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14080051I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 10777 FARALLONE DR I CON TRUCT ONALVARADO I PERMIT NO: 14080051 OWNER'S NAME: ROHIT & MEGHA GURTU OWNER'S PHONE: 4086897588 ❑ LICENSED CONTRACTOR'S DECLAR(A�TION License Class Lic. # _��� Contractor ok Il 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 erformance of the work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, as provided for by ection 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 -poi r regulations pertino unicipal Code, Section 9 18Z'e Sign Date �8 -25-1y ❑ 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 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 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. Signature Date 1001 JACKSON ST I DATE ISSUED: 08/07/2014 SAN JOSE, CA 95112 1 PHONE NO: (408) 799 -9918 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ KITCHEN REMODEL 150 SQ FT TO INCLUDE M,E,P'S, RELOCATE GARAGE DOOR, 200 AMP PANEL UPGRADE, REPLACE WINDOW IN LIVING ROOM Sq. Ft Floor Area: I Valuation: $20000 APN Number: 36935023 00 1 Occupancy Type: PE T EXPIRESIWORK IS NOT STARTED WI 180 DAYS O PERMIT ISSUANCE OR 180 DA FROM LAS ALLED INS P CTION. Issued by: Date: 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 rtino ' 'pal Coe, Chapter 9.12 and the Health &Safety Code, Se ns 2 , 5533: a d 2 4. Owner or authorized agi D/ /� Date: Of- 25- 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 I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 10777 FARALLONE DR I CON TRUCT ONALVARADO I PERMIT NO: 14080051 I OWNER'S NAME: ROHIT & MEGHA GURTU 11001 JACKSON ST I DATE ISSUED: 08/07/2014 1 OWNER'S PHONE: 4086897588 1 SAN JOSE, CA 95112 1 PHONE NO: (408) 799 -9918 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class �i Lic. # S99 p ' Contractor y Q Date (0 " �fo AID >,Q� �- � y 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.-100 ave and will maintain Worker's Compensation Insurance, as r by S ion 3700 of the Labor Code, for the performance of the w r ch tltie� ermit is issued. .wLl• 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 so regulation ' r Cupe ino Municipal Code, Section 9.18. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ KITCHEN REMODEL 150 SQ FT TO INCLUDE M,E,P'S, RELOCATE GARAGE DOOR, 200 AMP PANEL UPGRADE, REPLACE WINDOW IN LIVING ROOM REVISION M REMODEL 60 SQ FT TO HALL BATH; REMOVE AND REPLACE (3) WINDOWS, TO MEET EGRESS IN BEDROOMS, TANKLESS WATE HEATER, INSTALL GAS LINE FROM MAIN TO FURNACE- ISSD OTC 10/16/2014 Area: I Valuation: $20000 I APN Number: 36935023.00 1 Occupancy Type: I PERMIT E + S IF WO IS NOT STARTED WITHIN 18 DAYS OF PERMIT ISSUANCE OR 180 DAYS F AST CALLED INSPECTION. Issued by: Date: �!� RE- ROOFS: Date 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 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 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 Signature of 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 Qualit anagement District I will maintain compliance with the Cupertuio Muni ' al ode hapter 9.12 and the Health & Safety Code, Sectio 6i3,505/,25! 3 , and _ 53 . Owner or authorized agen Date:/J?,; � _ l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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 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. Signature Date Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • build,iinncup ertino.or n , -, v�cri"Tnr)M r r)PT RFT) nRTGTNAL PERMIT # LJ NEW CONS IKUC I IUN IJ twuluiUi-4 IJ L1LMilvaa aa�LJ • - --- - -- PROJECT ADDRESS C (� I-DO APN # OWNERNAME O PHONF4Rq E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX 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 A \ LICENSE B LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX ST ET ADDRES CITY, STATE ZIP PHONE - _ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK CL oOrh -,lam � C s 160L ir o ..'V- � v� o' ��C•t. i o�r�t a t/ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA o6 6 REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 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 IS THE BLDG AN El YES EICHLER HOME? ❑ NO I RECEIVE '' �' ` = a ';,: tss� + " -� '`z TOTVA,j,U�,l'IONe. / ////���/V// /ate PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER _� p (C �c a: _ By my signature below, I certify to each of the following: I am the operty owner or authorized agent to ac e owner's behalf. I have read this application and the information I hav ovI d is correct. a rea a Descri of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin o build.' onstruct' I auth repres Ives of Cupertino to enter the above - identified property for inspection purposes. Signature ofApplicant/Age Date: — [ SUPPL NT INFO QUIRED n ' ' LAN CHECK TYPE.,. , t x .� x. x I20UTIR(s SLIP ©R TlcouNTER { Ls sTnLDII�cJ?LANREVIEw New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building 5 permit for new building. xrxESS°f rr�PLAi�i\iivGPLAxxEVtEw ' aPTJBLIC WORKS _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure z {ter form if any Hazardous Materials are being used as part of this project. Planning Approval Letter or Meeting with Plannin g prior toE Y "'`� "RP ft _ Copy of ° submittal of Building Permit application. . ❑ M ��* �k ? ;SANITARY SEwEIt DISTRICT . r . �a . =,C „ ENVIRONIVIEIVTAL- ,HEAI;TH:`.,, ..`: BldgApp_201 1. doc revised 06121111 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 10777 FARALLONE DR DATE: 10/16/2014 REVIEWED BY: MENDEZ IlaADDRESS: APN: BP #: *VALUATION: 1$5,000 TPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Remodel, Bath (< =300 sf) IREMRESBAT PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK REMODEL 60 SQ FT TO HALL BATH; REMOVE AND REPLACE 3 WINDOWS TO MEET EGRESS SCOPE IN BEDROOMS, TANKLESS WATE HEATER, INSTALL GAS LINE FROM MAIN TO FURNACE �.. t. M rep: # <, t'laN Ch', Plumb. Plan Check 0.0 hrs $0.00- <::>t�.1'l�x,�'it� °t b1ec;' . 1'2r�uit Fete' Plumb. Permit Fee- IIT (?tl,C,,' a tech. fm! Other Plumb Insp. 1 0.0 1 hrs Thallb, Trzcp, Fe: 0 1 ocher f� -lec. h'!sp. 1"I"x. b Y'o, Fe"'. NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School Metriet ote ) Thoco foot aro haeod nn tho nroliminary information availahle and are only an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 E f 711113,) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 F__607 s.f. $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # $0.00 Window / Sliding Glass Door Replacement Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT 0.0 1 hrs $0.00 = # Plumbing $29.00 IPRWHEATR I Water Heater PME Unit Fee: $0.00 PME Permit Fee: $48.00 0 # Plumbing $72.00 IPGASRES Piping, Gas < =4 Outlets Cons•lra.wtion 7uv: Administrative Fee: IADMIN 00 0 E) Work Without Permit? 0 Yes • No $0.00 Advanced Planning .Fee: $0.00 Select a Non - Residential Building or Structure E) 0 Travel Documentation Fee: ITRAVDOC - - i $0.65 Strom Motion Fee: IBSEISMICR Select an Administrative Item Bldp, Stds Commission Fee: 1BCBSC $1.00 S gS $142.651 $746.00 ' . TOTAL FEE: 5 Revised: 08/20/2014 (tA t - P PLOT PLANS CHECKED By 14( DATE In (6 / �7 CANNING PT. D ATE BLDG. DEPT. 9x6 SW , CN) HALL CLOSET Iw llftru Tau uft_� f� H roftEg. 91-W s M (N) - P%) 2! �FDDR�ss ; to 77 r r,*KALLONE p R, CUPMr /NO C-4qS -011 SCop E : ,Jam 2- Bedroom W r rows wi+l 6X4 °sc.a W)NDOws, Replace 1(4t ken Njiv%�ow uA 4b)(30SLO IN►hdow Rem odeI &&room A Add SahfahneI C (0, PW Tio K(e.S: )Vah,r Hc-*,, -er, Tr sue) Gas I'K e- (h) ' 1 , <-..00 G As D 11A I �0 TPN Kos 7-AKAC71 7-r,-4) 2- i�� gQp,Ic, CUPERTINO Building Department OCT 16 2014 REVIEWED FOR CODE COMPLIANCE Reviewed By: CODES 2 013 C-6c 2-013 C-KC 2013 cc- 20 i3 CMC 2013 c-PC 20 13 E kfeK y DES' /Iry IvER�/p w�� RoN1T t;vl -Tu T �.1� ay olJ 0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10777 FARALLONE DR OWNER'S NAME: BE ZHANG OWNER'S PHONE: 4086897588 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor 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. 