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10050071CITY OF CUPERTINO B UILDING PERMIT I BUILDING ADDRESS: 21796 HYANNISPORT DR OWNER'S NAME: AGARWAL PUNEET & NARANG KAMINI lER'S PHONE: 4084768241 ❑ LICENSED CONTRACTOR'S DECLARATION License Class /� Lic. # v l 3I 7 Contractor �.Y6� �!%��-.r 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 app 'cant understands and will comply with all non -point source r gulatio/e,Cupertino Municipal Code, Section 9.18. Signature Date `. 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 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 i"'^mnify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the g.—ting of this permit. Additionally, the applicant understands and will comply with all non -point source re lations per thfaCupertino Municipal Code, Section 9.18. CONTRACTOR: S & B CONSTRUCTION PERMIT NO: 10050071 1409 4ARRIET AVE DATE ISSUED: 05/06/2010 CAMPBELL, CA 95008 PHONE NO: (408) 529-1818 BUILDING PERMIT INFO: BLDG F ELECT r– PLUMB MECH F RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION: RMODEL 2 BATHROOMS,I TUB,1 SHOWER,2 SHOWER VALVES,NO ELECT & NO LIGHT;NO RE -ROOF & NO STRL CTURAL Sq. Ft Floor Area: APN Number: 35613016.00 Valuation: $8000 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:-f—C'1Y 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 inspc ction. Sigm.ture of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hai a read the hazardous materials requirements under Chapter 6.95 of the Calil ornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe y Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air cont iminants as defined by the Bay Area Air Quality Management District I will mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & ;Safety Co e, Sectio 25505, 25533, and 25534. Owner or orized nt: Date: CONSTRUCTION LENDING AGENCY I her ;by affirm that there is a construction lending agency for the performance of work's for v hich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I uncerstand my plans shall be used as public records. Date0 -0-8/10 1 Licensed Professional 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: I,ot: APN ........: 35613016.00 DATE ISSUED.......: 05/06/2010 RECEIPT #.........: BS000010346 REFERENCE ID # ••.: 10050071 SITE ADDRESS .....: 21796 HYANNISPORT DR SUBDIVISION ...... CITY .............. CUPER-INO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: AGARWI�L PUNEET & NARANG KAMINI ADDRESS ..........: 21796 HYANNISPORT DR CITY/STATE/ZIP ...: CUPER`..'INO, CA 95014 RECEIVED FROM ....: S & B CONSTRUCTION CONTRACTOR .......: SABRIJA KUCEVIC LIC # 29043 COMPANY ..........: S & B CONSTRUCTION ADDRESS ..........: 1409 HARRIET AVE CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408) 529-1818 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 8,000.00 -------------------- 1.00 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 8,000.00 0.80 0.00 0.80 0.00 1BUSLIC FLAT RATE 1.00 :_14.00 0.00 114.00 0.00 1INSPREIFE HOURS 2.00 252.00 0.00 252.00 0.00 TOTAL PERMIT ---------- ---------- :367.80 0.00 ---------- 367.80 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CHECK 367.80 -------------------- #:_418 --------------- TOTAL RECEIPT 367.80 CITY OF CUPERTINO ADDITION/REMODEL OF CUPERTINO PERMIT APPLICATION FORM APN # `5 U C Date: O S o -_2 ((� Is a 2" unit being added? Yes ❑ No yes, ple<Lse fill out the permit application for 2" unit. Building Address: Mailing Address (if different from building address): Owner's Name: I' pne 4: f�G-A !,>,W+ L 41 +'J - 6 Z Contractor:_, Phone #: S L� CCN S (iIV C / 1 Fax #: S-21— Contractor License #: g 13 / 9 S Cupertino Business License #: Contact: Phone it: Fax #: Building Permit Info: Bldg. � Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition -What is being added?