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15040071N CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1065 COLONY HILLS LN CONTRACTOR: ALPS CONSTRUCTION & PERMIT NO: 15040071 REMODELING OWNER'S NAME: VINAYAK GUPTA 1011 S DE ANZA BLVD DATE ISSUED: 04/08/2015 OWNER'S PHONE: 4088986474 SAN JOSE, CA 95129 PHONE NO: (408) 898-6474 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ KITCHEN REMODEL 130 SQFT TO INCLUDE M,E,P'S ,2 Lic.� � —t � q "1q3 License Class 1 Contractor �}j% �S Com 564 -JJ# -f'C'n Date G qI0 S{ 1b 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. hereby affirm under penalty of perjury one of the following two declarations: 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: $25000 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 APN Number: 35930008.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES ORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D 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 F L S ° CALLED INSPEFTfON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Q� granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: c� with all non -point source regulations per the Cupertino Municipal Code, Section 918. r f RE-ROOFS: Signature Date " All roofs shall be inspected prior to any roofing material beinginstalled. 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 (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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. ` Owner /" Date: 4 / permit is issued. or authorized agent: 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 918. Signature Date CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 6V CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(a)_cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS' U 6 J5 r /A'O .n y b / `#-s L, 7 APN # 5 /'�/ ,& /[v -`J OWNER NAME /A0,yli LdQW /�u�l���vi �C^ PHONE uQ(Z 4C ��:1� E-MAIL'(J STREET ADDRESS 10 6 5 o lft� 44 � � Lr l XJ , , 0 1 (" n� (,� 10 �i 2 CITY, STATE, ZIP &004(" (g.. D i FAX CONTACT NAME �-1 L� 1ler PHONE ye ��jN2714 3 0 Ci E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM/1E /i ! S u 1� 1,"1 LICENSE NUMBER J 0 Ct (,� 3 S LICENSEE TYPE BUS. LIC # )-S67-7 COMPANY NAME L}(i 5 (vvn S�u 4(ozh 4 K l E-MAIL 11 �'S _CbT f YOC�rI [7 YI O� t°d ho o FAX STREETADDRESSt�II S OC' A-u,9 CITY, STATE, ZIP 50,1 gF51Z1 PHONEtfo� t�(og6�L ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE,ZIP PHONE DESCRIPTION OF WORK �'�`!/IGV�` U `�!� ._, lL�,�n l>v' G(J�-�/ IYiC,�✓ CCrI�,a,Yl� _ /�1,�4.J G,/1M _IO } SO-,�,�2 �7(a`5`jJ ff (jl w v /V - aAJ Lsn 1 �1�Q�� , �milirn�/�l' ' (G(J (T` a �lee'�'u cx'►� s EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA KITCHEN 5� REMODEL 11E4 OTHER REMODEL AREA PORCH AREA DECK AREA TOT DECK/PORCH AREA GARAGE AREA: FIDETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO 77> PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? NO �. -'; „p �� i "� iti '�� TO/I AL V�AyLUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have rovided 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 it c struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: _ Date: i)� f' O -7/ 15— SUPPLEMENTAL INFORMATION REQUIRED SLIP,A,:? CHECKTYPE �.R ROUTING _ New SFD or Multifamily dwellings: Apply for demolition permit for COVER T�t;OUNTER��- ��BUILDING PLANRE�'IESVs�� �`'t existing building(s). Demolition permit is required prior to issuance of building �CI w permit for new building.xp[t> _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. � m � � „� :.c rLvr> ,b �❑ UBLtc oiucs k �� � � Copy of Planning Approval Letter or Meeting with Planning to �. _ prior QR ARY SEWERDISTRr submittal of Building Permit application. -9 11 � NYIRONMENT�iI ;HE 2 Ti BldgApp_201 1. doc revised 06/21/11 9-3 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ Thew fees are haled an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) 1065 colony hills In DATE: 04/08/2015 REVIEWED BY: lialADDRESS: APN: BP#: *VALUATION: 1$25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Other Heck Irup. PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK kitchen remodel 130 SCOPE I sq ft to include m,e,p's NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ Thew fees are haled an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE i 4`r{' Nlech. 111 an Check Plumb. PIon (:'heck Is7ec. Plan (,°heck :l9ech. Permit Fee: Plumb. Permit Fee: htec. Per mir Fee Other Heck Irup. Other Plumb Inslr. ocher 1''lec•. Inap, Mech. Inch_ Fee: Plaurab. hasp. lee: l Iec_ Inslr, Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ Thew fees are haled an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 130 1 s.f. $645.00 Remodel, Kitchen (<=300 sf) 1REMRESKIT Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 1 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 � 7�i^irt,c�l 1.)r�t°ctrnc�ntatirrri Fees: Strom Motion Fee: IBSEISMICR $3.25 Select an Administrative Item Bldg Stds Commission .Fee: IBCBSC $1.00 N $4.25 $6,45 00 ,. Y L $649.25 Revised: 04/01/2015 ..wne'Y` V b 7,)') Ka G u� U 'S1✓0130s14P }�i�ehem I�ern�oe�j�IA'U N��►hs nrea/ air k weje.ys , irew 14--d 5 cvyk e S i Ze to 09440 TI /4 6"5 C6m 5 +Y(A c � a 'Yl G C0 I U /\(y PLAT CH KED BY �/1� DATE S C q po-r-4n 0, C'I---�, Cf u 0(K 7P DEPT BACK YARD c PERTIN0 -------------------------------------------------- ---------------------------------------------- --- rH (E) MASTER BDRM. BDRh1, ----------------------------------- Z3 1.1: d � ' J � \i� C btu b ���� �-• •^: _f , ww \ --------- PO I I I I I I I a In <7 E) / / / / / / / / / / (E) ' / FAM I LY/RM. RUila;n� 7F',awe \ z"- ne \ h� \ ze . (roll- Qy. ,r Qq \\ FC 41 / (E) KITCHEN ' / -7 y /' —3G 6 ----------- a , I ° � ° a � ° a � I I , I � I � � I / I / I � I � ' I I I '