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11060117 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10335 VIRGINIA SWAN PL CONTRACTOR:SHENOY ARVIND P AND PERMIT NO: 11060117 ANURADHA OWNER'S NAME: SHENOY ARVIND P AND ANURADHA 10335 VIRGINIA SWAN PL DATE ISSUED:06/14/2011 -R'S PHONE: 4084648501 CUPERTINO,CA 95014-2024 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TO CLEAR CODE ENFORCEMENT-BATHROOM(REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions TILES OVER TUBS,TAPS,SHOWERHEAD,WATER CONNECTIONS& Code and that my license is in full force and effect. VANITIES(299SQFT);GARAGE-ADDED SHEETROCK,2LIGHTS& 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:$30000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31646010.00 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. Signature Date Issued by..— ---7 Date: {d OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole comperV;ation, 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 foi -Is HAZARDOUS MATERIALS DISCLOSURE 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. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 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 .ode,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner ora had nt: 7 forthwith comply with such provisions or this permit shall be deemed revoked. Date: ��'J ,/ APPLICANT CERTIFICATION CONS RUCTION LENDING AGENCY 1 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 mify 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-p 'nt source regplations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I /,/CI understand my plans shall be used as public records. Signature ` Date Licensed Professional CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31646010 . 00 DATE ISSUED. . . . . . . : 06/14/2011 RECEIPT #. . . . . . . . . BS000013759 REFERENCE ID # . . . : 11060117 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 . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : SHENOY ARVIND P AND ANURADHA ADDRESS . . . . . . . . . . : 10335 VIRGINIA SWAN PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- --------- 1BCBSC VALUATION 30, 000 . 00 2. 00 0. 00 2 .00 0. 00 1BREMFIXT NO. FIXTURES 4 .00 126 . 00 0 . 00 126 .00 0. 00 1BSEISMICR VALUATION 30, 000 .00 3 . 00 0. 00 3 .00 0. 00 1EPERMITFE FLAT RATE 1. 00 84 . 00 0 . 00 84 .00 0 . 00 1INSPMIS HOURS 1 .00 126. 00 0. 00 126 .00 0.00 1PPERMITFE FLAT RATE 1. 00 84 . 00 0 . 00 84 . 00 0. 00 1PRWHEATR UNITS 1.00 50. 00 0. 00 50 .00 0. 00 1REMRESKIT SQ FEET 299.00 1140 . 00 0. 00 1140 . 00 0.00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1657. 00 ,0 . 00 1657. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 657. 00 AMEX --------------- TOTAL RECEIPT 1, 657 . 00 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10325 virginai swan pl. DATE: 06/14/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $30,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: P PERMIT TYPE: WORK To Clear Code Enforcement Case: SCOPE Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT Other Plumb Insp. 0.0 hrs $42.00 Other Elec.Insp. 0.0 hrs $42.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 in o. FEE ITEMS (I ee Resolution 09-05I f;ff. b 10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 299 s.f. Remodel,Bath(<=300 sf) Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $570.00 IREMRESBAT PME Plan Check: $0.00 0 # Plumbing Permit Fee: $0.00 $25.00 /PRwHEATR Water Heater Suppl. Insp.Fee-0 Reg. 0 OT0.0 hrs $0.00 ® Electrical PME Unit Fee: $0.00 $63.00 IBREWIXT Fixtures,Lighting PME Permit Fee: $84.00 Acoustical Fee: 0 Yes (j) No $0.00 0 Work Without Permit? E) Yes 0 No $742.00 G 1'ianninf; Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0 i Strony, Motion Fee: IBSEISMICR $3.00 1.0 hrs Inspections Bldg Stds Commission Fee: IBCBSC $2.00 $126.00 IINSPMIS Standard Inspections SUBTOTALS: $873.00 $784.00 TOTAL FEE: 1 $1,657.00 Revised: 04/29/2011 PROJECT DATA - RESIDENTIAL �• COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISI 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building aacugertino.org dOj Cupelfi"`N"1No r' PRO ADDRESS APN# ' 5 v1 X 4)d/,4 sw PL- 64 G�� C�3a 1 OWNER NAME/ `�V/N S i NC7 y" PHONEi'4 ` . J 4,G i E-MAIL STRE T ADDRESS CITY, STATE ZIP FAX 0 35 of R6 .Sty Cv pt-N cr (14 FAX APPLICANT NAME PHONE '' E-MAIL S T ADD SS CITY,STATE, ZIP FAX 335 V( 4(f A,4 51� P g fla7 �Sa ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRAcrOR ❑CONTRAcroRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT + r vim';,`t� .: k% x = a s•a r , $ f EXISTING USE(S): -`_ PROPOSED USE(S): 42 XI OCCUPANCY(S): TYPE OF J PARCEL CONSTRUCTION: �-�lv AREA: FIRE Y N I WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N SPRINKLERS: Existing Proposed Floor Area: First Floor: S.f. Second Floor: f. s.f. Garage s.f. s.f TOTAL: s.f. s.f. ci R 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 20� .J�dRTM60 . 