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10020125 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 1145 HUNTERSTON PL CONTRACTOR:ABHIJIT BARDE PERMIT NO: 10020125 OWNER'S NAME: ABHIJIT BARDE 1145 HUNTERSTON PL DATE ISSUED:02/23/2010 PER'S PHONE: 4082425083 CUPERTINO CA,CA 95014-5068 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL MASTER&GUEST BATHROOMS;ADD (commencing with Section 7000)of Division 3 of the Business&Professions SHOWER TO GUEST BATHROOM TUB&ENCLOSE WITH SHOWER GLASS;NO Code and that my license is in full force and effect. RE-ROOF&NO STRUCTURAL 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 Sq.Ft Floor Area: Valuation:$3000 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36221014.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued byY— - Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensatior, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: 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 declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I mu.,t Owner r authorized ent: forthwith comply with such provisions or this permit shall be deemed revoked. -7 Date:f/d APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name -unify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature �/ /" Date / 10 ' Licensed Professional CITY OF' CUPERTINO 3 ITEMS OF 3 PERM=:T RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: B'-k: Lot: APN 36221014 . 00 DATE ISSUED. . . . . . . : 02/23/2010 RECEIPT #. . . . . . . . . B:3000009805 REFERENCE ID # . . . : 10020125 SITE ADDRESS . . . . . : 1145 HUNTERSTON PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER A:3HIJIT BARDE ADDRESS 1L45 HUNTERSTON PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5068 RECEIVED FROM A3HIJIT BARDE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY A3HIJIT BARDE ADDRESS 1145 HUNTERSTON PL CITY/STATE/ZIP . . . : CJPERTINO CA, CA 95014-5068 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 . 00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 000 .00 0 . 50 0 .00 0 . 50 0 . 00 1REMRESBAT SQ FEET 1 . 00 570 . 00 0 . 00 570 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 571 . 50 0 . 00 571 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 571. 50 AMEX --------------- TOTAL RECEIPT 571.50 OWNER-BUILDER VERIFICATION 1. (Check one) I or7AI1 immediate family (parent,spouse or child)will perform: A. the work authori:.ed by this permit B. — A portion of the worn C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired :o do: A. _ All of the work B. — A portion of the woi k (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) ether than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed .............................................................................. ................ I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). ~� Property Owner's Signature: r' Date: 2-�� 2-�� Job Address: k�'r tro� S_ CC rll 1' %�c'4t ( YX) C i Permit# _Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. CITY OF C.UPERTINO ADDITION/REMODEL CUPEI,TINO PERMIT APPLICATION FORM APN # Date: "l 2 Z � v Is a 2° unit being added? Yes ❑ No ❑'If yes, please fill out the permit application for 2° unit. Building Address: LIS �k V NTS C,I Mailing Address (if different from building address): Owner' Name: Phone# Lt 0S, -2-49 `j 'C_)s23 Contractor: f Phone#: 17:>z l-tj Fax#: Contractor License#: _ Cupertino Business License#: Contact: 1 Phone#: M Fax#: Building Permit Info: Plumb. [� Bldg. Elect. �` Mech. F-1 Hillside E] Job Description: Addition-What is b ing added?(Be Specific): What is being remo eled(not including addition)? , r itis Remodel Includes Re-Roof: Yes ❑ No J!T If yes list number of squares Remodel Includes Structural: Yes ❑ No [Er Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning, approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached c-- Remodel: Kitchen Bath;P 1 - Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT,IT-B T__3 Valuation: Please check this box if the project is a f �)o Ua second-story addition ❑ Project Size: Express /{Standard ❑ Large ❑ Maj ❑ Please complete relevant portion of the Green Building �in hecklist & attach i�;t�he tthe application or if applicable, Green Building Points Achieved: clude in plan set sheet index. ***For Office Use Only*** Revised 07/06/09 Over-the-Counter 0 CITY OF CUPERTINO ADDITOPMEMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type S Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1DECKRAIL Deck Railing-)3ach B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry uptc 1,000 SF B (each) 1BCONSTAXR Construction"ax Res (new detachec garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame-zp to 300 B SF 1 PATIOMETAL Metal Frame 5 to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wo)d up to 300 B SF 1 PATIOENCLM Enclosed Mel al up to 300 B SF 1PATIOENCLO Other Enclos,;d Patio up B to 300 SF 1 COVPORCH Porch Covert d-Each B (Each) REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1 REMRESBAT Bath Remod0l up to 300 B SF 1REMREOTH Other Remodel up to 300 B " SF CITY OF C-.UPERTINO ADDITOrI/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 MECPLNCK Stand Alone N echanical. M Pln Ck(hourly I PLMPLNCK Stand Alone P:umbing P Pln Ck(hourly) IBCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee IBSEISMICRE Seismic Resid:ntial B ITRAVDOC Travel &Documentation B IBUSLIC Business Liwise B