(Be Specific): REE/10,E 2 1 R-�^�S T 'iUB SIroW 2 s k t w c,L- 1/prL v What is being remodeled (not including addition)? VO Ct- A`V t -/y- Remodel Includes Re -Roof: Yes ❑ NoIf yes list number of squares Remodel Includes Structural: Yes F-1No Do you have the pre -application planning approval? Yes ❑ No If yes, please provide a copy of your planning ap roval letter. Planner name: Square Footage: Addition: Porch: Deck: _ Garage: Detached Attached Remodel: Kitchen Cah L-- Oth,;r Type of Construction (Usage Class): Occupancy Type: I -A, 1-B II/IIIN-A ❑ IUIII B, IV -HT, V -B [ --� Valuation: Please check this box if the project is a second -story addition ❑ Project Size: Express ❑-9taffdard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Buildin g Checklist & attach it to the application or if applicable, Green Building Points Achieved: include in plan set & the sheet index. ***For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 CITY OF CL"PERTINO ADDITON/B:EMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1MECPLNCK Stand Alone Mech�mical Pln Ck (hourly M 1 PLMPLNCK Stand Alone Plumt ing Pln Ck (hourly) P 1B BSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICRE Seismic Residential B 1TRAVD0C Travel & Documentation B 1 BUSLIC Business License B '� �1JPSi /2 G M. indoor Air Qua 6ty and Finishes 8 Res)urce pts y=yes 't. Use Low?NO-VOC Paint 1 IACl/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IACWHealth pts y=yes 3. Use Low'No VDC Adhesives 3 IA011-lealth pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Res)urce pts y=yes Formaldehyde 61A(i/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes 3. Saai al EupDsW PatoWboard or MDF 4 IA(VHealth. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IA 2/Health pts y=yes 14. Flooring 1. Select FSC Certified Wood Flooring 8 Res)urce pts y=yes 2. Usa Rapidly Renewable Flooring Materials 4 Res)urce pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Res)urce pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Res)urce pts y=yes Total Points Available: Total Points Project Deceived: 14aF— 1-301 57 Q Q i °S jqC Zoo G:datalprogs/greenbuildir oouidelines/remodelers/greenpointsnnal212.D4proteoted.xls RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number:. f S �' l Name of owner. Pr m1 N I A G �'�� JRFcEiV1FdD Project address. 2,—) :7 16 'l i �i�"��% S►� (2- l 1)12— MAY 0 6 2010 Contact person. -v1kg ICAJ C-6 V1 Z— Phone. _�}'0 g— S��J ' /0 13y' Fax.—�� -�? —4 LZ Net square footage of lot. Existing Square footage: First floor: Second floor: Garage: TOTAL: Proposed Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y--� Is privacy protection planting required for the project?= �"N-- 3uild it Green Total Points On what floor(s) is work being done? Brief description of work. w A--/ E '�— Pf`a �" "�S ' t,</ 2 C`epua-,-- 6 li U Code editions: 2007 CBC 5(YN)2007 CFC (Y - N)2007 CMC (Y- N) 2007 CPC (Y - N)2007 NEC (Y - N) Effective 1/1/08 Plan Review Process Work Book Page -8-Revised 8/05/08 APPROVED IN A. CORDANCE WITH THE CITY OF CUPS JINO CODLLSS AND ORDINANCES ;IGNED __-- This st t of plains and specifications MUST be k apt on the fob at all times and it is unlawfr i to make any changes or alterations on sa Tie without written permission from the Bu Idmg Department, City of Cu rtino. The sta raping of this plan and specif cations SHAL - NOT be held to permit or to be an appro ral of the violation of any provisions of py City Ordinance or State Law. CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Z 1 -�-9 AJN S 0 TZ T 1I-- PERMIT # OWNER'S NAME: ZAM PHONE # k''/77 - 9-2L GENERAL CONTRACTOR: 5COs t12(�� p BUSINESS LICENSE # 9 fS ADDRESS: I29y DW L 9(.1NA1V)jCe- 00-- CITY/ZIPCODE: 4! ij WLE fat *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 SUBCONTRACTORS HAVE OBTAINED BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors an complete the following information: A CITY OF CUPERTINO 0S-0161- "(C) Date Owner / Coidractor Signature 0 5--0 4; -2-aro Date 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 / Coidractor Signature 0 5--0 4; -2-aro Date