14050037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22015 MCCLELLAN RD CONTRACTOR: C Ieo�q PERMIT NO: 14050037
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OWNER'S NAME: CHAUGULE VIJAY AND SANGEETA V DATE ISSUED:05/06/2014
OWNER'S PHONE: 4082341465 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
REPLACE 7(E)WINDOWS&3 SLIDING GLASS DOORS,
License Class Lie.# �`� SAME LOCATIONS&SIZE(WILL MEET EGRESS AND BE
TEMPERED WHERE REQUIRED BY CODE)
Contractor 1 A-G6#G W52o l-t'1; Date s[6l�L/
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:$6300
J 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:35713012.00 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 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 D LED INSPECTION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence ofthe 6 `
granting of this permit. Additionally,the applicant understands and will corn sued b ate:
with all non-point source regulations per the Cupertino Municipal Code,S tion
9 18.
RE-ROOFS:
Signature Date S G 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.
E] OWNE UILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I exempt from the Contractor's License Law for one of
the following two reas ns: 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 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,Sections ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued. S
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 CONSTRUC ON 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 q,
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTlNO (408)777-3228• FAX(408)777-3333•building(r�cupertino.org
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
2-2-01.9 r t I✓ ,+1U D S 3 ^ U I Z
OWNER NAME PHONE E-MAIL
V Pt U 4.900 kb It Ilia I
STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ZCONTRACTOR ❑CONTRACTOR AGFNT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAM.E W�2c�fiEK LICENSE NUMBER LICENSE TYPE BUS.LIC#
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COMPANY NAME E-MAIL FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC A
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
yD�ESCRIPTION OF WORK
K,E I0i G[;- l P+-Li-0 Li fCib
EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH
❑ATTACH
Ir DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY [J YES
BEING ADDED? []NO .ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑Y ._. �..�. -" TAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑N
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act oplde plrwdrty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it;e ate. I agree to comply with all applicable local
ordinances and state laws relating to building. traction. I authorize representatives of Cupertino to ente e above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: aft,I Iq
SUPPLEMENTAL O ATI REQUIRED � � 5amum � 's�
� sP �OMM z �..�.�:; ROUTING
New SFD or Multifamily dwellings: pply for demolition permit for • F �� � �;
R H1rC TINTER BUIL DIi�G P)AN RETE{[
existing building(s). Demolition permit i required prior to issuance of building w4
permit for new building. �� ��aPREss �c�� .rte
_Commercial Bldgs: Provide a completed Hazardous Materials DisclosureI
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to y
'` 7 R� ` SAl\ITARYSEI RDISTRICP
�. �
submittal of Building Pen-nit application. n _ a .
IN-
Mn1 �
B1dgApp_2011.d6c revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22015 McCLELLAN RD DATE: 05/06/2014 REVIEWED BY: MELISSA
APN: 357 13 012 BP#: "VALUATION: 1$6,300
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1GENRE
WORK I[REPLACE 7 E WINDOWS & 3 SLIDING GLASS DOORS SAME LOCATIONS & SIZE WILL MEET
SCOPE SS AND BE TEMPERED WHERE REQUIRED BY CODE)
A
07,
Lf c a. Plan(iu;r_<k 71 f'fzw?bf Plan C iwcd< £h,,ck
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llerw;!I ee: 'Ir.mtr. I'e"nit F`z-e:
oi=mcr':=c�e�.1'rts,��. 13Y13s�r I'irxmt fns,>. C)th��t'1,k€.Imp,
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kck Inst). Pce: 11"U b. Itis;. Fee: Elec.Ir p, k",(":
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the mina information available and are onlyan estimate. Contact the De t or addn q info,
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 10 # Window/Sliding Glass Door
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $557.00 1WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
f;cltl:llP`Zit`LZC3#1
,I(Jill frative Fee: 0
Work Without Permit? ® Yes (E) No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential 0
71-avel t)raelamentaltIon Fees: Building or Structure
Strong Motion Fee: IBSEISMICR $0.63 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
WWI
$1.631 $557.00 TOTAL FEE: $558.63
Revised: 04/01/2014
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