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09050143
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21947 LINDY LN CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 09050143 OWNER'S NAME: SHESHA KRISHNAPURA DATE ISSUED: 10/21/2009 01 ;" 'ER'S PHONE: 4088939926 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# F MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTIOMNEW SFDWL -2 STORY W/BASEMENT(5,936'SQ)- (commencing with Section 7000) of Division 3 of the Business & Professions ATTACHED Code and that my license is in full force and effect. GARAGE 541'- VACANT LOT. 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: $1050000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35625029.00 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 upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. /7� DateAv'e2 (� Signature Date Issued by- i'� �--- -- OWNER- BUILDER DECLARATION RE- ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, as owner of the property, am exclusively contracting with licensed contractors to 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. 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. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address c nd expenses which may accrue against said City in consequence of the gr .,g of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point sours gulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. q ,� `:� Date&� �` �^x' —/ Signature Licensed Professional i ti I CITY Y OFCUIPIERTIINO ii ILJ111LD1NG PERMIT Q �o� l ( `5" -f BUILDING ADDRESS: 21947 LINDY LN CONTRACTOR:JULIO MEJIA o PERMIT NO:09050143 CONSTRUCTION ' OWNER'S NAME: SHESHA KRISHNAPURA '361 W VIRGINIA ST DATE ISSUED: 10/21/2009 OWNER'S PHONE: 4088939926SAN JOSE,CA 95125 PHONE NO:(408)529-3634 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# r r r MECH RESIDENTIAL COMMERCIAL Contractor Date . I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW SFDWL-2 STORY WBASEMENT(5,936'SQ)- (commencing with Section 7000)of Division 3 of the Business&Professions ATTACHED Code and that my license is in full force and effect. GARAGE 541'-VACANT LOT. II(/3,-/c,-.•,..._//s^,ki.. �: 6)._1- k-- cs.i-ti -b LLL, - fes. I hereby affirm under penalty of perjury one of the following two declarations: ,_ _ p _ t9"J"" 3 ct f� '' ca--6w_ ,,,A.siit I have and will maintain a certificate of consent to self-insure for Worker's x`-1/3`�` �9��- Compensation,as provided for by Section 3700 of the Labor Code,for the L c-es-G-h sY% -1 i -4s 0 a,'tk-i I mss'tom. 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.. Sq.Ft Floor Area: Valuation:$1050000 APPLICANT CERTIFICATION ' I certify that I have read this application and state that the above information is APN Number:35625029.00 Occupancy Type: I 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 IIF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the 1 granting of this permit. Additionally,the applicant understands and will comply WIITIIIILN 1180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section ,1180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: Date: 9" 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 compensation, 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) �- -I6-„a I;as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: bate: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 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 9.112 and the Compensation laws of California. If,after making this certificate of exemption,l Health&Safety Code,Sections 25505,25533,and 25534. 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. O ner or or' ed agent:/ _ k.k \ ))s, 2Tr„�/ C ,Date: � t APPLICANT CERTIFICATION 1 CONSTRUCTION LENDING AGENCY . I certify that I have read this application and state that the above information is i 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 egulations per the Cupertino Municipal Code,Section ARCHITECT'S tECLARATION 9.18. P ai\13�yI7.- 1O1 understand my plans shall be used as public records. Signature \..C-Cic .- I Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 21947 lindy lane DATE: 11/30/2010 REVIEWED BY: bobs. APN: BP#: 0,7o,6-01V3 VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY IPENTAMATION SFD or Duplexc.. PERMIT TYPE: WORK GTGt� S% SCOPE tifcch. l'1, 4 ri-f•ch. Permit Fc u. Plrn, kh,( Prnfw• ,,. Other Akc•h, T7sl>. 0.:,,,, Of,:f F.Irc hulk. Lj 34cch, hj�p, Fce: 1.„•,, .. .. .rfnsp. 1'<<c. NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: ISUPPKFEE $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. © OT 1.0 hrs $126.00 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 Constr. Tax: IBCONSTAXR bld s $0.00 Acoustical Fee: 0 Yes E) No $0.00 0 Work Without Permit? 0 Yes E) No $0.00 E) Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fc ec . Building or Structure i Strong Motion Fee: IBSEISMICR 0 0 # Revision Bldg;Stds Commission Fee: IBCBSC 00 $0.00 IREVSFDWL SFDWL SUBTOTALS: $127.501 $0.00 TOTAL FEE: $127.50 Revised: 11/08/2010 CITY FIs F CUFE,n TING LPY6 /y FEE ESTIMATOR—BUILDING II"VISION ADDRESS: 21947 lindy lane DATE: 11/30/2010 REVIEWED BY: bob s. APN: BP#: 1990t 60/V3 *VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY TOTAL PENTAMATION SFD or Duplex USE: FLOOR AREA: PERMIT TYPE: WORKrev/- /t Ala Vlrn&c'-9L add S/. SCOPE / ,4 ' 4/. ' s. ' .,i McOh. Plan Check [ q Plumb, Plan Chock r Elec.Plan Check ;Lfech:Permit fee.• . Plumb. Permit Fee: Elec. Permit Fee: Other,Meeh.Insp. Other Plumb Imp. Other Elea.Insp. J'1eeh.Insp. Pee: Plumb. hop. Fee: Elec. Insp.Fee: NOTE: These ees are based on the •relimina in ormation available and are onl an estimate. Contact the De,t or addn'I info. FEE ITEMS fFee Resolution 09-051 ELI7/1/10j FEE QTY/FEE 1<TEMS Plan Check Fee: 1SUPPKFEE $0.00 Select a Misc Bldg/Structure Supp!. PC Fee: 0 Reg. 0 OT [ 1.0 hrs $126.00 or Element of a Building A PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fees Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr.Tax: 1BCONSTAXRbI lgs $0.00 Acoustical Fee: 0 Yes € No $0.00 0 Work Without Permit? 0 Yes e No $0.00 • Planning Feet • • $0.00 Select a Non-Residential Travel Documentation Fees: Building or Structure0 �� a Strong Motion Fee: 1BSEISMICR ._soi0 Bldg Stds Commission Fee: 1BCBSC .00 $0.00 1REVSEDWL SUBTOTALS: $127.50 $0.00: TOTAL $127.50 • Revised: 11/08/2010