14120062CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10172 BILICH PL I CONTRAC TOR: NAUTICA I PERMIT NO: 14120062
OWNER'S NAME: RAY ASHISH KUMAR AND NINIVA 11282 LIME DR I DATE ISSUED: 12/11/2014
OWNER'S PHONE: 4083102899
❑ LICE/NSED CONTRACTOR'S DECLARATION
License Class lJ Lic.# 3 a /0 2 6 Z
Contractor. Au i a i o °3 C— ^� Ct "Date (2 f(
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 12 t
Signature
❑ 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
SUNNYVALE, CA 94087 1 PHONE NO: (408) 667-1586
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMODEL KITCHEN 200 SQ FT, MASTER BATHROOM 170
SQ
FT
Sq. Ft Floor Area: I Valuation: $30000
APN Number: 31621065 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 18 DA PERMIT ISSUANCE OR
180 DAYS FR M LA CALLED INSPECTION.
Issued by: Date: % l`
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(x) 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, Sections 05,2553 and 25534.
Owner or authorized age Date: / 2 //
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
mlzxv rrIITICTRT
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 l\ I%
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org 1" 1'
IrTTr)M n AnnITTnN R2 AT.TFR ATTnN / Ti n REVISION / DEFERRED ORIGINAL PERMIT #
PROTECT ADDRESS!
d 1 � 31L�c
APN # ' , ^ n �lU/' n5 /
(.f( [� (�
OWNERNAME �t S
PHONE / o A O
J
E-MAIL
STREET ADDRESS
`�hZ clesc&u-T
CITY, STATE ZIP
f(7
FAX
1
AV,
)4.4 ,►
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 H o,J i b �SNc�,J
LICENS NUMBER
coo
LICENSE TYPE
BUS. LIC #
17 iS
COMPANY NAME
E-MAIL 1 1
FAX
N UT(C4 Co,t/srz�u/ate
0\Tai, 4u�ic c T_tJJi0.C_o
STREET ADDRESS
CITY, STATE, ZIP
PHONE
Q tlhtr 04,
VV.V 9 7
?Ufi 15 A0
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
k I Fc �-( S Te- •� G
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 O ST=
REMODEL AREA S,
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
-GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UMTS:
IS A SECOND UNIT ❑ YES
BEING ADDED? �IO
SECOND STORY OYES
ADDITION?
3
IWNO
Q O O (�
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ONO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ElNO
f,2ECEIVED BYg
''� �'✓�+�
_.s
TOTAL VALUA ION:
a
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the roperty 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating.to building construction. I authorize p en fives of Cupertino to enter the above -identified roperty for inspection purposes.
12 �1
Signature of Applicant/Agent: Date:
SUPPLEMENTA RMATION REQUI D,pLnxuilNG
SLIP,
., ;
`' t
OYER -THE COUNTERS
bING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buil gr
{
permit for new building.
t (Ni�IItG PLAN REvtEw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosuref��xat�nnRDa
"
❑ puBLlcvoluzs
_
form if any Hazardous Materials are being used as part of this project.
-
DE]?TzR '
_ Copy of Planning Approval Letter or Meeting with Planning prior to
s�D'FIRE
>'
q;, SANUARY SEWER DISTRICT 4
submittal of Building Permit application.
;
�q,ENVIRO'NMENTAL'IIE&FA"
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
�101V UcmrnR A'TnlD _ 72TTTT .T11NC DIVICION
r 11c "h.
111trrrih. Phw-i C:`heci
111u,nh. Peri nit Pee.
other Pluinh fraf7.
F'hwlbl hish. Fee:
NOTE: This estimate does not include fees due to other vepartments (i.e. rlanning, cuollc rrL.rno, 1 —, .runL y v� .....�
__ _ .. .• ._- ___ �_-�______.: ___ ....,.:,,.a,.. ,.�,, ,,..,. ,,..t,. ,.., ncf:.wnto f'nntnrt tha Wont for addnl info.
/1lsirlcl, clt" . !/Luau a...1. cw-1....v
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
10172 BILICH PL
DATE: 12/11/2014
REVIEWED BY: MENDEZ
ILEADDRESS:
APN:
BP#:
EVALUATION: 1$30,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
Suppl. PC Fee:; Reg. ® OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
USE:
$0.00
PME Plan Check:
WORK I
REMODEL KITCHEN 200 SQ FT MASTER BATHROOM 170 SQ FT
170 s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
SCOPE
Permit Fee:
r 11c "h.