1 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 1 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. Signature Date ❑ frBq OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code), 1 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. 1 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 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, 1 become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. 1 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. Signature / G5" Date y 1 "1 CONTRACTOR: RE ZHANG 10777 FARALLONE DR CUPERTINO, CA 95014 PERMIT NO: 14080051 DATE ISSUED: 08 /07/2014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL KITCHEN REMODEL 150 SQ FT TO INCLUDE M,E,P'S, RELOCATE GARAGE DOOR, 200 AMP PANEL UPGRADE, REPLACE WINDOW IN LIVING ROOM Sq. Ft Floor Area: Valuation: $20000 APN Number: 36935023.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 184 DAYS OF PERMIT ISSUANCE OR 180 DAYS LAST CALLED INSPE9TION. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l 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 1 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 will maintain compliance with the Cupertino Municipaf Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: DateC7L___/ ?pt� J__ 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 ^ FAX (408) 777 -3333 < buildino cpcuoertino.org �I f' ❑ NEW CONSTRUCTION ❑ ADDITION ALi cRATION / TI ❑ REVISION /DEFERRED ORIGINAL PER.M17 R_ E PROTECT .ADDRESS RAL6 olV . N 'M�k o &v 1 35— �3. 6v FJ . f v PHONE o —75-, �'Q I E -MAIL /stO':> �.[rti�1`'U� pU{ � j :V'J�l O © l,JirJSJ �(r_� �p� ,h p STR_FrADDRESS10777 ��LpL0A)Fb , I CITY, STATE, ZIP / 9i 'J •Y I F.AX r Li k-r/ AJo CONTACT 1'AA4E U(r� r 0 ' �i ] �Ti � !<C (; PHONE STREETADDRESS ®7 77 F AAA LLCOJE ®k • CnY.STATE, ZIP CU E I FAX CA ❑ OUT+ER•BUILDER ❑ OWNER AGET.`r ❑ CommACTOR ❑ coNTRACTOR AGENT BENGA'E=..R ❑ DEVELOPER ❑ TzNANr CONTRACTOR?!A14E ( ( I LICENSE TYPE BUS. COMPANY NAME E -MAIL I FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARCHTTECTIENGINEERN'AME I LICENSENUAOFR BUS. LIC COMPANY NAME E -MAIL FAX STREET ADDRESS STATE, ZIP- I PHONE �CITY, DESCRIPTION OF WORK tO4kA DOe ) l6-0A?4p -to 2-OZ RAt P (Saf Y-&Q- ,Cro &L Aaw- � , S- - L)/ &f eft Ct I-VG R W1A1Db11J 10' Lo (�J, �Qc� G JREMe'Ve- EXISTING USE PROPOSED USE -TONS R 7YPE : STORIES �IlYF+. M USE TYPE I OCC. SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA KITCHEN .I OTHER R540DEL AI �,� A p ., `REMODEL AREA PORCH AREA DECK AREA TOTAL DECY -TORCH AREA GARAGE AREA: U DETACH ❑ ATTACH I m DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ 1^rS BEING ADDED, PNO ADDITION? EZO -- PRE- APPL- IC- 47'iON -- YES - L�:rS,.P_AOYIDE_COL'Y_OF _15THE13LDG.4N 71 —IS PLANNING APPLE ❑NO PLANNING APPROVAL LE TTER FICKLER HOME? NO`S CEII�EDB By my signature beloNv, I certify to each of the following: I am the property o\� ,ner or authorized anent to act on prope Tamer's behalf. ]have read this application and the information I have provided is correct. I have read the Description of Rork and verify it ' accurate. I a�ee comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter he above -i d p /ro/�e for inspection purposes. Signature of Applicant/Ac�nt: Date: SUPPLEMENTAL IN N ATION REQUIRED New SFD or Multifamily d-vellings: Apply for demolition per mmit for 7="4 K Sk4 ''.k ER TH>iCOtThTERBLII D existing building(s). Demolition permit is required prior to issuance of buildin PLAN REVIEW permit for new building. �'E1s s,,.i" L4�I�I\G�PL?�REiE�i _Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure [ T, I, =PUS>7c voRRS form if any Hazardous Materials are being used as part of this project. min. . 4 iryy F�' _ Copy of Plannin� g Approval Letter or Meetin_ g with Planning prior to TAI2GF c�z � s FIRRDEPIok`v :Za � -� submittal of Building Permit application. �,❑ fA70 -.+ yrs' .- � ITAI2S SFR RDISTm0L - ?�� .� -, � : �r - Blda 4ppj011. doc revised 06/ ?1 /11 I CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION jg�ADDRESS: 10777 farallone dr DATE: 08/0712014 REVIEWED BY: Mendez APN: BP #: ",57- `VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Phimh_ In.�l�. l -ee' PENTAMATION 1 R3SFDREI PERMIT TYPE: WORK kitchen remodel 150 sq ft to include m e 's relocate garaqe door, 200 amp panel upgrade, replace SCOPE window in living room NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate- Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1 -053 Eff.' 711113) FEE Pfnmh Plan ('hmrG Elec. Plan Check 0.0 hrs $0.00 I'lu,nh. 1'exr7?ir h'cL,. Elec. Permit Fee: 1EPERMIT i!r, r; Lr.tr (I;Lfr }'iurnb In.>> ET--1- Other Elec. Insp. 0.0 hrs $48.00 Suppl. PC Fee: 0 Reg. OT Phimh_ In.�l�. l -ee' I 1.h'c. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate- Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1 -053 Eff.' 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (< =300 so IREMRESK T Suppl. PC Fee: 0 Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 1 amps $48.00 Electrical 1 IBELEC200 Services Permit Fee: $0.00 Suppl. Insp. Fee: Reg. COT p 0 hrs $0.00 0 # Window / Sliding Glass Door $431.00 1WJIJREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Q 0 Work Without Permit? ® Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential 7 Building or Structure E) 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $144.60,$1,124.00 TOTAL FEE: 1 $1,268.60 Revised: 0711 012 01 4 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 950143255 Telephone: 408 -777 -3228 Fax: 408 -777 -3333 JOB ADDRESS: W . `F 4M PERMIT # IqOF0061 OWNER'S NAME: u- fi PHONE # 0? ° 2 9 GENERAL CONTRACTOR: r BUSINESS LICENSE 4 ADDRESS: e5 kj CITY /ZIPCODE: 34P —roc— c4 5v z- *Our municipal code requires all businesses working in the city to have a City of Cupertino business 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 Please check applicable subcontractors and complete the following information: Date ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Pq- Q C R ET B0 Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood lass / Glazing A-4 c, 5.5 :✓ Heating Uw-o e C I i ,5v 3 r a/ Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / ontractor Signature Date CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 ^ FAX (408) 777 -3333 ^ buildino aacupertino.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 t io777 FA kA LLrwF b k ' APN BP# /! Ln �'fOn 5"/ DQYVNER NA E H ®�, OWNER ADDRESS q ��Q� LJ ESCRIPTION OF WORK: �MatitE�'Q� y / /� �— r Ce.*) fao Mf 2-m Am P gQn-)k X_DQMttbn &W-M - _ Q F n, AuKI nee Q. t V G k M (,Wr Coalt We are providing y 3%h an Owner- u I er Acknowledgment and Infor tion 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. V 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.) Mrq 1. 1 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. 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. PqQ 3. 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. M4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. `PPG 5 1 1,nderctalld 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" under state and federal law. M6. I 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. M7. 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. :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. OwnerBuilderForm 2010.doc revised 04114110 P"4 9. 1 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 l may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. MS-1 a I 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. Mi 1. 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. MG 12. 1 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 affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: 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 si nature. Property Owner's Signature: Date: &J-712SdLf - -------------- -- ----- ---- -- ----------- --- ----- -------------------------- ----------------------- ---------- ------------ --- ------ ------- --- -- -- (NOTE: The following 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, orother 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: OwnerBuilderForm 2010.doc revised 04114110