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11040140 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10335 VIRGINIA SWAN PL CONTRACTOR "" PERMIT NO: 11040140 OWNER'S NAME: SHENOY ARVIND P AND ANURADHA $� ((� } �� DATE ISSUED:04/19/2011 OWNER'S PHONE: 4084648601 , PHONE NO: L- LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB L License Class Lic.# �� Lf I Z MECH RESIDENTIAL� COMMERCIAL� Contractor / Date 4 1 JOB DESCRIPTION:TO CLEAR CODE ENFORCEMENT CASE: 15 WINDOWS&2 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions DOOR REPLACEMENTS(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. 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 Sq.Ft Floor Area: Valuation:$6000 permit is issued. APPLICANT CERTIFICATION APN Number:31646010.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature_ � Date `f" � � �� OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I 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. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I / -: rl a ent: become subject to the Worker's Compensation provisions of the Labor Code,I must Own�r or a r� UDate: �' Lu(� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of"ark's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c^ s,and expenses which may accrue against said City in consequence of the ing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION e...a all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31646010 .00 DATE ISSUED. . . . . . . : 04/19/2011 RECEIPT #. . . . . . . . . : BS000013231 REFERENCE ID # . . . : 11040140 SITE ADDRESS . . . . . : 10335 VIRGINIA SWAN PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SHENOY ARVIND P AND ANURADHA ADDRESS 10335 VIRGINIA SWAN PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024 RECEIVED FROM . . . . : ARVIND SHENOY 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 6, 000 .00 1. 00 0. 00 1 .00 0.00 1BSEISMICR VALUATION 6, 000.00 0.60 0. 00 0 .60 0.00 1WINREP EACH 8 17. 00 1264 .00 0. 00 1264 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1265.60 0.00 1265.60 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 265.60 AMEX --------------- TOTAL RECEIPT 1,265.60 L A;V' eZ6(Q 0C C. � SUS-0 KOK\ xv Y, ori 1 � 5 7t3 X,0 l r) 6c�rborn SD3c) to X10 xo Com,x� COMMUNITY MM,,TMENT DEPARTMENT BUILDING DIVISION-CUPERTINO � APPROVED IOM of pians andsperi cationst an ial. MUST be kept at s, c n. It is unlawful to make on Same,or to deviate without approve'from the Building Offic The stamping of this plan and Fr�r,� i � y be held to permit or to br r locations SHALL NOT ��;.�•.wal of the violation of any provisions of any(';:'y Ordnance or State Law. BY / • _. �s7 Y DATE PERMIT N0. CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10335 virginia swan pl. DATE: 04/19/2011 REVIEWED BY: bobs. APN: I BP#: "VALUATION: $6,000 Y PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK To Clear Code Enforcement Case: 15 windows and 2 door replacements non structural SCOPE __j NOTE. Theseees are based on the preliminaty information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 09-051 f ff'. 7; .-10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $632.00 1 WINREP Replacement ` PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (D No $0.00 Work Without Permit? G Yes 0 No $632.00 Planning Fee: $0.00 Select a Non-Residential G Building or Structure 0 Strong Motion Fee: 1BSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $633.601 $632.00 TOTAL FEE: 1 $1,265.60 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:103,':E, OWNER'S NAME: V' y PHONE# 0 R , 3'►�1"3SZ' 2. GENERAL CONTRACTOR: C 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. 11 Y , 1'' a � , `'(' I 'gyp I am not using any subcontractors: --%yo eigatu W Date Please check applicable subcontractors and complete 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 ontracqor Signature Date L• 1. i 4 �ly � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 •FAX(408)777-3333•building(M.cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS � `///��I jSr I1CLJ�ILI� •� v, OWNER NAME {{ V ��`1, �� PHONE �,C�) E-MAIL STREET ADDRESS S - ^4 n 03 G v i_ CITY, STATE,ZIP FAX CONTACT NAME A_P t///V1 STREET ADDRESSEE ( L-614 ti-e— CITY,STATE, ZIP FAX J ❑ OWNER-BUILDER ❑ OWNERAGENTC� ONTRACIOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON�RAC 0 NA LICENSE NUMBER LICENSE TYPE BUS.LIC# ibi COMPANY NAME - ( E-MAIL FAX ;{ F �. Cwt- 27C S_) = 7rt -3s 3 .. j STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MALI, FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 15 r,�t✓tii c ti�S > d U, I��— EXISTINGUSE PROPOSED LSE CONSTR TYPE #STORIES EXISTG NEW FLOOR DEMO TOTALS AREA AREA AREA NET AREA ° IT BATHROOM KITCHEN OTHER rk REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH 4 �s ❑ ATTACH ,48 u0 M M. � N DWELLING UMTS: IS A SECOND UNIT ❑YES SECOM STORY ❑YES WI - `a` BEING ADDED? NO ADDITION? NO PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: PLANNING APPL A ❑NO PLANNING APPROVAL LEITER By my signature below,I certify to each of the 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 have prQvided 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 bu g c Ion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Zion. Signature of Applicant/Agent: Date: SUPPLEMENTAf INFORMATI QUIRED _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. r _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 2g�c form if any Hazardous Materials are being used as part of this project. Ix �� - - _Copy of Planning Approval Letter or Meeting with Planning prior to r � a a � submittal of Building Permit application. 1�T4dlaR Drs t�tT �` BldgApp 201 Ldoc revised 03/16/11