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11080054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10815 BROOKWELL DR CONTRACTOR:KRISHNAN PERMIT NO: 11080054 MUSARAVAKKAM S OWNER'S NAME: KRISHNAN MUSARAVAKKAM S 10815 BROOKWELL DR DATE ISSUED:08/08/2011 NER'S PHONE: 4086566364 CUPERTINO, CA 95014-4608 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# F MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 WINDOWS B DESCRIPTION: REMODEL 120 SQ FT TO BATHROOM,REPLACE 10 (commencing with Section 7000)of Division 3 of the Business&Professions W/1 SLIDING DOOR NON-STRUCTURAL 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:$10000 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 APN Number:36921019.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT E ES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 YS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 i Signature of Applicant: Date: 1 her yaffirm 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) 1,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,Sections 25505,25533,and 25534. I will 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections-25505,2553 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this o Date: permit is issued. Owner or authorized agent: 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 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.1 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 -mnify 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. 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: 10815 Brookwell Dr. DATE: 08/08/2011 REVIEWED BY: gs APN: BP#: rVALUATION: j$10,000 R�PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex lex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK SCOPE Li NOTE: Theseees are based on the preliminaryinformation available and are onlyan estimate. Contact the De t or addn7 in o. FEE ITEMS (Fee Resolution 11-0531s'ff.' T1i11) FEE RIOEE I MISC ITEMS Plan Check Fee: $0.00 0 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 = # Window/Sliding Glass Door Permit Fee: $0.00 $522.00 1 wINREP Replacement Suppl. Insp. Fee42) Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes E) No $0.00 0 Work Without Permit? 0 Yes E) No $0.00 G) Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Strotm Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg? Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.00 $1,110.00 TOTAL FEE: $1,112.00 Revis d: 07/04/2011 , CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 - FAX(408)777-3333 - building(aDcupertino.org �'bgQb ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/7 ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS 4_�( t] r"J w 4 `L APN# OWNER NAME h L� �iQiR V Y+ PHO ,1 f E-MAJ1 STREET ADDRESS Cl wry LC �j�_ CITY, STATE.ZIP C '1 1 FAX CONTACT NAME , �`�'��.`_ �f PHo `t E-MAIL LYI i Ll h1rl C;l�� cam STREET ADDRESS ` i CITY,STATE, ZIP /6� (� cf -' (s'htc�� -'sC , FAX ❑OWNER OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHTPECr ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER. LICENSE TYPE BUS.LIC# COMPANY NAME E-M¢Lm FAX STREET ADDRESS _ CITY,STATE,ZIP PHONE. _ ARCHITECT/ENGINEER NAME LICENSE NUMBER- - BUS.LIC# COMPANY NAME _ E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE _ 'ESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES Ck& USE TYPE OCC. S .FT. VALUATION S EXLSTG 1 NEW FLOOR DEMO TOTAL AREA 1 AREA i�1` C. AREA NET AREA BATHROOM KITCHEN OTHER RE11,40DEL AREA �l` REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ` ATTACH #DWELLING UNITS: ' IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? FO ADDITION? NO PRE-APPLICATION QYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY:. TOTAL VALUATION: PLANNING APPL# PgNO PLANNING APPROVAL LEITER EICHLER HOME? NO J }1� 1 o By my signature below,I certify to each of the following: I am the property owner or authorized agent to aci-&the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t ulln /construction. I authorize representatives of Cupertino to enter the above-id properly for inspection purposes. Signature of Applicant/Agent: �/ ,\!h Date: (T C SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TBE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC woRxs form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FM DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/11/11 ' 1 1 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building@cupertino.org ZUPERTINO J Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS i O 1 £-- % C.tk� APN BP# OW NAMr CJ 7 OWNER ADDRESS _� F I f (A ft,� DESCRIPTION OF WORK: Re i 4t" 4 0- , __J We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) a . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. . 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. � 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license i numbers on permits and contracts. f . I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I.may be considered an "employer" under state and federal law. ` \0_6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 4 � . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderFonn 2010.doc revised 04/12/10 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. M t A W -K VAM c v Project address. Contact person. r Phone. Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second flog - Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? N Is privacy protection planting required for the project. Y 'luild it Green Total Points On what floor(s) is work being done? Brief description of work. Code editions: 2007 CBC (Y-N)2007 CFC (Y -N)2007 CMC (Y-N) 2007 CPC (Y -N)2007 NEC (Y-N) ; Effective 1/1/08 .. M Plan Review Process Work Book Page-8-Revised 8/05/08 2, W1 �. W4 "it x5o 471, SPLf W2 MAS' --�W5 lip 'bD2 M• 86 7I•�x 36 IV X0 OX W �vt a� x� L \r tJC, _. D t Ott ivC, PD M1 Sex Bot► 7� XSD wi CA �sv 14 1�.� �� 9�G �o��';� $A-�t'R�uh✓1 R-�� f,Q��-, �c�i r�c�a�-�' � cat - ,_. ''`Q Building Department City Of Cupertino La 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: r"'� S " W CLL. R l v C PERMIT# OWNER'S NAME: Nj K- 15 N r4 AvJ PHONE# - GENERAL CONTRACTOR: .r--- -- BUSINESS LICENSE# ADDRESS: — CITY/ZIPCODE: *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 ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: — k I Signature Date Please check applicable subcontractors and complete the following information: V 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 l Date ner/,C'ft-�r Signature