14060065CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22386 HARTMAN DR
CONTRACTOR: PORTITALIA
PERMIT NO: 14060065
CONSTRUCTION
OWNER'S NAME: NADIA JADVAR
5841 ARAPAHO DR
DATE ISSUED: 06/11/2014
OWNER'S PHONE: 4087322868
SAN JOSE, CA 95123
PHONE NO: (408) 210 -4917
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
REMODEL (E) MASTER BEDROOM (240 S.F.) & (E)
License Class Lic. # 011 *4331 2—
MASTER
Contractor �rk1�01�1Q� Date 0� j �'�
BATH (115 S.F.) ADD 1 (N) WINDOW IN BATH
(TEMPERED)
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
Sq. Ft Floor Area:
Valuation: $35000
performance of the work for which this permit is issued.
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: 32613133 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 OT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DA E 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 DAY + D 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
granting of this permit. Additionally, the applicant understands and will comply
ed by: Date: 4�la
with all non -point source regulations per the Cupertino Municipal Code, Sectio
9 18.
06 "' 1
RE- ROOFS:
Signature Date I
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.
❑ 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 (See.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, Section j 25505, 2,A5�5ss33.�and
Section 3700 of the Labor Code, for the performance of the work for which this
^^25534.
Owner or authorized agent: �\h14 Date: 06"if"�
permit is issued.
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
CUPERTINO
r1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building ftupertino.orq
v
r1 IVI ___ ,— M "Milvi TAT /TIRFFRRFTI ORTCUNAT. PF.RMTT4
LJ NEW CONS IKUC:I ION L—I A1JLJ111V1v
4 IJ„.L _A
APN # ,OETD 'C ' I ? / 3
OWNERNAME
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PHONE %- `3,Z +rip &^
f D 1'j
E -MAIL
STREET ADDRESS
CITY, $TATS,
G w �O
FAX
1Z/IIPo
CONTACT NAME
PHONE
E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME s
Chris More.�(.o
LICENSE NUMBER qt, * �' n
`� i..
LICENSE TYPE
BUS. LIC # %VS
Jf
COMPANY NAME ♦ ,
'Dr }.t.k ,(ti COws�yv G}�p r
E -MAIL
IS QaR.T11��AWA �CNS] � aN
FAX
STREET ADDRESS ,
S`�dy t �rrq ko Qrw
CITY, STATE, ZIP tO
S Art� CA
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK ��11 "; 6 � l e4+
R2Vr10 pc��v a o wn ^- 2 h �� r cw,c,✓' -40 � t.c. %
dA e6_C:6 1 C4 k ewc u t, QJJ C Ct U �A
U 'pilt
QA i A t. l n C (0JA+ .
r♦ frotjM G pV1
EXI NGUSE
PROPOSED USE
CONSTK rYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
REMODEL AREA lit 5 91
I KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: LJ DETACH
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY -[]YES
BEING ADDED? ❑NO
ADDITION? []NO
PRE - APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
El
EICHLER HOME ?O
,r
-
'
TOTAL VALUATION:
35' 000
_ _
By my signature below, I certify to each of the following: I am the property owner or authorized age n the 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 is a ate. I agree to comply with all applicable local
ordinances and state laws relating to Ilding constructio . uthorize representatives of Cupertino to enter above - identified property for inspection purposes.
'`
�'� 'n Date:
Signature of Applicant>Agent:
SUPPLEMENTAL INFORMATION REQUIRED
, ,rl'aTv cIMCK TYPE, .` 1
;. i buTHVC SLIP .
New SFD or Multifamily dwellings: Apply for demolition permit for
- ❑
TH rUCOUNTER
❑ BUILDING, AN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
Oift
rh s
h
permit for new building.
C EXPRESSi
❑ PLANNn`Gra AN RI vlEw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTA DnRD'
❑ PuBra47 WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑ FIREVErT
Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR
❑ SANITARY sEiz nLSTRrcT
_
submittal of Building Permit application.
z a
❑r: ENVIRONMENTAL HEALTH-
BldgApp_2011.doc revised 06121111
WE CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
22386 HARTMAN DR
FEE
DATE: 06111/2014
REVIEWED BY: MELISSA
1WADDRESS:
APN: 32613133
BP #:
*VALUATION: 1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
Suppl. PC Fee: E; Reg. 0 OT
O.0
PENTAMATION 1 R3SFDRE
PERMIT TYPE: i
WORK
REMODEL E MASTER BEDROOM 240 S.F. & E MASTER BATH 115 S.F. ADD 1 N WINDOW
SCOPE
IN BATH (TEMPERED)
240 s.f.
