10070014 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 FINCH AVE CONTRACTOR:UPPAL CONSTRUCTION PERMIT NO: 10070014
CO
"BIER'S NAME: AMITA AGARWAL 2245 PETERSBURG DR DATE ISSUED:07/01/2010
OWNER'S PHONE: 6509065292 MILPITAS,CA 95035 PHONE NO:(408)507-6750
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F
License Class__ Lic.# 5N 1 9 5 MECH r- RESIDENTIAL r COMMERCIAL
Contractor.y FP-Al- CVN S_J• to Date
JOB DESCRIPTION:BATHROOM REMODEL,NO STRUCTURAL(SOSQFT)
I hereby affirih that I am licensed under the provisions 6f 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:$4000
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 whichs
APN Number:37540053.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply l Lv
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date.•=
9.18.
nature Date0
RE-ROOFS:
•❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this 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
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Owne or uthorized agent-
Compensation
Compensation laws of California. If,after making this certificate of exemption,I � Date:
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
the above mentioned property for inspection purposes.(We)agree to save
.inify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex OVER THE APPLICATION 1 R3SFDADD/REM
USE: COUNTER? 0 Yes 0 No TYPE:
MECHANICAL 0 Yes 0 No PLUMBING 0 Yes 0 No I ELECTRICAL 0 Yes 0 No
x
oC a
0 0
3 �
OCCUPANCY TYPE: TYPE OF FL12 AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s .ft.
R-3 (Custom) II-B,111-B,1V,v-B 0 $0.00 $0.00
TOTALS: F 0 $0.00 $0.00
NOTE: Thesefees are based on the preliminary in ormatior available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 Eff.' 7,1`09) FEE QTY/FEE MISC ITEMS
Plan Check Fee: 90.00 50 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT 0.0' 1 hrs 90.00 $570.00 1REMRESBAT
PME Plan Check: 90.00
Permit Fee: 90.00
Suppl. Insp.Feer Reg. 0 OT 0.0 hrs 90.00
PME Unit Fee: 00.00
PME Permit Fee: 90.00
Acoustical Fee: 0 Yes 0 No 90.00 0
Work Without Permit? 0 Yes 0 No 90.00 0
Planning Fee: $0.00 Select a Non-Residential 0
"firr?r „ rr ,, i Building or Structure
Strom Motion Fee: $0.00 Select an Administrative Item
Blda Stds Commission Fee: 50.00
SUBTOTALS: 310.001 $570.00 TOTAL FEE: $570.00
Revised: 6/30/2010
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37540053 .00
DATE ISSUED. . . . . . . : 07/01/2010
RECEIPT #. . . . . . . . . BS000010759
REFERENCE ID # 1OC70014
SITE ADDRESS . . . . . : 10430 FINCH AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AM]TA AGARWAL
ADDRESS . . . . . . . . . . : 104:30 FINCH AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : UPPAL CONSTRUCTION
CONTRACTOR BHRJAN UPPAL LIC # 31802
COMPANY . . . . . . . . . . : UPPAL CONSTRUCTION CO
ADDRESS 2265 PETERSBURG DR
CITY/STATE/ZIP . . . : MILPITAS, CA 95035
TELEPHONE (408) 507-6750
FEE ID UNIT QUANTITY ;MOUNTPD-TO-DT THIS REC NEW BAL
---------- - --------- ----------
1BCBSC VALUATION 4, 000. 00 1 .00 0 .00 1. 00 0 .00
1REMRESBAT SQ FEET 1. 00 570 .00 0 .00 570 . 00 ------0_00
- --------- ---------- ----------
TOTAL PERMIT 571. 00 0 .00 571 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------
CHECK 571 .00 #184
---------------
TOTAL RECEIPT 571 .00
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# � _ 0 Date:
�) �( --
Is a 2nd unit being added? Yes ❑ No ❑ If yes, please fill out theerrmit application for 2nd unit.
Building Address: /0 q `30 F l� CA/ t? Vr <7 1,c P,,7 .1'I'v-70 C14
' ��t� � L.'
Mailing Address (if different from building address)
Owner's Name: Phone#
t,- P M lw15_0: q O C �`L y Z_
Contractor: Phone#: o g 5"'n
L) P/9/+-L Fax#:
Cupertino Business License: � ? h tate Contractor License#:
Contact: �l ,-t,11"��}� Ul f n/� �- Phone#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas): ' .
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape 1'roject Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building P9m1t Info:
Bldg. Elect. Plumb. [r Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
R aJd1/� c�Lo eA
What is being remodeled(not including a dition ��`��
Remodel Includes Re-Roof. Yes ❑ No [' If yes list number of squares
Remodel Includes Structural: Yes ❑ No [�
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your plannin approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath ✓ Other
Type of Construction (Usage Class): Occupancy Type: V-'7
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V.B Valuation: 0,0-O - cn 0
Please check this box if the project is a
Project Size: Express [ andard ❑ Large ❑ T4a'or ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if appli-able, Green Building Points Achieved:
include in plan set& the sheet index. G
Revised )5/18/10
M.Indoor Air Quality and Finishes
1.Use LowND-VOC Paint 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes D
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
E 1 �
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1
Total Points Available: L 1401 1301 57
Total Points Project Received: 0 0 0
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 0 ki `Is D 11%4&H PERMIT# 7 Dc:�'
OWNER'S NAME: 19 m �% R 1 PHONE# 67 0 Z
GENERAL CONTRACTOR: CON teAO -BUSINESS LICENSE#
ADDRESS: !Z;2 ti -r/'1R 1 1PG, j2g ptjj,,ej0kY/ZIPCODE: Q
*Our municipal code requires all businesses working it 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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and compl ate the following information:
SUBCONTRACTOR BUSINE iS 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