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13090045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 MARY AVE CONTRACTOR:PARAKULAM PERMIT NO:13090045 GOPALAKRISHNAN R AND DOPA OWNER'S NAME: PARAKULAM GOPALAKRISHNAN R AND GOPA 10341 MARY AVE DATE ISSUED:09/09/2013 OWNER'S PHONE: 4086239436 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] License Class Lic.# ADD WATER CLOSET TO UPSTAIRS BATHTUB AREA 129 SQ Contractor Date FT 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. Sq.Ft Floor Area: Valuation:$1500 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 APN Number:32652014.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYV LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the IDate: !.- Issued b '• granting of this permit. Additionally,the applicant understands and will comply 3'' with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, fJ1 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 contractor to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 255059 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: �l 3 permit is issued. do— I certify that in the performance of the work for which this permit is issued,I s fall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point Aource regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. cy Signature Date ` `f IsPERMIT APPLICATION CONSTRUCTION COMMUNITY DEVELOPMENT DEP RTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTIN0, CA 95014-3255 Da CUPERTINCI (408)777-3228•FAX(408)777-333,•buildingCa�cugertino.org 13 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATIO /TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 7APN �# - h � ' � ASV ZsO OWNERNAME E-MAIL _VA_7X,# �ko � STREET ADDRESS 110 1nS��eS1.n�Y��.cA-cam CITY,STATE,ZIP C�{��I� >C �. I y FAX CONTACT NAME RK /T PHOIIE E-MAIL I STREET ADDRESS CTTY,STATE,ZIP FAX ®OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR P CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NU7BER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MA L FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Jfr EXISTING USE PROPOSED USE CONSTI TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREAREMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: Q DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY ❑YES BEING ADDED? []NOADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 115-0 OD By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's beha have'read this VV application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with`aal ordinances and state laws relating toding refion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: l 1113, SUPPLEMENTAL INFORMATION REQUIRED _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Dii closure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning priol';to submittal of Building Permit application. B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10341 mary ave DATE: REVIEWED BY: mendez APN: BP#: "VALUATION: 1$1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION SFD or Duplex 1 RPFIX USE: PERMIT TYPE: WORK add water closet to tub room located on 2nd floor SCOPE a Mech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Eler...Plan Check Nfech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit 1"ee: i C)ther alerch.Insp, Other Plumb Insp. 0.0 hrs $47.00 Other Glee.Insp. Li ke A. Insp. Fee. Plumb. Insp.Fed: Elec.Insp,Fire: NOTE:This estimate does not include fees due to other Depa ments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc-). Theseees are based on the preflinina information available and are only an estimate- Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1 # Plumbing Suppl.PC Fee: (F) Reg. ® OT 0.0 1 hrs $0.00 $10.00 1BPFIXTURE I Fixture or Trap PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl. Insp.Fee-0 Reg. ® OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 t;ons1?-action Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ®Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC j$47.00 Building or Structure Strong Motion Fee: IBSEISMICR $0.50 1.0 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly $139.50 $149.00 _ �� � $288.50 Revised: 07/01/2013 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTI'NO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-333 3•building(a)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted)in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 'O 3 4 1 �p /�P-Y „ U 6_ APN BPO OWNER NAME 1 l J *'t OWNER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may,incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) PS 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prpperty. NS 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. tr> 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an"employer" under state and federal law. ri� 6. 1 understand if I am considered an"employe lr" under state and federal law, I must register with the state and federal government withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee."I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with'the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 0 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 ti IS 9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business,Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board(CSLB)at 1-800-321-CSL13(2752)or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware`of and consent to an Owner-Bulilder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. ,J-r, 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. r1S 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors'State License Board may be unable to.. assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court.It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured whileworking on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is.issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the';city may be required to be presented when the permit is issued to verify the property owner's sin re. Property Owner's Signature: Date:ill3 - --- ---=--------------------------------------------------------------- - - ---- ----------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply fora construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF I Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)io apply for, sign, and file the documents necessary to obtain:an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work):; Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under.penalty of perjury that I am the property owner for the address listed above and I personally filled out the . above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. I Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 31" 58.5" 3 7" 0 31" 3 5 11 Commode Bath Tub Shower 71" 36" Door 39„ A� Commode 411 Door ® Door H 28.5" ,��,,• 30" H 4.. . CUPERTINO Flui!-Jing Department SEP p 6 2013 Plan Proposed REVIEWED FOR CODE COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTiNO Reviewed By: /ED Planning to add a commode in BathffnseJi1fla r This set of plans ion§ T�'e"qt he YELLOW above jC.?,,,; dL'ri--C construction. It is unlawful to make any ChB C"3 or alteratlol is on dame,or to deviate therefro-n,without approval from the Building Official. The .^t rrpin !of this plan and specifications SHALL NOT ���,r 91 IN ATM A �} t:c i:_'d o p rmit or to be an approval of the violation of any provisions of any City Ordinance or State Law. (03 ( rr1 A1Y r v �Y � Sy 1 vl c L127/ No CA atS`-v t y PE�S,�rr No 1309 � PA ��s � - � k 31" 58.5" 0 31" 3511 37110 ° Commode Bath Tub Shower M )V lo 71" 36" Door 39" 411 Door ® Door H F> 28.5" 30" 4" 4" Curre, P — CUPERTINO --coiriinQ Department SEP 0 6 2013 REVIE-:V'1E:,) F3R CODE COMPLIANCE Reviewed By: