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14060144CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10387 ANSON AVE CONTRACTOR: BROTHERS HOME PERMIT NO: 14060144 IMPROVEMENT OWNER'S NAME: MILIND AND SAURABHI BHISE 2510 DOUGLAS BLVD DATE ISSUED: 06/23/2014 OWNER'S PHONE: 4089338339 ROSEVILLE, CA 95661 PHONE NO: (408)295-0680 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL F] LICENSED CONTRACTOR'S DECLARATION REPLACE 7 (E) WINDOWS & 1 (E) PATIO DOOR, LIKE FOR f� /�/ C 7 Lic. # j% e% LIKE, SAME SIZE & SHAPE (ALL WILL MEET EGRESS & License Class !� 1P 5 /7 BE Contractor Date TEMPERED WHERE REQUIRED BY CODE) 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 formance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $5868 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: 32641004 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 180 OM L INSPECTION. 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 theDate: / O y' granting of this permit. Additionally, the applicant understands and will with all non -point source regulations per the Cupertino Municipal Code, S 9 18. Signatur Date -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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1, 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) 1, 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code^Sectio505,3�d 25534. /Section 3700 of the Labor Code, for the performance of the work for which this Date:ZOwner or authorized age 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 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 she be deemed revoked. work's for which this permit is issued (See. 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 918. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS Ij APN # OWNER NAME l PHONE q0 3 EE -MAIL STREETADDRESS 1.7rl /l .7A3 Aae r K/r CITY, STATE ZIP ��ry7 RYI- V • ,E-MAIL FAX CONTACT NAME PHONE STREET ADDRESS CITY, STATE, ZIP I FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER �O LICENSE TYPE C a BUS. LIC # COMPANY NAME E-MAIL FAX c STREET ADDRESS CITY, STATE, ZIP G . O �/ j PHONE /66 ` ` (/ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK , ` . nb p / pmo ROL s •yam U15i� EXISTING USE PROPOSED USE CONSTR. 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 AREA REMODEL AREA PORCH AREA DECK AREA�AND TAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: UNIT ❑ YES SECOND STORY E] YES BEING AIDED? ❑NO - ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES - '_ >. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER 1-1 EICHLER HOME? x / - q!5 49 , By my signature below, I certify to each of the following: I am the pro rty owner or autho zed agent t ton the pro wner's al£ I have read this application and the information I have provided is correct. I have read the Description of Work and veri rate. I agree to comply with all applicable local ordinances and state laws relating to ng constru I authorize representatives of Cupertino to enter the ab dentifigd property for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENT RMATION. REQUIRED �� New SFD or Multifamily Apply for demolition permit for�� Iv 3QVER=§L� NO BUILDI�OP.1;.�I�REPIEK' � -�. existing building(s). Demolition permit is required prior to issuance ofbuilding 1 - permit for new building.mm Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ® { i �I AaIAlvs TUTI cs _ form if any Hazardous Materials are being used as part of this project.. � _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �Q RV ---5K,% _E ISTRrCT BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO TTT Ar A Tl1D T2TTTT "11VP_ D1IVIgInN A ;ile�lr_ Pf��r;t%t �ce: t'hunh. Plon C.acc.'fi NOTE: This estimate does not mctuae fees aue to otner uepurtmen,a (t.e. 1 rurtrrorrg, _ .. ­- •• __.. __ _ ____ _, ,.ug, ..........t., n., —a—"toCantart the Dent for addn'l info. Ulstrtet, etc'.. mese ees ure uuseu urt ura r-rr..rr...r. FEE ITEMS (Fee Resolution 11-053 a. 7/1/13) .•...••••»•-�•- »---______ FEE _.___ __ _ QTY/FEE ADDRESS: 10387 ANSON AVE DATE: 06/23/2014 REVIEWED BY: MELISSA APN: 326 41 004 BP#: VALUATION: $5,868 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex $0.00 PENTAMATION 1 GENRES PERMIT TYPE: USE: $0.00 Suppl. Insp. Fee: Reg. Q OT WORKREPLACE 7 E WINDOWS & 1 E PATIO DOOR LIKE FOR LIKE SAME SIZE & SHAPE $0.00 SCOPE $0.00 A ;ile�lr_ Pf��r;t%t �ce: t'hunh. Plon C.acc.'fi NOTE: This estimate does not mctuae fees aue to otner uepurtmen,a (t.e. 1 rurtrrorrg, _ .. ­- •• __.. __ _ ____ _, ,.ug, ..........t., n., —a—"toCantart the Dent for addn'l info. Ulstrtet, etc'.. mese ees ure uuseu urt ura r-rr..rr...r. FEE ITEMS (Fee Resolution 11-053 a. 7/1/13) .•...••••»•-�•- »---______ FEE _.___ __ _ QTY/FEE ____ MISC ITEMS Plan Check Fee: $0.00 ® # Window / Sliding Glass Door $418.00 IWINREP Replacement Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT O.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'rJi sfr vt ,lion Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure Strop Motion Fee: IBSEISMICR $0.59 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 m ®LS ��,a , $1.59 $418.00 TOTAL FEE: $419.59 Revised: 04/01/2014 O^ 040 9 C ®'�a � x tb387 "t� hk 0qon SCA. q5tt� CUPER 8tJi►dinq 09Partrnent ?c REVIEVVEU 1= / UR LOU1= CO 1 �0 N1PLfANCE Reviewed By �3 j 'tUlf-A xox of 3k% PERMIT NO. qJS(P-*' �o 7L) p� x OX +s € COM UNITY DEVELOPMENT DEPARTMENT UILDING DIVISION - CUPERTINO APPROVED V This set of plans and specifications MUST be kept at the l -:• job site during construction. It is unlawful to make any J x changes or alterations on same, or to deviate C o therefrom, without approval from the Building Official. � - The stamping mp+ng of this plan and ' ' SHALL NOT be held to perm° a an a the violation so ity j 'tUlf-A xox of 3k% PERMIT NO. qJS(P-*' �o 7L)