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15030174F, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10335 JUDY AVE CONTRACTOR: NICOLAS PERMIT NO: 15030174 CONSTRUCTION OWNER'S NAME: GOOMER MUNEESH AND DEEPTI TRUSTEE 2652 CARLO SCIMECA DR DATE ISSUED: 04/30/2015 OWNER'S PHONE: 4085052145 SAN JOSE, CA 95132 PHONE NO: (408) 712-8564 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITIONS (1363 SQ License Class Lic. # �p 71 FT);INTERIOR REMODEL (1620 SQ FT); REROOF (1900 SQ Contractor 1� C, �� &(fk01-_ Date 6 C FT). -� I hereby affirm that I am licensed under the `provisions of Chapter 9 DEFERRED #1 -TRUSS CALCIS - ISSUED 7/21/15 (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: $320000 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: 37508048.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITIIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned, property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 D D INSPEC VION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comp y Issued b - Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date i / I , 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. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous 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 permit is issued. Owner or authorized agent: Date: 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 Lender's Address 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, ARCHITECT'S DECLARATION 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. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION $ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ' -3255 10300 TORRE AVENUE • CUPERTINO, CA 95014 �R (408) 777-3228• FAX (408) 777-3333 • building(afcupertino org - ---- -- - ❑ ADDITION ❑ALTERATION / TI - ,,. e 1~ -� " LW' REVISIQ�T 1 DEFERRED ORIGINTAL PERMIT' lJr� 3O 7 y PROJECf ADDRESS I n33 -3 U D Y A\/ c ATN R OWNER NAME AV N . S�i Coom�K PHO CITY, ST ATE, ZIP E-MAIL�1GOaFArnXU PER-nro CA Igo 1y STREET ADDRESS IS3'1� E 4ofi5014� CONTACT NAME ' �J r� G e-V\C S k fv P '5 >1 I S^ O 2-7- 6 E-MAIL evNe—S %A STREET ADDRESS CrI'Y, STATE, IP I' A-rm s+ -y q El OWNER ❑OWNER-BUII.DER ❑OWNERAGEN'C ❑CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT Q'ENGDNTEER ❑DEVELOPER ❑ TENANT CONTRACTOR NAME I 1 LICENSE NUMBER �� (q I n AlICENSE TYPE BUS. LIC 9 COMPANY NAME l`_ L / r� tils 5Lw� uc.`A E-MAIL "Mer A1le GA 43 , Ltmq FAX STREET ADDRESS CITY, STATE, ZIP I ' PHONE ARCMTECTIENGLNF_'ERNAME {/ LICE'SENUMBER "'1r LJ �S. k-WP� I BUS. LIC m COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZiP PHONE DESCRIPTION OF WORK Tis S r cel r i^ k4*M ,. Q . iM USE TYPE OCC. SQ.FT. VALUATION (S) EJOSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM. KITCHEN, OTHER ` REMODEL AREA REMODEL AREA REMODEL AREA ..UAKAUtAREA: UDETACH❑ ----±'1! AT TACH mDWELLING UATITS: UNrr ❑ YES SECOND STORYD? ❑NO ADDITION? NO PRE -APPLICATION ❑ YESE COPY OF IS THE BLDG AN❑YESPLANNTING ADPL,' ❑ NO ROVAL LETTER EICHLER HOME? -- TOTAL VALUATION: - _ By my signature below, I certify to each of the following: I am the property owner or authorized agent to application and the information I have provided i c rrect. I have read the Description of Work act on pr rty owner's beha I have read this ' and verify ate. I agree to comply with all applicable local ordinances and state laws relating representatives of to building con traction. I authorize Cupertino t 'feed property for inspection purposes. oe a above,,-��Iid Signature of Applicant/Agent: /en Date: (2 O 6 1—p SUPPLEMENTAL INFORMA ON REQUIRED New SFD or Multifamily d-wellings: Apply for demolition for PL 41, CHECKTS�E yrs yr= itOi3T GSLIP` w= hu permit existing building(s). Demolition permit is required prior to issuance of building r } a OkWmH1rcoTThrER ��}$uuDmG PL 'iz permit for new building, 1 4Fti �xPSEssggmb 5R --1- _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ,I�GP.LANREV.LEw. 'c' PLA.131 ��5r4NDA2tD[] form if any Hazardous Materials are being used as part of this Pty o project. rad CjLARiiE fl�FiItEDFP� — _ Copy of Planning Approval Letter or Meetingwith Planning prior to g p Vi1-0 g a a: T submittal of Building Permit application. _ B1dgf4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO 0-1-W IPIRF. FCTTMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, anaw ay ee , ti vailable and are on1v an estimate. Contact the Dept or addn'l into. Distract, etc.. These ees are based on the rehmnaa FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) 10335 JUDY AVE DATE: 06/08/2015 REVIEWED BY: PAUL limADDRESS: APN: 375 08 048 BP#: 15030174 VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or DuplexPENTAMATION USE: L 1 GENRES I PERMIT TYPE: i WORK DEFERRED #1 - TRUSS CALC'S SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, anaw ay ee , ti vailable and are on1v an estimate. Contact the Dept or addn'l into. Distract, etc.. These ees are based on the rehmnaa FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) MP<:It. NICtYt C'dJEtL'h Phlwh. Plart (7. ("'d Elec, 11/an (..'heck ;wei:It. Pet-wi( Fee: lun2b, Permit Fee: Elec. Pannir Fee. Other .l,kch. Insp. Other Plana Insp. Oilier GIec. Inst:>. ED ,Y(.h. Ltisp. Fee: Plutrb. 11sh. Fe: 1slec. Insp. Fee: V-4- 'S r District School NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, anaw ay ee , ti vailable and are on1v an estimate. Contact the Dept or addn'l into. Distract, etc.. These ees are based on the rehmnaa FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) an orma on a FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L .J # $286.00 Deferred Submittal 1DEFSUBM Suppl. PC Fee: Reg. OT [0A hr's $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: AChninistrative lice: 0 E) Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure I � Travel Documentation Fees: Strong Motion. Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: , $0.00 $286.00 TOTAL:FEE $286.00 AA L Revised: vats i Jcu 15 'r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10335 JUDY AVE CONTRACTOR: NICOLAS PERMIT NO: 15030174 CONSTRUCTION OWNER'S NAME: GOOMER MUNEESH AND DEEPTI TRUSTEE 2652 CARLO SCIMECA DR DATE ISSUED: 04/30/2015 OWNER'S PHONE: 4085052145 SAN JOSE, CA 95132 PHONE NO: (408) 712-8564 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. �� CONSTRUCT ONE STORY ADDITIONS (1363 SQ FT); # INTERIOR REMODEL (1620 SQ FT); REROOF (1900 SQ Contractor_ llco -j- col����Date p I hereby affirm that Yam licensed unde� a provisions of Chapter 9 FT). (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 Sq. Ft Floor Area: Valuation: $320000 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. APN Number: 37508048.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIlv 180 DAYS O PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DA LED 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 A74 granting of this permit. Additionally, the applicant understands and will comply Is Date: / with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. i Signature Date d 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. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 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 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: r 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. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ng(_d)cupertino.orq ❑ NEW CONSTRUCTION K11 r ADDITION ❑ ALTL-RA-TION / Ti ❑ REVISION/ DEFERRED ORIGINAL PERMIT # �•Ru1l:C�AUUKESS j V _..