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10010057 r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10059 OAKLEAF PL CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10010057 OWNER'S NAME: JHANESHWAR NAYAK DATE ISSUED:01/13/2010 NER'S PHONE: 4089968747 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB F License Class—� Lic.# — MECH� RESIDENTIAL F COMMERCIAL� Contract Date \ JOB DESCRIPTION:REMODEL 45 SQ FT TO BATHROOM 5X9 NON I hereby affirm that I am licensed under the provisions of Chapter 9 STRUCTURAL (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 Sq.Ft Floor Area: Valuation:$10500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32618053.00 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 construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ����, 9.18. Issued- `r . Date QSignatur Date �... OWNER-BUILDER 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) 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 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 255059 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. 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 I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,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,Ier or a d agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION 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 vnnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION �•.:,ting 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 Signa Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32618053 .00 DATE ISSUED. . . . . . . : 01/13/2010 RECEIPT #. . . . . . . . . : BS000009551 REFERENCE ID # . . . : 10010057 SITE ADDRESS . . . . . : 10059 OAKLEAF PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JHANESHWAR NAYAK ADDRESS . . . . . . . . . . : 10059 OAKLEAF PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1127 RECEIVED FROM . . . . : KB BUILDERS CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- 0 . 00 1BCBSC VALUATION 10, 500 . 00 1. 00 0 . 00 1010 0 . 00 1BSEISMICR VALUATION 10, 500 . 00 1.10 0 .00 . 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 00 0 . 00 1REMRESBAT SQ FEET 45 . 00 570 . 00 0 .00 ----570_00 ------0_00 ---------- ---------- TOTAL PERMIT 686 .10 0 .00 686 . 10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------- CREDIT CARD 686 . 10 VISA --------------- TOTAL RECEIPT 686 .10 r r RESIDENTIAL PROJECT COVER SHEET Assessors Parcel Number: Name of owner. �lau -Q. J Project address. C � - c Contact person. Phone. Fax. Net square footage of lot. - Existin Proposed Square footage: First floor: Second floor: Garage: TOTAL: 10 foot b 20 foot clears aces inside the garage? Y Are there at least two y p Is privacy protection planting required for the project? �Y Build it Green Total Points On what floor(s) is work being done? Brief description of work. l �YN} Code editions: 2007 CBC N)2007 CFC N)2007 CMC 2007 CPC N)2007 NEC N) APPfit)VED IN ACCORDAW't WITH THE CITY OF r Effecti=PWORO c DL5 AND ORDINANCES txh 1 DATE This set of plans and specifications MUST be kept on the job at all times and it is unlawful to make any changes or alterations on same without written permission from the Building Department. City of Cu rtino. The stamping of this plan and specifications SHALL NOT be heli to penriit or to be an approval of the violation of any provisions of any City orrjinance or 111kate Law. t .3 tR 'ri Plan Review Process Work Book Page-8-Revised 8/05/08 BROOKS BUILDING & DESIGN 487 Oak Ridge Drive fax 650-299.1520 Redwood City,CA 94062 cell 650-207-6128 PROJECT ESTIMATE -S c v v-Q- L.V o r"�� toosct or-oc-ker.-Y �kacc C ce- ZA 's�t A.- �5 Vj' �e.w e- p ec . r. CITY OF CUPERTINO °} ADDITION/REMODEL CITY OF ION FORM' CUPS TINO PERMIT APPLICAT Im1mg-1 APN # 3 ZDate:.Cv !� f��3 .