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14030163CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 11560 LAKE SPRING CT I CRONTTRKCATOR: MITRA CHITTAJIT AND I PERMIT NO: 14030163 I OWNER'S NAME: MITRA CHITTART AND PRIYANKA 1 11560 LAKE SPRING CT I DATE ISSUED: 04/01/2014 I I OWNER'S PHONE: 4085696598 I CUPERTINO, CA 95014 I PHONE NO: I ❑ LICENSED CONTRACTOR'S DECLARATION License Contractor Lic. # Date 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. 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. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Date W OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall �ot employ any person in any manner so as to become subject to the Worker's ompensation 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. 0,iunawre� Date DG /D(l20 f �1 JOB DESCRIPTION: RESIDENTIAL [-] COMMERCIAL ❑ REMODEL M.BATH AND GUEST BATHROOM & POWDER ROOM 125 SQ FT TO INCLUDE M,E,P'S Sq. Ft Floor Area: I Valuation: $10000 APN Number: 36654036.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 0 DA YS OF PERMIT ISSUANCE OR 180 DAY OM LAST CALLED INSPECTIION. Issued by: Dater b_/ RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Se ions 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION t 11 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO(�� 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 wv (408) 777 -3228 FAX (408) 777 -3333 • building(aD-cupertino.ord ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 115-60 Lake Spry (M. are-t + nv APN11 �♦ in 111 OWNER NAME C'h i it aJ f Mi f ra 9- I ri HA n NCO. M1 PHONE / O n Y,6,) s $ E -MAIL : L J STREET ADDRESS " r/ O Lake :51P 71*; n ef• ((7� CLI STATE �� ro GA gJ-0 14 FAX CONTACT NAME , , + , yry� C h;�ta PHONE 4 0 8 s6 9 6sq s E -MAIL STREET ADDRESS 11 J O Lake ^�r� �I L+ `❑ CITY, STATE, K� ^ - FAX OWNER ❑ OWNER- BUILDER ❑ OWNERJ AGENT' CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME SAM ^� 0 /OUAN /, 1J LICENSE NUMBER 643 !1 S(l 5 �-(J LICENSgYPE BUS. LIC # e /_ -7 g iJ �l COMPANY NAME ,o,M NFje�4L E -MAIL 5'arn.� @ ma l -G�,yn FAX STREET ADDRESS ^r0 S /`701 Qu>nens CITY, STATE, ZIP �Q se PHONE / O g 72 -2 Il� _! 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE /,� DESCRIPTION OF WORK 8 /tT / f QOO NI lC FI �1 D}iE ; 1)Ma5 a -er ACt 'tA ^ A-_/0 /0 CL -'ub W1fh stauI Re4olock f0; le t, re/.:"a(x ir)s ic& wo, -- ovY "4`h s ; e leG�» Cu r'le_ - '61661. Cl 2)Gue5�- 6a — !?ep/acA 4ub W ;-A stag, geplaa foIle% -, 001d eleotr %c ou1lPf'rar 6 Ob1: EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM EII'tP %f - ` KITCHEN. - - OTHER REMODEL AREA Maser -7 40 REMODEL AREA REMODEL AREA PORCH AREA DECK A TOTAL DECK /PORCH AREA GARAGE AREA: LJDETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION [I YES IF YES, PROVIDE COPY OF IS THE BLDG AN [] YES 'j'n'r n r • * _ * *• PLANNING APPL # []NO PLANNING APPROVAL. LETTER EICHLER HOME? []NO '^ i r ^;` By my signature below, I certify to each of the following: I am the property owner or authorized age— <o ac o� the properly o ner's behalf. I have re is application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree o comply with -likable local ordinances and state laws relating t building co tructio . I authoni4e,4epresentatives of Cupertino to enter the above - identified pr-o-PtTryTorinspection purposes. Signature of Applicant/Agent: Date: 3 0 SUPPLEMENTAL INFORMATION REQUIRED` C7 $OUTIN G SLLP $UIL DING MAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for r O >I II17k T1 R existing building(s). Demolition permit is required to issuance of building' permit for new building . "F'`p�€ ❑`pLANNINGPLAJ�tE1sIW ' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�AAaRn ❑uBLIC,tivoRxs form if any Hazardous Materials are being used as part of this project. €� �� G ' t;;II2E Copy of Planning Approval Letter or Meeting with Planning prior to �p>a "� DEPT ❑ sANITARYsSXWE msTMT, submittal of Building Permit application. is �s`E s , .D,,EN�zo�i�NTA�IIRALTH.. BldgApp_201 1. doc revised 06121111 CITY OF CUPERTINO FRE ESTIMATOR — BUILDING DIVISION a , Li.��ar- f'lcrr� C izc:R F' /rums, i' /ar7 C "&':.k v�>cir P,>rtarit1 "c.>c; T1a.mb. Prrr itI��rc: t'� €. f'zr,r 1 "'c Ch'Gr 0tho-Phlrnb Ins,r. Chher°11<`r. ip�p. 1.1ac, !nv) { �e: 1'lurrt =r. Msp. 1,ce 1 Gec I,�g 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School riictr ;rt otn 1 Thoca foot nro hacod nn tho nroliminany infnrmatinn availahlo and are aniv an ostimaty_ Cnntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 E . 711113) ADDRESS: 11560 lake spring ct DATE: 04/01/2014 REVIEWED BY: Mendez APN: BP #: *VALUATION: 1$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Suppl. PC Fee: (j) Reg. ® OT PENTAMATION PERMIT TYPE: 1R3SFDRE i WORK REMODEL M.BATH AND GUEST BATHROOM & POWDER ROOM 125 SQ FT TO INCLUDE M E P'S SCOPE a , Li.��ar- f'lcrr� C izc:R F' /rums, i' /ar7 C "&':.k v�>cir P,>rtarit1 "c.