11020094 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1282 S STELLING RD CONTRACTOR:SANDIUM PERMIT NO: 11020094
OWNER'S NAME: ASHOK BANGALORE 4223 VERDIGRIS CIR DATE ISSUED:02/24/2011
OWNER'S PHONE: 4088239064 SAN JOSE,CA 95134 PHONE NO:(408)894-9072
L LICENSED CONTRACTOR'S DECLARATION [ r—
(� n Q i BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class W .&Lic.# 0 Z)v �t � � � F
MECH RESIDENTIAL COMMERCIAL
Contractor G k V 1M Date 02 `Z y (it
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD ADDITIONAL INSULATION TO ATTIC R VALUE R-38,
(commencing with Section 7000)of Division 3 of the Business&Professions R-19 INSULATION TO SUBFLOOR
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 Sq.Ft Floor Area: Valuation:$2500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36611107.00 Occupancy Type:
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 constructs , re �authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above ntioned property r inspectio urposes. (We)agree to save
indemnify keep harmless the Ci upertmo ag . st Iiabilities,judgments, WITHIN 1 0 AYS OF PERMIT ISSUANCE OR
costs,an xpenses which may ac against said City n consequence of the 180 DA OM LAST CALLED INSPECTION.
granti of this permit. Additio 11 ,the applicant un rstands and will comply
with I non-point source reg do s per Cuperti Municipal Code,Section ✓� LJI
9.1 . ( Issued by: Z' -'Y / Date:
Si ature Date V Z "� 1 If
( OER- R DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
[contaim efined by the Bay Area Air Quality Management District I will
permit is issued. ' ain compliaawiththe C Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall alth&Safety de,Secti 5505, 533,and 25534.
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 Owner or au t ed �nt /
become subject to the Worker's Compensation provisions of the Labor Code,I m t Date: O 2 1 ZH (t
forthwith comply with such provisions or this permit shall be deemed revoked.
ONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
C and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
L ►g of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36611107 . 00
DATE ISSUED. . . . . . . : 02/24/2011
RECEIPT #. . . . . . . . . : BS000012766
REFERENCE ID # . . . : 11020094
SITE ADDRESS . . . . . : 1282 S STELLING RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ASHOK BANGALORE
ADDRESS . . . . . . . . . . : 1282 S STELLING RD
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5204
RECEIVED FROM . . . . : TYLER LEWIS
CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867
COMPANY . . . . . . . . . . : SANDIUM
ADDRESS . . . . . . . . . . : 4223 VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE . . . . . . . . : (408) 894-9072
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 500 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 500 . 00 0 .50 0 . 00 0 .50 0 . 00
1INSPMIS HOURS 1 . 00 126 . 00 0 . 00 126 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127.50 0 .00 127 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 127 .50 MC
---------------
TOTAL RECEIPT 127.50
P/
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: Z ST�I✓L f n/ DATE: Z•2.�•(� REVIEWED BY:
I L APN: BP#: *VALUATION: $2,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: I I PERMIT TYPE:
WORK 40 C—
SCOPE n/ �-.V D rf d 11�1"Oil .1
W, r>.
r it f`c'c;Lj "
tt // Fftl _ Itris ._ IYlSI%,
Ili J." 1: kc<-- gip; /-w
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resohrtion 09-051 E,ff 7%1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
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
C`onsiruction 7'a
Acoustical Fee: 0 Yes (E) No $0.00
Work Without Permit? 0 Yes (F) No $0.00 E)
Plannin_Fee: $0.00 Select a Non-Residential E)
1 r-i;t<.�r')c3�.trtares,tr�lir,rd lcre'.�'-
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $0.50 1.0 hrs Inspections
Bldg Stds Commission Fee: 1BCBSC $1.00 $126.00 IINSPMIS Standard Inspections
SUBTOTALS: $1.50 $126.00 TOTAL FEE:, $127.50
Revised: 01/15/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: I Z S 2 S. -S-rt4 o Aj ' a-p PERMIT#
OWNER'S NAME: PHONE # A 0 1 Z
GENERAL CONTRACTOR: S ( BUSINESS LICENSE# S$8 %14k
ADDRESS: 3 CITY/ZIPCODE: S aS
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL CUPANC INSPECT ) WIL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND LL SUBCON CT HAVE OB T INED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontract s: b Z I//
Z-,u
Signr4he46;1�o
Date
Please check applicable subcontractors 7dcomplet wing 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
Owner/Contractor Signature Date
CITY OF '�• i �0' `- iu
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
//o2a�9
APN# 2 w t l �-� b Date:
ol IZ9
lzcw
Building Address:
Mailing Address (if differen om building address):
Are Hazardous Materials being used as part of his project? Yes ❑ No
HOA: (Exterior work only) Yes F1 No part
yes, provide letter from HOA
If Residential,is house an Eichler? Yes ❑ No Ell'if es, needs planning approval.
Owner's Name: Phone #: Np e
Av3 �L 6 y
Contractor: Phone: ztOJ3 9.44 16l
0 0A Fax: 65o 6 tq oSos
Contractor License #: el
Cupertino Business License #: L<,-ANoi
Contact: Phone: qu F) L(T2 �6 q
CJt Fax/e-mail: T 9
Residential Commercial ❑
Job Description: N,00 A-u p l T-LO,v � It-) S w Q UATO PrT T I L
IL---v.mac..v C-- 2,
A&h VZ--O, 1 nJ-,j,-A�1 oti%
Building Permit Info:
BldgC'�' Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ I1/III B, IV-HT, V-B ❑
Valuation: 42 t500 Square Footage: i t Z oo
Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 12/06/10