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11090099 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11139 SUTHERLAND AVE CONTRACTOR:WESTCOAST PLASTERING PERMIT NO: 11090099 CO OWNER'S NAME: VENKATA UPPULURI 760 DELAWARE AVE DATE ISSUED:09/15/2011 NER'S PHONE: 4087188412 SAN JOSE,CA 95123 PHONE NO:(408)629-7022 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Class C- -15- Lic.# /-7—L br k MECH r- RESIDENTIAL r COMMERCIAL Contractor W I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RESTUCCO FRONT PORTION OF EXISTING SINGLE (commencing with Section 7000)of Division 3 of the Business&Professions FAMILY Code and that my license is in full force and effect. DWELLING(630SQFT) 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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. I 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 permit is issued. Sq.Ft Floor Area: Valuation:$7500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35617064.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. q Signature Date Issued by: Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I I Healoh&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. µ autho ' ent: Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i- '-mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address &.,.acing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11300 sutherland ave. TDATE, 09/15/2011 REVIEWED BY: APN: BP#: "VALUATION: 1$7,500 y°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: p PERMIT TYPE: WORK restucco front portion of existing sfd. SCOPE NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 EIT 7,7!11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00630 s.f. Restucco Suppl.PC Fee: E) Reg. C) OT 0.0 hrs $0.00 $490.00 ISTUCOAPP PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Q Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Strom,Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS; j $1.75 $490.00J TOTAL FEE: $491.75 Revised: 09/02/2011 ~CI to �A1�S CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building cDcupertino.org Q p NC Dom, CUPERTINO A� - ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PROJECT ADDRESS APN# OWNER NAME PHONE AE-MAIL STREET IDRESS STATE,ZIP FAX v CONTACTN PHONE E-MAIL 4:/V iV�ra'� STREET ADIIS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT -7 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Si C GJh S i �L�s Z� Z �� i; G CQWANY NAME E-MAIL FAX ✓'1 Lt v1 (L- &uw�ts;c Limp. -G z4'-7Gzz STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCR]PTION OF WORK � r � �1 `M e o rJG c'1 Pt L,—, — S C,� (6,30 [14C LJ CA-; arc J-Cvt,i v 4ti ��cC�o , EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.Fr. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL r AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER i REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ODETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICATION E]YES IF YES,PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED BY: C� j T VALI��IQI3 /� PLANNING APPL# [-]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO V3 UC// By my signature below,I certify to eac a following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I ha provided' correct. escnptton o oretix_is accurate. I agree to comply with all applicable local ordinances and state laws relating buil "n Structi trnes•ef ertiao to ent a above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE AL ORMATION QUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply or demolition permit for R-THE-COUNTERBUILDING PLAN REVIEW -OVEIn existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS 0"PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 13 MAJOR ❑ SANTTARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgt4pp_2011.doc revised 06/21/11 Building Department City Of Cupertino LM 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: j ; 3 S✓T(. (�'�1..�. `) 14vC` PERMIT# �` 1 OWNER'S NAME: PHONE#( 2 1 L --2- ,6E Z-6E ERAL CONTRACTOR: 44- rr-,, BUSINESS LICENSE# ADDRESS:' G, .. CITY/ZIPCODE: G' �% Z *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(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL B ONTRAC O HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ature Date Please check applicable subcontractors and c plete 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