10120089I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10235 VICKSBURG DR
vER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
permit is issued.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
ature
Date
12/ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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.
APPLICANT CERTIFICATION U��J
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
wilding construction, and hereby authorize representatives of this city to enter
.i the above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. "
Date
CONTRACTOR: JOSE PEREIRA & MINOO PERMIT NO: 10120089
MEHTA
10235 VICKSBURG DR DATE ISSUED: 05/13/2011
CUPERTINO, CA 95014 PHONE NO:
JOB DESCRIPTION: RESIDENTIAL U COMMERCIALE]
ADD LVING ROOM,OFFICE & POWER ROOM(439SQFT)
500 SQ
FT CARPORT & REMODEL KITCHEN(239SQFT);NO RE -
ROOF &
HAS STRUCTURAL AND NO PRE -PLANNING APPROVAL
Sq. Ft Floor Area: I Valuation: $100000
APN Number: 36907011.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: i�.�� Date•
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25PON 25533, and 25534.
Owner or authorized agent: Date: 201
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name _
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING
BUILDING ADDRESS: 10235 VICKSBURG DR
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
f�
License Class n 1 Lic. 2-
t4
Contractor (� f01 %a L ) ILIP:;2 -IU _ Date Z ��
hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Date 2
OWNER -BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
CONTRACTOR: UPPAL
CO
2245 PETERSBURG DR ' DATE ISSUED: 05/13/2011
1 hereby affirm under penalty of perjury one of the following three
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.
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
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.
APPLICANT CERTIFICATION
I emit} 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
's, and expenses which may accrue against said City in consequence of the
ung of this permit. Additionally, the applicant undcrstands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signatu
Date
MILPITAS, CA 95035 PHONE NO: (408)';07-6750
BUILDING PERMIT INFO: BLDG I— ELECT 1_ PLUMB
MECH F RESIDENTIAL r— COMMERCIAL
JOB DESCRIPTION: ADD LVING ROOM,OFFICE & POWER ROOM(439SQFT) 500
SQ
FT CARPORT & REMODEL KITCHEN(239SQFT);NO RE -ROOF &
HAS STRUCTURAL AND NO PRE -PLANNING APPROVAL
p •21 `1 i nn�j��2 c✓ U,o__J__ tk �_,'P L it
Sq. Ft Floor Area: I Valuation: $100000
APN Number: 36907011.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner
2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professiona
i i
! I VW
M1111 11 1111 !1111111! 11, 111! 111i1 1 � 11 069WRO I
BUILDING ADDRESS: 10235 VICKSBURG DR
OWNER'S NAME:
0 LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 4
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
permit is issued.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
0,- OWNER -BUILDER DECLARATION
17
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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
construct the project (See.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. — ')
CONTRACTOR: UPPAL CONSTRUCTION
Co
2245 PETERSBURG DR
MILPITAS, CA 95035
kim va
PERMIT NO: 10120089
DATE ISSUED: 05/13/2011
PHONE NO: (408) 507-6750
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r, COMMERCIAL F -
JOB DESCRIPTION: ADD LYING ROOM,OFFICE & POWER ROOM(439SQFT) 500
SQ
FT CARPORT & REMODEL KrrCHEN(239SQFT);NO RE -ROOF &
HAS STRUCTURAL AND NO PRE -PLANNING APPROVAL
9/20/2011 -REV#2-EXTEND PORCH AT FRONT ENTRANCE-ISS'D 9/2012011
Sq. Ft Floor Area: I Valuation: $100000
APN Number: 36907011.00 1 Occupancy Type:
Issued
RE -ROOFS:
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.
Signature of Applicant: — Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25.532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner ora Datc-Ab—�
20
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records,
Licensed
CITY OF CUPERTINO
FEE FST111' , AT,414111, - VftJIL1)IVG -NIVISIOV
19 ADDRESS: 10235 vicksburg dr. )ATE: 06/21/2011
APN: #:
REVIEWED BY: bobs.
*VALUATION:
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
I
PENTAMATION
I PERMIT TYPE: 1GENRES
WORK
revise shear wall at restroom location
SCOPE
I
Chl-
ivuip—, These tees are based on mepreinninary iniorinanon avanahte ana are oniv an esumam uontactme hent far aaan7 into.
