fl �� L ,,1 APN# , OWNER NAME ,C (� PHONE E-MAIL 2-71- 8S-9E STREET ADDRESS LL CITY, STATE,ZIP (f UPC 1N0 FAX APPLICANT NAME PHONE r E-MAIL f STREET ADDRESS / �+ � CITY,STA- )e- e / FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT &oNTRAcrOR ❑CONTRAcrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT DESCRIP'�`IQLcI OF 4YQRK ., ', ;.t '. '640i" 51 EXISTING USE(S): J n -�PROPOSED USE(S):n�lo F OCCUPANCY(S): �? TYPE OF PARCEL \ CONSTRUCTION: AREA: FIRE Y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N SPRINKLERS: Existing Proposed Floor Area: First Floor: S.f. S.f. Second Floor: s.f s.f. Garage TOTAL: S.f. s.f. BY: Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N Governing Codes: 2010 California Building Code (based on the 2009 International Building Code) 2010 California Residential Code (based on the 200I�3lEme?i' TMENT 2010 California Plumbing Code(based on the 2009 UnifW pLQAZFD NO 2010 California Mechanical Code(based on the 2009 Uniform 2010 California Electrical Code(based on the 2009 International lect 2010 California Energy Code This set of plans andEspect ��9�tUST be kept at the 2010 California Green Building Standards Cojpb site during construction. it is unlawful to make any Cupertino Municipal al Code changes or alterations on same,or to deviate p p 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 DATE r7ea 03109111 PERMIT NO. Gr` C�PGa�E E=xrs � f v�3 - �.cf�'r l �<�cci GC,�►�E2 ��cv��- ��G cue i y ;1 109,07. 11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 2,0352- awY PERMIT# OWNER'S NAME: 1AA41A4,4 ,A PHONE# 4oe 66 7,5oos- GENERAL CONTRACTOR: .^i�� tdE �,5 _ J BUSINESS LICENSE# ADDRESS: G G ,4ve - _ tT� if0 CITY/ZIPCODE: 94O''7 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS ECTIOI�(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS /V BTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 0c) Q 7 -Si ature Date Please check applicable subcontractors and com ete the follo ing information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # �( Cabinets & Millwork Cement Finishing Electrical Excavation Fencing X Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering JC Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Ow r/Co tractor gignature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36936010 . 00 DATE ISSUED. . . . . . . : 09/07/2011 RECEIPT #. . . . . . . . . BS000014692 REFERENCE ID # . . . : 11090054 SITE ADDRESS . . . . . : 20352 GILLICK WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER ANJALA MANGAL ADDRESS 20352 GILLICK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ENRIQUES DESIGN INC CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 .00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 15, 000 . 00 1.50 0 . 00 1 .50 0. 00 1REMRESBAT SQ FEET 100 . 00 588 . 00 0 .00 588 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 590 .50 0 . 00 590 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 590. 50 1441 --------------- TOTAL RECEIPT 590 . 50 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20352 gillick way DATE: 09/07/2011 REVIEWED BY: bob s. APN: BP#: EVALUATION: $15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK sfe remodel 2 baths non structural. SCOPE NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormalion available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution I1-053& 71/1 F FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: E) Reg. 0 OT 1 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Feer Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes (F) No $0.00 Advanced PlanwRg._B c: $0.00 Select a Non-Residential G Building or Structure Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.50 $588.00 TOTAL FEE: $590.50 Revised: 09/02/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPfRTINO (408)777-3228• FAX(408)777-3333• buildinaCcDcupertino.org 'y0c jY1�� ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEF`ERRED ORIGINAL PERMIT# PROJECT ADDRESS / APN# OWNER NAMER/�,I A) / / PHONE j� EMAIL STREET ADDRESS //L/J G�- TY, STATE2 � i FAX CONTACT NAME K X/V l' ICJ ` PHONE „� /// ^ 0 j E-MAIL;n/✓�/ J^ fC�IC� c7��.G STREET ADDRESS r 1 y)\1 t s ' iTY,STATE. ZIP ,� /I�V /� ° 12 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR 1:1HITE CONTRACTOR AGENT ❑ ARCCT ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR NAME ' j LICENSE NUMBER LICENSE TYPE.i, n BUS.LIC# -"n (�� S 3373 � cedc COMPANY NAME / '� EMAIL FAX 400 ,371 7- STREET ADDRESS / CITY,STATE,ZIPiG�„j PHONE 09 6675QS ARCHITECT/ENGINEER NAME 1 LICENSE NUMBER 1 `ZV � BUS.LIC# COMPANY NAME / E-MAIL i�! FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WO 6 c O/Z_C / -boor' EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) AREA NEW FLOOR DEMO TOTAL AREA 0 �o V'IT 10/(/' /-S AREA AREA NET.4REA __S7/L-0 '� BATHROOM KITCHENOTHER REMODEL AREA / REMODEL AREA REMODEL AREA n PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH l/ ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL V UATION: PLANNING APPL# ❑NO PLANNING APPROVAL LE R EIC R HOME? []NO By my signature below,I certify to each of the foll ing: I e owner or authorized agent to act on the prrrperty owner's behalf. I have read this application and the information I have provided i correct. I e read t Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co s c'o aut nz representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: q / SUPPLEMENTAL INF RMAT N REQ RED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwe ngs: Apply for demolition permit for �VV*R-THE-COUNTER U BUILDING PLAN REVIEW existing building(s). Demolition ermit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ PUBLIC WOPM form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06/21/11