% '_l �J� C%.) FIE t InD APN# 375 L -)g 0 jL OWNER NAME yn� U14EeS, g �p 9711J0I �` G®4' PHONE= ,�} � / ��V[j`J2��fJ GMAIL STREET ADDRESS p (y5-.1:��, f 1 CITY. STATE, ZIP �y FAx CONTACT NAME PHf�.�,- E-MAIL `.d VV ',[I i✓ F-L- sTREE'r MRr-cc _ CI'r1'. STATE 7Ir FAX ❑ OWNER !VNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 0_11C1.TECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME a LICD-NSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAR :.� LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL A. flli i f.3d�p'7�1 gl' ry 0 `Lt FAX �CVo'a3tll, STR bT DrY S! /i I/ i ! V7 CITY. SG •. 7IP typ/y PHONE DESCRIPTION OF WORK 22- ��'" �'i�71 11le- ii �.vc� z • d - ESISTINGUSE �rt PROPOSED USE CONSTR. TYPE #STORIES USE TYPE E OCC. SQ.FT.VALUATION (i) EXISTG NEW FLOOR I DEMO IOTA I. /n� AREA , AREA 1 aT G AREA NET AREA � f� � I s� , it GG\ v 1 l � rj 6� � �� 13ATHROOM KITCHEN OTHER �y REMODELAREA i' j REMODELAREA I a,�, Qy REMODEL AREA (ETACH PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE= AREA: �6 J Y Q.5 /� � q ❑ ATTACH ". DWELLING UNITS: ISA SECOND UNIT OYES SECOND S'I'ORV ❑YES BLINGADDED?.PtO ADDITION? Pllz PRE -APPLICATION 9VES IF YES. PROVIDE COP)' OF PLANNING APDL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES . -I EICHLER HOME". TOTAL VALUATION: 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: 1 have read this application and the information i have pro"' ed 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 buildi g construction. I authorize representatives Of Cupertino to enter the above -identified pro erty for inspection purposes. Signature of Applicant/Agent: 9 Date: () 2_5 201 SUPPLEMENTAL INFORMATION REQUIRED PLAN CITECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for building(s). Demolition permit is required prior to issuance of building ❑ OVER-THE-COUNTER El BUILDTNG PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this prgjcct. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting %vith Planning prior to submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgA13p_201 /.doc revised 0612///1 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10335 JUDY AVE DATE: 03/27/2015 REVIEWED BY: MELISSA PC FEE ID APN: 375 08 048 BP#: Z&a=30Z7 -VALUATION: $320,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du USE: Duplex 2nd Unit? Yes 0 N OTC? 0 Yes E) No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK ADD 1,363 S.F. TOE SFD & RECONFIGURE & REMODEL REMAINING E 1,620 S.F. RE -ROOF SCOPE EXISTING 19 SQ'S OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 1,363 $2,736.52 1R3PLNCK $1,961.64 IRNNSP Elea. Insp, Fee: $0.00 1,900 s.f. $323.00 Re -roof t 1RERODFRES Permit Fee: $1,961.64 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1,363 1 $2,736.52 $1,961.64 MECH, HOURLY; Yes;;: �Itio PLUM$, HOURLY §Yes : Q Na' ELEC, HOURIJ'' ;Yes '_ No ; Afeclr. Plan (.'heck Plrutvb. Plcrrt C:Yacrk Elea. Plan Check ;bler..lr. Perr)rfl Fee: 1'h' . Permit Fee: Flec. Perinir Fee: Other AIech. Insp. Other 1'lurnb Ii'mr).Li Other Elec. Imp. I.Mcch. Ins. Fee: PhrrrrG. hzsp. Fee: Elea. Insp, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Divirirt_ otc L Thova fooc are hacod an the nreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,736.52 1,620 s.f. $5,172.00 Remodel, Other IREMRES2 Supp1.PCFee: 0 Reg.OT 0.0 hrs $0.00 PME Plan Check: $0.00 1,900 s.f. $323.00 Re -roof t 1RERODFRES Permit Fee: $1,961.64 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CAtZSIT action Tax: . 6hnin i'trative Fee: 0 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $190.82 Select a Non -Residential Building or Structure 0 0 i Tr4n'el Documentation F(les Strong Motion Fee: IBSEISMICR $41.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $13.00 sUBTOTALs: , $4,943.58 $5,495.00 TOTAL FEE ; w. . r ..:a . ....:.... . $10,438.58 Revised: 02/14/2015