FEE ITEMS
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No
$0.00
L_Lj hours Plan Check, Hourly
$252
A
Suppl. PC Fee: G Reg. 0 OT
Q.0
hs
$0.00
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
Cons,M!Ief�on 7�1'v
F
Acoustical Fee: 0 Yes E) No
$0.00
0
G
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee-
$0.00
Select a Non -Residential
Building or Structure
G
Strona Motion Fee: IBSEISMCR
$0.50
Select an Administrative Item
Blda Stds Commission F= IBCBSC
$1.00
T
$1.50
T,
$252.00f
253.50
Revised: 04/29/2011
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10235 vicksburg dr.
DATE: 12/15/2010
REVIEWED BY: bob s.
wch. Plan Check
.i'' 211%!! Plan c I'cCA 1 1
Eke. Plan ("/?Oc
'I I
*VALUATION:
1$100,000
,PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Duplex
[_USE: I
R THE
JNTER? 0 Yes 0 No
PENTAMATION lR3SFD,ADD
PERMIT TYPE: A
Elec' lny' Fo�?:
$0.00
Permit Fee:
$1,169.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
(s.f.)
wch. Plan Check
.i'' 211%!! Plan c I'cCA 1 1
Eke. Plan ("/?Oc
'I I
$1,438.00
R-3 (Custom)
%t C. Permit F"e:
OMer,lkch. In p,
�1, 4 3 8. �OO
Akck hmp,Fee:
, , ,
P/Umb, hup. Fee,:
�Lj
Elec' lny' Fo�?:
$0.00
Permit Fee:
$1,169.00
Suppl. Insp. Fee10 Reg.
0 OT:TTMhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.7onsiruction Tax
MUNN
W&JE,
0 Yes 0 No
$0.00
MECRI, HOURLY 'Q'Ves'(F) No.
!'PLUMB, HOURLY OYes ,ONo
TLEC,HOURLY OYes ONID
wch. Plan Check
.i'' 211%!! Plan c I'cCA 1 1
Eke. Plan ("/?Oc
'I I
$1,438.00
"?him!).Perni'l e.61:
%t C. Permit F"e:
OMer,lkch. In p,
On, ler Plumb lnsp
I
Akck hmp,Fee:
, , ,
P/Umb, hup. Fee,:
�Lj
Elec' lny' Fo�?:
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addnl info.
FEE ITEMSffiee �R,,,wol�yfion 09�-05I E . �7/1/101
FEE
QTY/FEE
T
MISC ITEMS
Plan Check Fee:
$1,438.00
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: E) Reg. 0 OT:=hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,169.00
Suppl. Insp. Fee10 Reg.
0 OT:TTMhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.7onsiruction Tax
Acoustical Fee:
0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
PLLONGRNGR
$57.07
0
0
TrOlvel Doewnenfation kees:
Strom, Motion Fee:
IBSEISAffCR
$10.00
Select an Administrative Item
Bldg Stds Commission Fee:. IBCBSC
$4.00
SUBTOTALS:
$2,678.07
$570.00
TOTAL FKK�
1 $3,24
Revised: 12/07/2010
imADDRESS: 10235 vicksburg dr.
1/20/2011
REVIEWED BY: bob s.
APN:
I BP#:
EVALUATION:
1$500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE: I
hrs
PENTAMATION 1GENRES
I PERMIT TYPE:
WORK
12nd revision extend porch at front entrance.
SCOPE
1
'Fee:
I
NOTE: This estimate does not include fees due to other Depts (Le. Public Works, Sanitary Sewer District, School District, etc.).
t nese tees are basea on ifte Pretimmary mrorn
FEE ITEMS (Fee Resolution 11-053 L�JL7L/7,/11'
Plan Check Fee: Hourly Only? 0 Yes (D No
Suppl. PC Fee: E) Reg. 0 OT
F-0.0-
I hrs
PME Plan Check:
Permit Fee: Hourly Only? 0 Yes E) No
Suppl. Insp. Fee -0 Reg. 0 OT
16.61
hrs
PME Unit Fee:
PME Permit Fee:
onslru'cfion
Work Without Permit? 0 Yes E) No
Advanced Plannjng Fee:
F ee.
IBSEISMCR
Bldg Stds Commission Fee.
IBCBSC
avaname ana are only an estimate contact tne vent ror a
FEE QTY/FEE I MISC ITEMS
$0.00 = hours Plan Check, Hourly
$0.00 $130.001 ISTPLNCK 1
$0.00
$0.00 1
$0.00
$0.00
$0.00