111trrrih. Phw-i C:`heci
111u,nh. Peri nit Pee.
other Pluinh fraf7.
F'hwlbl hish. Fee:
NOTE: This estimate does not include fees due to other vepartments (i.e. rlanning, cuollc rrL.rno, 1 —, .runL y v� .....�
__ _ .. .• ._- ___ �_-�______.: ___ ....,.:,,.a,.. ,.�,, ,,..,. ,,..t,. ,.., ncf:.wnto f'nntnrt tha Wont for addnl info.
/1lsirlcl, clt" . !/Luau a...1. cw-1....v
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
-----------
FEE
------
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
200 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee:; Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
170 s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Permit Fee:
$0.00
Supp!. Insp. Fee -.(E) Reg. ®OT
Q,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(;Ona tra"110'1 711:c:
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
A
'C /)t;t_°7,172"rt'6a1rd7lt)Yl 1`Ff'S:
Strony, Motion Fee: IBSEISMICR
$3.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
sd
$5.90
$1,290.00 ... TOTAL FEE: :
$1,295.90
Revised: 10/01/2014
CUPERTINO
�
Ouilding Department
5` lilt J
ms
REVIEWED f -:OR CODE COMPLIANCE
Reviewecl By.
V
\J
o
,Qt
cl
4r
v
CUPERTINO
�
Ouilding Department
5` lilt J
ms
REVIEWED f -:OR CODE COMPLIANCE
Reviewecl By.
v
44
-----------------
AIA
/71 PL,
.. . . . . . . . . .
Ol
ce-
e
At
C14
-2
-60"— 1 UNDERSTAND AND APPROVE
70-1" 1 :=I OFTHE ABOVE PECIFICATIO
2 28-21" 1 SIGNEE M—P
13341" —210"
36" 3"
6,1 47 1"
24" 5,, 2j8J
2 471A6'f 27 753' —76" 281
CD �4_
T J
T -
ca
(D
Cl)
B18DWB
3QB214 B,
co =Mmo ED
co F --- ---------
-- ------- J DEC- 1-0 2914 ---------
cr)
Cb
co
rn
A
1 14
/ \ I N 04 PLO'J' PLAIN6
CHECKED BY
PL Ely
Elyr.
IDATE
LE
jog
LP Y i COMMUNrTY DEVELOPMENT DEPAIP
BUILDING) DMSION - CUPERTINO .BLDG. : G.
CB36-L 8T3 790 ------- APPROVED
24TDW361813 ---------- This set of plans and specifications MUST be kept at the
NBC3036-BLR W3636B job site during construction. It is unlawful to mak-a any
changes or alterations on same, or to deviate
therefrom without annrnVf-%.f from the RuiI&P rm
ve-;!ml 9)c
V
"- t". C, I
4- !>c1e,3gs. --
5C-0
bildirqq D,.Mar
The Stamping of this plan and specifications SHALL NOT
—33" if 3 1.------------------------------------ fit -------------------- A& palrxrut or- to -be- an- apprev,^J �of th� v:/., la Gn-
--- DEC- - f f
.Ifg 5 any provisions of any City Ordinance or St to Law.
4 25T 2, QQS1 89 CS18 zy REVIEWED F
OR CODE C'
—36" —3611 %� OMPLIA
4 'r L A -F
—113-81" -7 153J ��0308 1 3 T NO. Reviewed f3y ',;eA
f.3 I I i I I I
1314L I C- 4 pe-
117136 "
31,F- ------------ -------------------------- ------------
-4
70 3 ,,
M
1 It
Z -e -e-16
344
20S
A