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13100025 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1126 HOLLYHEAD LN CONTRACTOR:PROGRESS BUILDERS PERMIT NO: 13100025 OWNER'S NAME: RAMACHANDRAN KARTHIK&NARASDvIHAN 508 QUAIL BUSH CT DATE ISSUED: 10/02/2013 OWNER'S PHONE: 4084645288 SAN JOSE,CA 95117 PHONE NO:(650)331-2828 E!r LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# DEMO ON(E)PROPERTY PER PLANS&SPECS FOR FUTURE Contractor Aeo!! "Ai�$S 41r,AbDate la`.- Z /j ADDITION/REMODEL AS PER PLANS FOR BP#13090204 IN I hereby affirm that I am licensed under the provisions of Chapter 9 PLAN CHECK AS OF 10/2/2013 (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: l 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:$9000 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:36226027.00 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 WITHIN 180 DAYS OF RMIT 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 DAYS F C LLED 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 is e l0 7iZ13 granting of this permit. Additionally, applicant understands and will comply with all non-point source regulations_�A, r the Cupe o Municipal Code,Section 9.18. RE-ROOFS: Signature Date !u,9 02—l 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, 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 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. I 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 Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertin unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, 533,and 25 4. Section 3700 of the Labor Code,for the performance of the work for which this jo / permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY 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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \D 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingCa_cupertino.org CUPERTIN� i ❑NEW CONSTRUCTION FfADDITION LJ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# 7 O y PROIECTADDRESS //A / 1/O� �s..� 7N It Q //f r. Z/ 7 OWNER NAME ,�4 ew7f�k� ,t�lle!lbs/o a PHONE G^Q„ -`�r��_ E-MAIL ,LA/f Ayly.eO STREET ADDRESS 11Zd /f le"o y .I c�fs�'CITY, STATE,ZIPS/J� �p Cfl- vro FAX CONTACT NAME 1- ,4 /O✓ [,� PHONE /(, / E-MAIL 11-Y,4 Doe STREET ADDRESS ! / .�J �. CITY,STATE,,ZIP `_ A�� �/ ! FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ' CONTRACTOR ❑CONTRACTOR AjG&ENT dwARCHITEEcTT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME � ♦ LICENSE NUMBER f/;o6P LICENSE TYPE BUS.LIC"Af #r2 e COMPANY NAME G SAT C�/� /T�C� F°X 67O /si•��P� STREET ADDRESS CITY,STATE,ZIP PHONE/f- _svgs ARCHTTECT/ENGINEy-0� �,M L.�tAi771� LICENSE NUMBER cyBs7� BUS.LIC# COMPANY NAME 7771 E-MAIL FAX /.tet-3.l7--`cot ,,*Aft . sfCo4 s 'J`�� 77 7 STREET ADDRESS/�� T77 / / C CITY,STATE,ZIP'`,_+ �O� 9Sy2 PHONE4(�_I_ ��J `#0400DESCRIPTION OF WORK GG77lI�V „ t ��/ /�'� • 1��•�foG,i�'oeJ moi✓ rf- P.C.o �� 'PLOWS .moo -SARI j' AW;ctr .,yrs 7b 8c../o%� EXISTI'G USE PROPOSED USE CONSTR TYPE I #STORIES vs,e�� �� . t/ USE TYPE OCC. SQ.FT. VALUATIONEXIST (S) AREA G/Z!S ^E A !O',S'Z AREA _W FLOOR DEMO /A '. TOTAL ARE !1.4 BATHROOM KITCHEN /� OTHER G- REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DEC/K AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH AS Il 5) b JR-ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SEC D STORY BYES / BEING ADDED? @kNO ADDITION? NO PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES Ij�B*� ' TOTAL VALUATION: PLANNING APPL# J]NO PLANNING APPROVAL LETTER EICHLER HOME? �NO �r w 170 C.)V By my signature below,I certify to each of the following: I am t e property owner or authori nt to ac n the perry owner's behalf. I have read this application and the information I have provided is correct. I hav read the Descnpt' f Work and verify it urate. I agree to comply with all applicable local ordinances and state laws relating to building constru tho,._T—p esentat s of Cupertino to enter the above-identifi d property for inspections purposes. Signature of Applicant/Agent: Date: ��d2 LO�> SUPPLEMENTAL INFORMATI QUI D c�HEci TYPE� .� •_ ,R oxuvc it New SFD or Multifamily dwellings: Apply for demolition permit for o -. cou13a� © slnL INCrPI�ANRE�w , existing building(s). Demolition permit is required prior to issuance of building v� permit for new building. - xPR>y� RvIE� _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure vs aoxresi form if any Hazardous Materials are being used as part of this project. i o _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. a '` ru .r"�;"EIaVIRQNIVIEI�T'�T:$EAL`TJ�x_< c: BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1126 HOLLYHEAD LN DATE: 10/02/2013 REVIEWED BY: MELISSA APN: 362 26 027 BP#: "VALUATION: 1$9,000-� *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1GENRE WORK DEMO ONE PROPERTY PER PLANS &SPECS FOR FUTURE ADDITION/REMODEL AS PER SCOPE PLANS FOR BP# 13090204 IN PLAN CHECK AS OF 10/2/2013 Xlech.Ilan Check Plumb. Plan!Check Elec..Plan C he=ck :L1ec:h.Permit Pee. Plumb.Permit Pee: Elec. Permit Fee: L Alech.Insp. Other Plumb Insp. LLJ Other Islec.Insp. .Insp.Fee.: Plumb. Insp.Pec:: Islet.Imp,Free: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelhWdna information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-033 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 1 hours Plan Check,Hourly Suppl.PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $139.00 1STPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee-(E) Reg. 0 OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: AdministrativeF'ee: Work Without Permit? 0 Yes (j) No $0.00 0 Advanced Planning.Fee: $0.00 Select a Non-Residential Travel Documentation Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.90 F 1.0 hrs Inspections Bldg Stds Commission Fee: 1BCBSC $1.00 $139.00 ISTINSP Inspection,Hourly $1.901 $278.00 $279.90 ,.\ Revised: 08/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 'Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST -` JOB ADDRESS: //2,0 PERMIT`# °;"1a0 "257 OWNER'S NAME: PHONE:# ® / —262& GENERAL CONTRACTOR: ,egos BUSINESS_yLICENVS' 5 31tf 3 ADDRESS: 5-Z:>6' cls'/ &e,Sy C,7' CITY/zIPCOD59'1 *Our municipal code requires all businesses working in the city to have a Citi of 6356'P,e h O.business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:_ Signature Date Please check applicable subcontractors and complete the following information: 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/ContractorS' ature Date rko g5 X55 �� �DELS FX. TP; CcfP��•irlo !j�'�O�Ny' 's 'dr �,L� �,�41� 7ii�.- e�;�ivf.�e•�L C-c�r.'.e,�e��2 ��e.. 77�fE- Pt_oll.F_cT t_oe,0e,►"r--p q!t_ //26 ,/Cote- Tom_ ��tl ,��S,�o�✓S:�i/i �,� �f���•7'/ori �SO���•'�t/ 77,-J-r COX- 77rr- 460r/4 07 / a,4.'Ie 405o�ey,��W7,*A-1 4-4,10 ' DoQu�� T.o� S 4t Bpi 7`T� oL .rl or- �5 - r'��rar/�D• ...cam UC f 2 W3 BY