2010 California Residential Code (based on the 2010 California Plumbing Code(based on the 2009 Unifo r, ) 2010 California Mechanical Code based on the 2009 Unif ode 2010 California Electrical Code(based be kept at the 2010 California Energy Code job site during construction. It is unlawful to make any 2010 California Green Building Standards Co&ehances or alterations on same,or to deviate Cupertino Municipal Code therefrom,without approval from the Building Oficial. Tho stamping of this plan and specifications SHA`,I.l__NOT b^ held to jerm t or to he an a;z:;aval of the of any provisions of any Ci`-y C rdiciance or Stat '-Lw. BY�.�.�.. d4t ' vim......-..... �,...��...._. DATE �PERMIT NO. �Zo' etfqa f ' ential.doc revised 03/09/11 1 - I . y dOo fi°G-lL� �5) . O t IF AdOo r r t t! f S`N y r OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333- buiiding5cupertino.org CUPERTINO 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: sIT�0AJ;3TSS�l�ulN,d� �t �'LSb«/ eP# OWNERNAMEVf/vl" C �� t /D' S V/ �tJlP X4'f1,*,.J n(6- CV" N C,4- �%SO< DESCRIPTION OF WORK: /t'� Fii , 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.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- uilder" 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 VI-3. construction and are not hiring a licensed Contractor to assume this responsibility. '�tS �'3. I 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. ft4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. v 5. 1 understand if 1 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 ari"employer'under state and federal law. 66. I understand if I am considered an "employer' under state and federal law, I must register with the state and /e ral 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. 7. 1 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. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for ty fi nanciall or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. avnerRuilderFonn 1010.doc revised 04114110 teve I understand I may obtain more information regarding my obligations as an "employer"from the Internal nue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I m the party legally and financially responsible for proposed construction activity at the site address listed above. 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide (by all applicable laws and requirements that govern Owner-Builders as well as employers. X12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the Fn-formation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification a ceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature.' Property Owner's Signature: ! Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForin 1010.doc revised 04/14/10 CONSTRUCTION PERMIT APPLICATION - Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 'UPERTINa (408) 777-3228 • FAX(408) 777-3333• building aecupertino.org L]NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# h •"� J.3 i V i b 1!✓r P+ S�.Iry 1��z�w cA 7 S� C r �'5� l� O� <--� owNER xAI�� 1f, N 6J �' {-C--�v�_a P1114 j (e/71-MAIL sT a.DDRls i"Pt't rci ��- d r' 4�U -�L .r�' 7)l.ec^ (--A 'b�1 T FAX CONTACT NAMEr[l j�! ��-C7�1?y PHONE C" 04 1 6 661 Cr��TAr� _ FAX ❑ OWNER DOWNER-EUIDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE �TION� OOF�WO1RKL1 p6s T p 1 Olot/ �Q CfEE'y ;�ccdfn� S�Ww✓/ � GTr71/�GC � (�C�?�1 G s kill c� rte, EXISTING USE PROPOSED USE CONSTR TYPE #STORMS man � EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM GJ KITCHEN OTHER REMODEL AR REMODEL AIL_ REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH..aEA I GARAGE AREA: ❑ DETACH ❑ ATTACH #DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES RMG ADDED? ❑NO ADDMON? ❑NO PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER -....... F' ., By my signature below,I certify to each of the following: I am the property owner or authorized agent to act n 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 to building on I authorize representatives of Cupertino to enter the above-id ntiyficc property for inspection purposes. Signature of Applicant/Agent '�" 6 Date: �/ / //w-1/ SUPPLEMENTAL INFORMATION REQUIRED 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. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure .n if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp 2011.doc revised 03/16/11