�Is n a 2n unit being added? Yes ❑ No ❑ If yes, please fill out the permit application for 2 unit. Building Address: O Mailing Address (if different from building address): Owner's Name: Phone# "6" 7't Contractor: Phone#: 65'O - aO'7 - /16k Fax#: Contractor License#: ss pl`{2�b Cupertino Business License#: Phone#: (­,�—Z:>• �)-677 6 k'Z-8- Contact: • Fax#: Building Permit Info:Elect. Mech. ❑--� Hillside F]Bldg. �. Plumb. �---~ []��� �_ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? S x Remodel Includes Re-Roof: Yes ❑ No Erif yes list number of squares Remodel Includes Structural: Yes ❑ No Q"' Do you have the pre-application planning approval? Yes ❑ No ❑ P If yes, lease rovide a copy Ig ap lanners name: Square Footage: Addition. Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath H S Other roTypef Construction (Usage Class): Occupancy Type: w I-A I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B �2 -7_3 Valuation: []/� i ' Please check this box if the project s a � l fj second-story addition J ❑ Project Size: Express tandard ❑ Large ❑ or❑Maj Please complete relevant portion of the Green Building points Achieved: • to the application or if applicable, Green Building �. Checklist& attach it include in lan set& the sheet index. ***For Office Use Only*** Revised 07/06/09 Over-the-Counter E:1 CITY OF CUPERTINO ADDITION/REMODEL CITY Of SCHEDULE CUPE�T1N0FEE Fee Group Permit Type Quantity Fee ID FFeelDescription Q �' S Ft 1R3SFDADD ADDITIONS 1 PLL ONGRNGR Long Range PL Planning/Residential 1 R3 INSP Dwellings Inspections B 1 R3PLNCK Dwellings plan check B 1 R3 REPINSP Dwellings Repeat B Inspection 1 R3REPPLNC Dwellings Repeat Plan B Check 1 R3H INSP Dwellings Hillside B in ection 1 R3HPLNCK Dwellings Hillside plan B check 1 R3 HREINSP Dwellings Hillside B Re eat Inspection 1 R3 HREPLNC Dwellings Hillside B Re eat Plan Check 1 R3 ALTIN SP Dwellings Alternate B Materials Inspection 1R 3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS -- Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PR SEWER Sewers P 1B PSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee B 1 BSEISMICRE SeismicResidential 1RER OOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE • Fee Description Fee Group Permit Type Quantity Fee ID S Ft 1R3SFDADD OR DECKS 1R3SFDREM 1 DECKWOOD Deck(Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) 1R3SFDADD OR GARAGES DETACHED 1R3SFDREM ' 1GARDTW<=1K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1BCONSTAXR PATIO detached garage) Construction Tax Res (new 1R3SFDADD OR 'S OPEN 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR& SUN ROOMS 1PATIOENCLW Enclosed Wood up to 300 B 1R3SFDREM SF 1 PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF ------------------ 1 COVPORCH Porch Covered-Each B (Each) 91n REMODELS 1R3SFD REM REM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan check 300 SF 1REMRESBAT Bath Remodel up to 300 B V( SF 1 REMREOTH Other Remodel up to 300 B SF M.Indoor Air Quality and Finishes 1.Use LowNc)-V©C Paint 1 IADJHealth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHealth pts pyes 0 3.Use Low ft VDC Adhesives 3 IA(JHealth pts yeses 0 4.Use Salvaged-Materials for Interior Finishes 3 Resource pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IACJHealth pts y=yes 0 6.Use Exterior Grade PIy►+Vood for Interior Uses 1 IAQ/Hsalth pts y=yes D 7..Ssal alE�c Dwd Rarl6ldxed or MDF 4 IAQJHealth.-pts ynes D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whola House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts Ayes 0 2.Use Rapidly BenevaaWe Flooring Matarials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IaQlHealth pts y=yes 0 5,use VrA mvo GPS f*��TOW Nqf �'. lngt"d pny�64�oMO N !4 with Low Vmg� 4 Resource pts y=yes 0 Total Points Available: 1 1401 130 57 Total Points Project Received: 0 01 01 G:data/progs/greenbuiidnoguidelines/ramodelers/gree�pointsfinal212.a4proiected.xls Community Development 10300 Torre Avenue #. Cupertino CA 95014 { €� Telephone(408)777-3228 Fax(408)777-3333 CITY 0� "IftoU PE TINO Buildo artment in PERMIT # _ Jos ADDRESS: � / /?/-.)t no OWNERS NAME: PHONE # GENERAL CONTRACTOR: v` � FAX # I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the f ollowin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation r-----T—Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature