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11080113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11110 CHADWICK PL CONTRACTOR:JON R CRASE PERMIT NO: 11080113 CONSTRUCTION INC OWNER'S NAME: DWIVEDI TARUN AND GAURI 164 GILMAN AVE STE A DATE ISSUED:08/15/2011 t� ;R'S PHONE: 4089739083 CAMPBELL,CA 95008 PHONE NO:(408)370-1485 ❑ LICENSED CONTRACTOR'S DECLARATIONr- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 0 Lic.# ( «47 � p �I�11MECH f— RESIDENTIAL� COMMERCIAL Contractor CW 1e C 4! S If-VC- Date �l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MASTER BATH SHOWER&TOILET RELOCATION AND (commencing with Section 7000)of Division 3 of the Business&Professions WATER Code and that my license is in full force and effect. DAMAGE REPAIR TO SHEETROCK IN OTHER BATHS& ENTRY(170SQFT) 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. 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:$10000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35617083.00 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. I Signature Datey` C U Issued by: �' �-�— -� Date:( L WNER-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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain [have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I 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 Health&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. Owner o utl ri t: 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"Ork'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 it' -1nify 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 granting 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: 11110 Chadwich Place DATE: 08/15/2011 REVIEWED BY: RDW IMIAPN: BP#: "VALUATION: j$10,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK Math shower and toilet relocation and water damage repair to sheetrock in other baths and entry. SCOPE Aproximately 170 Sq/ft. NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 11-05;1.:?f. ?/1.-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =1 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $588.00 1REAMESBAT 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 Acoustical Fee: 0 Yes 0 No $0.00 Work Without Permit? 0 Yes 0 No $0.00 G Planning Fee: $0.00 Select a Non-Residential Q Building or Structure Strom Motion Fee: 1BSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.00 $588.00 TOTAL FEE: $590.00 Revised: 07/04/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 • buildingCcDcupertino.org CUPERTINO * �p,� ��Q E]NEW CONSTRUCTION [:1 ADDITION ALTERATION/TI [:1REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS 1. � k `-0 C-k�W`CK � APN 4 -3 OWNER NAME ? ---2,,� PHON cto� E-MAIL STREET ADDRESS t�- C �L CITY, STATE,ZIP FAXCa k p1Z CONTACT NAME 1 PHONE C-0— E-MAIL K4Cc-'sial 4ctL STREET ADDRESS d CITY,STATE, ZIP cytcCAU,,28ELL ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER 11DEVELOPER ❑ TENANT CONTRACTOR NAMEC� C LICEN SE INL�UI;.^/ LIC E TYPE BUS.LIC# ow k COMPANY NAME E-MAIL FAX <Z_P,� Coy 3 STREET ADDRESS CITY,STATE,ZIP PHONE i 6 6 IL s Q -� CA ��ca— 4� ARCHITECT/ENGINEER NAME , LICENSE NUMBER BUS.LIC# COMPANY NAME K E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 10&U14&tE l r D EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH7 DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: T AL VALUATION: PLANNING APPL# ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO l0 ca-y— By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prrperty 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 to buildin onstruction. I Vthorize representatives of Cupertino to nter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFrApply TION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwelling for demolition permit for OVER-THE-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 WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ ME 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 06/21/11 PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 •building aacupertino.org CUPERTINO PR0ffJ DRESS APN# CB C-k,'�V WLC kC f�L JD W l V is 1 STtEE ADDRESS CITY, STATE,ZIP FAX ` HO Ck ASD W LC-K � �.p�'n,.sD C Q- ��0 � APPLICANT NAME PHO 9t2�i'0&4� E-MAIL � p.i C� JaRp -c STREET DD SS CITY,STATE, ZIP F ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ONTRACrOR ❑CONTRAcTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT DESCRIPTIOI�I VQRI t UPS . " t3 —'� '&8 el cbe- EXISTING USE(S): PROPOSED U E(S): f OCCUPANCY(S): /n TYPE OF PARCEL �C� CONSTRUCTION: AREA: FIRE SPRINKLERS: Y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N Existiniz Proposed Floor Area: First Floor: s.f. s.f. � Second Floor: s.f. s.f. � Garage s.f. . s.f. TOTAL: s.f. S.f. , 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 2009 International Residential Code) 2010 California Plumbing Code(based on the 2009 Uniform Plumbing Code) 2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code) 2010 California Electrical Code(based on the 2009 International Electrical Code) 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData-Residential.doc revised 03109111 m4s 30� � p � 1 COMvL1m-ry DpJ-i_OPM1 r -DF ^RTciVT BUILDING D!`v"`, frCIJ1Q'F��=i i INO This set of PIP ns anisR-`cificatbrs RA!,;ST by *. +2i`he ffJC� IS �IJ •- COilS+lil .'JC' Itf..'ar, c therefrom, Val frofil tfl? t U �' I1 f ,f this rihn be,he.id:o it Ut�r., of a I 1c ' -v:" J „•t� �` of ca!i' Or..t U.ic !-vi. B V a I Oft FE BBFtwiif IVO. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 10 C L PERMIT# 8" 0 11 �s OWNER'S NAME: T -� PHONE# `{U�rS GENERAL CONTRACTOR: R S BUSINESS LICENSE# ADDRESS: ((p e CLQ CITY/ZIPCODE: C A-v-J%a.L CGCOlb *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: — Signature Date Please check applicable subcontractors and complete the folio 'n information: j/ SUBCONTRACTOR BUSINESS NAME �t-4--�, 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 Ow ntractor Signature Date