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14120048 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22216 CUPERTINO RD CONTRACTOR:STERLING GENERAL PERMIT NO: 14120048 CONSTRUCTION OWNER'S NAME: BALIGA SUNIL BANTUAL&REKHA 1506 DELL AVE STE D DATE ISSUED:12/09/2014 OWNER'S PHONE: 4083142728 CAMPBELL,CA 95008 PHONE NO:(408)871-1372 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] IN MASTER BATH,REPLACE TILE &DRYWALL IN License Class___ Lic.# ��''�'��, SHOWER Contractor u Date %;) . AREA ONLY. I hereby affirm that n 1� ense r der t re p ovisions 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:$20629 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:32617047 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 DAYS FROM AS,-T ALLED 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 Date: C Z granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Secti 9 18. RE-ROOFS: SignaturelY �� Date !!Jt1kJ All roofs shall be inspected prior to any roofing material being installed.If a roof is �v 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(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. 1 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 25505,25533,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. 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. S ignature Date CONSTRUCTION PERMIT APPLICATION h� V COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \� 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 \\\ CUPERTINO (408)777-3228•FAX(408)777-3333•buildingokupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#—# PROJECT ADDRESS APN# OWNER NAMEPHONE' / �(p E-MAIL l A KCS- -,x) STREET ADDRESS �r CITYCJAI 9A-) , STATE,ZIP FAX CONTACT NAME ( PHONE E-MAIL STREET ADDRESS I CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME" LICENSE NUMBER VI LICENSE TYPE BUS.LIC# fJ4 COMPANY NAME 1 i E-MAIL FAX STREET ADDRESS4 CITY,STATE,ZIP ^ PHONE �_ ARCHITECT/ENGINEER NAME LICENSE NUMBER C� BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK r 0 V� EXISTING USE PROPOSED USECONSTR 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 TOTAL DECKIPORCH AREA GARAGE AREA: LJDETACH ❑ATTACH #DWELLING UNrFS: IS A SECOND UNIT [3 YES - SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ILEI i � `,�,_ TOTAL VAhUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO - r'- Q By my signature below,I certify to each of the following: I am the property owner or authorized agent to a property 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 repr1sentatives of Cupertino to enter the above-identifi d property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for 1 t R TXWC0UNTER+' BUJLDI)VG PLAN REVIEW ` existing building(s). Demolition permit is required prior to issuance of building i permit for new building. CREs� Y„ PLANNINGPLAN REVIEW t;3 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure YPURLICWORxs form if any Hazardous Materials are being used as part of this project. �FII2EAD0 i _Copy of Planning Approval Letter or Meeting with Planning prior to fl MAJORS SATJTARF SEWER DISTRICT submittal of Building Permit application. � fz t r F 5; k 1x5 �1VVIROI4117ENTAL°HEALTFI,nv. BldgApp_2011.doc revised 06/21/11 CUPERTINO Address PURPOSE SMOKE / CARBON MONOXIDE ALARMS F1 FILE OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building a- �cupertino.org -� Permit No. # of Alarms Smoke: t © Carbon Monoxide: This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single - family and multi - family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel - burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: Irt dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement O r (or Owner Agent's) Name: Si nature ...... ............................................... ............................... Date: Contractor Name: Si nature. `` ..............Lic.# .l v. .) ........ 2% Date:3..Ir. L. 6nSAIL�10r� Smoke and CO formm.doc revised 03118114 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22216 CUPERTINO RD DATE: 12/09/2014 REVIEWED BY: MELISSA APN: 326 17 047 BP#: *VALUATION: 1$20,629 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du 12X PENTAMATION 1 GENRES USE: p PERMIT TYPE: WORK IN MASTER BATH REPLACE TILE & DRYWALL IN SHOWER AREA ONLY. SCOPE �'. �r. po iM;h�P£�dii("'heck rrrY%'%Fee, .11tliwb. fee, 11hw,b fn q,. 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 prelimina information available and are onl an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053.Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes No $0.00 = hours Plan Check,Hourly Suppl.PC Fee: Reg. ® OT 0.0 1 hrs $0.00 $143.00 1STPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (E) No $0.00 Suppl. Insp. Fee: Reg. ® OTJ 0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes No $0.00 L G Advanced Planning Fee: $0.00 Select a Non-Residential 7.. 3.< Fees: Building or Structure 0 Strong Motion Fee: IBSEISMICR $2.68 1.0 hrs Inspections Bldg Stds Commission Fee: 1BCBSC $1.00 $143.00 ISTINSP Inspection,Hourly E" A $3.68 $286.00 TOTAL FEE: $289.68 K. _ W. Revised: 10/01/2014