10080053 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 10846 WILLOWBROOK WAY CONTRACTOR..-r P-44—i.4E PERMIT NO: 10080053
VNER'S NAME: PUNITMA MALHOTRA za DATE ISSUED:08/06/2010
OWNER'S PHONE: 4087865264 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
ic.# d R EPAIR DRYROT IN HALL BATH/REPAIR SHOWER PAN
License Class L
/1 j� *SEE NOTES*
Contractor 01_/1 LIdI7.fTi"G[W 417 Date S16
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. Sq Ft Floor Area: Valuation:$850
1 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 whi s Al N Number:36922043.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the "5 X
Date:
granting of this permit. Additionally,the applicant understands and will comply Is:;ued by: ,
with all non-point source regulations per the Cupertino Municipal C de,Section
9.18.
G RE-ROOFS:
nature Date O G� Al I roofs shall be inspected prior to any roofing material being installed.If a roof is
in:talled without first obtaining an inspection,I agree to remove all new materials for
in:.pection.
❑ OWNER-BUILDER DECLARATION
Si;nature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I Have read the hazardous materials requirements under Chapter 6.95 of the
C difornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: H math&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. w 1 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti sl25505,25 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I iereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. w ark's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
7 the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
.-mnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I mderstand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Building Department
III City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# l '�
OWNER'S NAME: PHONE# aS/a
GENERAL CONTRACTOR: ; BUSINESS LICENSE#
ADDRESS: C CITY/ZIPCODE: SQ , w
*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 SUBCONT TORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signal ure 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/Contractor Signature Date
CITY OF CUEERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36922(43 . 00
DATE ISSUED. . . . . . . : 08/06/ 2010
RECEIPT #. . . . . . . . . BS000C11113
REFERENCE ID # . . . : 10080(53
SITE ADDRESS . . . . . : 10846 WILLOWBROOK WAY
SUBDIVISION . . . . . . .
CITY CUPER-INO
IMPACT AREA . . . . . .
OWNER PUNITHA MALHOTRA
ADDRESS 10846 WILLOWBROOK WAY
CITY/STATE/ZIP . . . : CUPER`.'INO, CA 95014-4541
RECEIVED FROM . . . . : CALI CONSTRUCTION
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOJNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----
1BCBSC VALUATION 850 . 00 1. 00 0 . 00 1. 00 0. 00
1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 . 00
1STPLNCK HOURS 2 . 00 252 . 00 0 . 00 252 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 367.00 0 .00 367 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 367. 00 VISA
---------------
TOTAL RECEIPT 367. 00
CITY OF CUPERTINO
ILE ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
l�9 e �3, X /ra
Is a 2"d unit beingadded? Yes ❑ No If es, lease fill out the permit application for 2"d unit.
BuA ��6 SsIUri/Ow61&�
Mailing Address (if different from building address):
07 er's Name: Phone#
Co actor: Phone#:
k/i 61qS LlC-bew Fax#:
Cupertino Business License: State Contractor License#: Z/-
Contact���S� ��� Phone#:
Fax#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape`'Vater-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ `Vater Budget
Building Permit Info:
Bldg. Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
l��L�e olGtca �4u b j'im- h_-4W
�i
�P4
ZA �-SMAIrl" fin 1,17 i�
Remodel Includes Re-Roof: Yes ❑ No lig' I'yes list number of squares
Remodel Includes Structural: Yes ❑ No 9
Do you have the pre-application planning approval? Yes ❑ No
If yes, please provide a copy of your planning a -oval letter. Planners name:
Square Footage: J
Addition: Porch: Deck: _ Garage: Detached Attached
Remodel: Kitchen Bath Othe-
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B El II/III/V-A ❑ II/III B, IV-HT, V-B [J Valuation:
Please check this box if the project is a
Project Size: Ex ress ❑ Standard ❑ Lar e ❑ Major❑ second-story addition ❑
Please complete relevant portion of the Green Building;
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
Revised 0511 E/10
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19846 Willowbrook Way DATE: 08/06/2010 REVIEWED BY:
APN: BP#: "VALUATION: $850
*PERMIT TYPE: Building Permit PLAN CEECK TYPE: Alteration/Addition/ Repair
PRIMARY R)Z a I. i APPLICATION
USE: SFD or Duplex F100 -iRk,' . TYPE:
a a,wre air d rot in hall bath/ repair shower master bath
00
3 �
1,1110d, Mout C wcr; l lc. f'Inl Chem
1<'inill Pct's
(111t: ' b1e;'Ii- ince. OIrr,rr l'Itunh hz�J. OIFtcr L7 . luip.
NOTE: Thesefees are based on the prefindnaty information avails.Ve and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 09-051 Elf.' 17:'1:'09) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
( Non 7_01,
Acoustical Fee: 0 Yes Q No $0.00 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential 0
l;OCt i 1)cx Nn1('nlc1liu)7 FC V. Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 2.0 hrs Standard Hourly Rate
Bldg Stds Commission Fee: IBcasC $1.00 $252.00
'" ' ASi3B �TALSs. $1.50 $252.00 "' $253.50
amu.
Revised: 8/06/2010
LANDSCAPE WATEI:-EFFICIENCY CHECKLIST
Connnunity Development Department
10300 Torre Avenue 408.777.3308/Fax 408.777.3333
Cupertino, CA 95014 planning@cupertino.org
C U P E RTI N O http://cupertino.org/planninc,
Applicant Name: C� /7 J (�{ '; yr Email:GCc/l. /'JS Ue-76 D/3
Project Site Address: t)Nz"51 /11R42�01_ Phone: c)S/,)
Total Landscape LE ndscape area: All the planting areas, turf areas, and ivater
Area (square feet): features in a landscape installation. The landscape area does
not include footprints of buildings or structures, sidewalks,
driveways, parking lots, decks,patios, gravel or stone walks,
Turf Area: other pervious or non-pervious hardscaF.es, and other non-
irrigated areas designated for non-leve-opulent (e.g., open
spaces and existing wildland vegetation).
Non-Turf Plant Area: T,irf: A ground cover surface consisting of non-native grass
s pecies that is customarily moived. Anrival bluegrass,
l.entucky bluegrass, perermial ryegrass, red fescue, and tall
Special Landscape Area: fescue are examples of cool-season turf grasses. Bermuda
Water Feature Wet Surface Area: grass, kikuyu ass, seashore paspalum, St. Augustine grass,
zo}lsia grass, and buffalo grass are ivarm-season turf grasses.
If>10%of landscaped area,water budget calcu-
lation required with landscape project submittal. See reverse side for other definitions.
NOTE: If landscape area exceeds 2,500 sq.ft.,a landscape project:ubmittal shall be required. If no landscaping is proposed,enter
"0"above and proceed directly to the signature block at the botton.of this form.
Landscape Parameter Requirements Project Compliance
Turf Total turf area shall not exceed 25% of the landscape ❑ Yes ❑ ]:o
area,or 1,250 square feet,whichever is lesser in area. r Iro T"'u - Yey ;,"e_
to�`ti.u2L�-diculc.t'�I: i_"�C.
-ILII ia':dsca:'e}:cilCl'l_ l"Illi ttal
All portions of turf areas shall be wider than eight(8)feet. ❑ Yes
Turf(if utilized)is limited to slope: not exceeding 15%. ❑ Yes
Non-Turf At least 80% of non-turf area shall<onsist of native or ❑ Yes o
low water use plants. [lf 1I":" % 'ater'L-'_d`et calcula:;011 "equL'"ec.
\v ith landscape prosect s-ib"mttal'
Hydrozones Plants with similar water needs shE 11 be grouped within ❑ Yes ❑ Nc,
hydrozones. Each hydrozone shall be controlled by a Flanits can be ggoaped per
separate valve. Table 1 .1=.O;CiC ,
Irrigation System Systems shall be designed and mai:itained to minimize ❑ Yes ❑ 1`:0
water waste(e.g.,runoff,low head drainage,overspray).
Low-volume irrigation shall be utilized in non-turf areas.
Irrigation shall only occur between the hours of 8:00 pm [ii no,Fi-ovide e:f i nation cn back]
and 10:00 am.
Soil A minimum of eight(8)inches of n Dn-compacted topsoil ❑ Yes ❑ o
shall be available in planted areas. nn cn backs
Soil amendments,such as compost or fertilizer,shall be
appropriately added according to t 1e soil conditions at Yes ❑ �'o
the project site and based on what is appropriate for the
[i.no,Provide ide p la lotion on back.
selected plants.
Mulch A minimum two(2)-inch layer of n.ulch shall be applied ❑ Yes ❑ No
on all exposed soil surfaces of plan ing areas,except in
areas of direct seeding application e.g.hydro-seed). ['`ao,°rcride e;:pian.ati `;l ca"backl
I am aware of available informational resources regarding native and low water use plants,irrigation efficiency,and other aspects of
water-efficient landscaping. I certify that the information provided on this checklist is correct,and the installed landscape complies
with the requirements of Chapter 14.15.1 also understand that any changes to the project will necessitate a new checklist.
Signature of property owner or authorized representative Date
Page 1 of 2