$418.00
L1e�ttr, I'larr ('heck
liec:/r_ Pc>rmif Fee:
NOTE: This estimate does not
Plumb. Permit Fyea;:
Other PlvMb fns'rr.
11I:.,rzi?. Inv). Fee:
J,°e, . Pion Check
Eicc Perth Fee
%ibex 1,sc,C Imq,".
Insp. 1 I-c:
due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Ilicfrirf vir 1 Thnco foot — hacod nn fiha nrolirnin— infnrm"dnn auailahlo and aro nnlu an octiwrato Cnntart tho Dant fnr addn'l ;"fn_
FEE ITEMS (Fee Resolution 11 -053 Ef. . 711113,)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
115 s.f.
$626.00
Remodel, Bath (< =300 sf)
IREMRESBAT
Suppl. PC Fee: E; Reg. 0 OT
O.0
Thrs
$0.00
PME Plan Check:
$0.00
240 s.f.
$418.00
Remodel, Other
IREMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee:G Reg. ® OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_T_7T Cons!1`uc ion 747a:
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
I Building or Structure
i
1r« lvl Dovlwnwnlul orl Fees:
Strong Motion Fee: IBSEISMICR
$3.50
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$2.00
$5.50
$1,044.00
To, FEE:
$1,049.50
Revised: 04/01/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408- 777 -3333
JOB ADDRESS: 72.2734b4 Pmr V
PERMIT # 0d6..5—
OWNER'S NAME: WO.0 0 a,
PHONE #; t{0 � 3z 28(08
GENERAL CONTRACTOR: -PO 4 A-. K I'% A Cons " c�ha r%
BUSINESS LICENSE # 3 q2B
ADDRESS: 5bq I hvAprko Dr we q5 12,3
CITY /ZIPCODE: .C_v , ,Aiti b • 01'501LA
*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:
�ffi. ,
Owner / Contractor Signature
1 �
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
�ffi. ,
Owner / Contractor Signature
1 �
Date
CUPERTINO
CONTRACTOR/
Iq
LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: -2--Z�9-L
PERMIT #/1/ 6 006-5-
OWNER'S NAME: Wock',c, 3.A,ov-
PHONE #,
GENERAL CONTRACTOR: N,�',VcOta
BUSINESS LICENSE #
.ADDRESS: Sb�t P,,cdako Qv\�p cvtis10
--AS 12
CITY/ZIPCODE:, C v A-rr c, D(LA
*Our municipal code requires allbusinesses working in the city to have a City of Cupertinobusiness license.
NO BUILDING FINAL .OR .FINAL "OCCUPANCY INSPECTIONS) 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 applicabW%;subcon- - 0 orsan& complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
b
2 -7 C>-7
Glass / Glazing
V V (D
-2
Heating
Insulation
Landscaping
Lathing
Masonry
Painting Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
C�z
22 e)-7
Owner /'Contractor Signature Date
m
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CD
3 o m s scvwE : R�oQ MASTER BEDR' _ M & BATHROOM;
-� Ce)
LIGHTING. PLAN
1/4' = V-0'
1/7/14
CHARUSMA DESIGN �� ®,�
_ GE
GODE
RE�1E
Rev'ON BY
JADVAR RESIDENCE
MASTER BEDROOM &
EXISTING PLAN
1/4" = V -0'
12/20/13
CHARISMA DESIGN
�::jiaa�l�lul
7
Wo
�fl��t
r�
C9440
JADVAR RESIDENCE
MASTER BEDROOM & BATHROOM
LIGHTING PLAN
1/4' = i' -0°
1/7/14
CHARISMA DESIGN
JADVAR RESIDENCE
MASTER BEDROOM & BATHROOM
ELECTRICAL PLAN
1/40 =
1/8/14 7'/
CHARISMA DESIGN ,,, ��
co[J4 Cokp