>c; T1a.mb. Prrr itI��rc: t'� €. f'zr,r 1 "'c Ch'Gr 0tho-Phlrnb Ins,r. Chher°11<`r. ip�p. 1.1ac, !nv) { �e: 1'lurrt =r. Msp. 1,ce 1 Gec I,�g 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School riictr ;rt otn 1 Thoca foot nro hacod nn tho nroliminany infnrmatinn availahlo and are aniv an ostimaty_ Cnntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 E . 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 F 125 s.£ $626.00 Remodel, Bath (< =300 sf) 1REMRESBAT Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. ® OT 10701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("onsirliction Tax: fZf.t;tlfrl,4'TI'tIi�`P`c't': 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure C) � /7 "tdi'a,.t` t'_)tii- f;i� €'t'ttfill(>7'F / "£E:'S': Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $1.00 t LET $2.00 $626.00 TOTAL FEE: $628.00 Revised: 01/15/2014 a tt C .00 OWNER - BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinat7a cuDeriino.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 S 60 1-AKE SP 9'tNG Cj APN BP# OWNER NAME P K I `1 AN K A 04 11- T -A5t7� OWNER ADDRESS Ll lT% DESCRIPTION OF WORK: N fI ST (= K A N D G U E- S f} T I t { t` A OD U L 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.) Lti1. I 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 property. qO 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. ftJ3. 1 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. tl�_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. LM-5. I 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" understate and federal law. f M 6. 1 understand if I am considered an "employer' 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. N 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. P M 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. OwneiBuilderForm 2010.a:oc revised 04114110 E h� OH 9' I 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 -CSLB (2752) or vdww.cslb.ca.gov for more information about licensed contractors. f10. 1 am aware of and consent to an Owner - Builder 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. 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. 4�% 12. I 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 while working 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 a�firm that there is a construction lending agency for the perrormance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: PRIVANKA MI—rKh Lender Address: 11! k LAKF �;PKII\IC, (7 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 ure. Property Owner's Signature* Date: 03 2 ZZ20/V -- ------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The folloiving Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF 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) to 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: Address of Authorized Agent: Tel No 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. Property Owner's Signature: Date: 014me7BuildeiFon7i 2010.doc revised 04114110 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: I I S 6 b LhKF S PP, 1 N PERMIT # OWNER'S NAME: Pk I AN KA Z- cH i -TTAT/ 7 M I-TTKA PHONE # GENERAL CONTRACTOR: SAM .bo 00,BUSINESS LICENSE # -- ?9 Z. ADDRESS: CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino 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: Owner / Contractor Signature Date 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 / Contractor Signature Date Original Master Bath CV ndow AF set of plans and s 34„ . ..................... LP" -'Ar A',i =IN I V, JS1 k r;t at the N' f r sS..,;? CO1itrV� }i3i1. u n1vt; s , <; ciiy thc !:!'out " gal - om'U'A p.,r.- ?c"7 ' si c weir ,. , i r\sOT ....._....... ,................................. 70:5 ".... �. ...t.,r �• L C 111V -DM "Mt VIS of ea.�y U:f; ,i.. i slwz� C)d By B i.I .. 34" T. Height 97" ��SCRIPTION . MR T SST fl Fr rM A-VCET F-1 xTuKE , L l C� H T l j 2 / Ni�ME � r21`jAN lest Z• CHITTelTIT MIT ' sPQ,1 CT- CVPE:9T' v,� �RL= H w� D�rNC,, F\ 7t- F- AUCE -r TdILET , gpr"rH TUg —� SrALL ,PAINT, CLEC. OUTCE1 ►3IDFfi Remodelled, Master Bath Light Scones ............... 3419.1 nrininal GuPgt Rath Patricia Garcia From: Chittajit Mitra [chittajit @gmail.com] Sent: Thursday, October 30, 2014 3:28 PM To: Patricia Garcia Subject: Request to extend building permit # 14030163 Dear Patricia, I would like to request for an extension for the building permit application # 14030163. Site Address : 11560 Lake Spring Ct, Cupertino Current Expiration date: 11/11/2014 The permit was for remodeling a master bath and guest bath. The guest bath was completed and inspected. However, due to unforeseen scheduling delays with our contractor, delays in getting tiles etc. our master bath work has gotten delayed. The project has started but will not be ready for inspection by 11/11/2014. I would like the date to be extended by 180 days. Appreciate your consideration in granting us the extension. Please let me know if you need any further information for processing the request. Best regards, Chittaj it & Priyanka Mitra 408 -569 -6598 chittajit kgmail.com