15040154 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10227 S FOOTHILL BLVD CONTRACTOR:JBS CONSTRUCTION PERMIT NO:15040154
OWNER'S NAME: SHUKLA SUNIL AND RINKAN 21831 ALCAZAR AVE DATE ISSUED:04/21/2015
OWNER'S PHONE: 4083689364 CUPERTINO,CA 95014 PHONE NO:(408)390-5577
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
�p MINOR FIRE DAMAGE REPAIR: 40 SQ FT OF ROOF
License Class_ Lic.# "1 S a ? REPAIR;23 LINEAL FEET OF ROOF OVERHANG REPAIR;
160 SQ FT STUCCO REPAIR;REPAIR OVERHEAD
ContractorSCk 01 -,/ 7700.rJ\)Date1 --,;--0 Ir SERVICE
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. Sq.Ft Floor Area: Valuation:$1500
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:34214077.00 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 LAST CALLED 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 Issued by:�' ! 4Z-,;-eV Date: -
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918. 3 S Com' oV�S^C'��J e1 1 1 U'✓1
RE-ROOFS:
Signature ►'��- S' to 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
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
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)
1,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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. ryC-1; 01
0Y- -, IS S Cir ST
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 p,)-a 0 )
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,atter making this certificate of exemption,I
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
CUPERTINO (408)777-3228• FAX(408)777-3333•building(afcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT 9
PROJECT ADDRESS APN#
0 2.27 S. Fddttii 11 `t31Vd• Cu -'ih 3 4 a - I LI - 0767
OWNER NAME PHONE E-MAIL
SU NI L— SH-J R - A I 40_&_ S 61-g 3 615unilerel-WKIanootlook.
STREET ADDRESS CITY, STATE,ZIP FAX C�
227 SrOvi-A Foo-f-kin 1 1 d ' C v p gft-TI'r)n CA- q!b'-ol`J
CONTACT NAME5 V PQ ry�S ONE hfi ern �� E-MAIL
-'osE f-Z EY N civ s o ^76$ -5-4 6ADS rer movr6wid-Y car4A
STREET ADDRESS CITY,STATE,ZIP FAX
Is6psr Surr2 r
n 8/h E—re-h j e v+F j. De ei
El OWNER ❑ OWNER-BUILDER 120OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSENUMBER =LICENSEE BUS.LIC- v ZTANDV v �a A B
COMPANY NAME E-MAIL FAX
_7 '[5 e0 NSTK%JL t 01J 70LrJJ 4 nj wt -CAWt
STREET ADDRESS CITY,STATE,ZIP PHONE
92 31 A c-•0.-7aV, Aw P- E fL_T i N 0 C -9 Q 1 0 0- 5.577
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKI, qo S t 4y oi p p al
r16 ,001-0
0.1 se �3
a �X ' r o o'f dv�r 1�a�r+ 3� 11`6 t0 s -0 tf r0_ o.i r- o4 stve.e 0
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EXISTINGUSE PROPOSED USE CONSTRTYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY [:]YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑1'HS IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESr RECEIVE TOTAL VALUATION:
PLANNING APPL# E]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑'NO r k`T'�,i IWO-co
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to build'n construction. I authorize representative of C pertino to enter the above-identified pro rty for inspection purposesj
Signature of Applic Agent ( Date: 2 1 Ana���► Gbh.
SUPP MENTAL INFORMATION REQUIRED � �
New SFD or Multifamily dwellings: Apply for demolition permit for
OVER=THEOUNTER t- BUILDING PLAN REVIEW h '
existing building(s). Demolition permit is required prior to issuance ofbuilding
permit for new building. , ItEs� � �
a 3 m� k>AIN PLANIZEVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L1STAI�IDARD �} IIBLIcwaRxs
form if any Hazardous Materials are being used as part of this project.
D$PT
_Copy of Planning Approval Letter or Meeting with Planning prior to
6R s ❑ SAA7TARYSEWERDISTRI �
submittal of Building Permit application. � t-
' . . �° ONMEI�TAlFLEALTA
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10227 S Foothill Blvd DATE: 04/21/2015 REVIEWED BY: Sean
APN: BP#: "VALUATION: 1$1,500
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: ----[ - Alteration/Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK Minor fire damage repair: 40 sq ft of roof repair; 23 lineal feet of roof overhang repair; 160 sq ft stucco
SCOPE repair; repair overhead service wires from panel to roof(PG&E).
i
tm^ ,.
I'M amw
... .. "
aleck. Plan(:'heck llhwiL Plaut('heck Elec.Plan("heck
alech_ Perntil Fee: Plumb.Permit Fee: I Elec- Permit Fee.
Ocher.11cch. Irisp. Other Plumb Insp. Other Elec.Insp.
Li
a'lech. Insp. F'ee: I'htrreb. Lup. lee: 1lec Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ftes are based on the prelimina information available and are onk an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes Q No $0.00 F--0--j hours Plan Check,Hourly
Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $0.001 1
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes Q No $0.00
Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee:
Work Without Permit? ® Yes No $0.00
Advanced Planniniz Fee: $0.00 = hours Inspections
TrOvel Doebanenlalh-w Fees: $429.00 ISTINSP Inspection,Hourly ®�
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
` � $1.50 $429.00 TONAL FEE $430.50
Revised: 04/01/2015
FLOORPLAN SKETCH
M Borrower: Shukia Sunil&Rinkan File No.: 10227 S Foothill
Property Address:10227 South Foothill Blvd Case No.:150205005
City:Cupertino State:CA Zip:95014
Lender:First Technology Federal Credit Union
d i .
28' APR 2 1 2015
r ge
18'
Entry
Kitchen
Living.Room Dining .
Area
Bath
.. .Bedroom Bath
Bedroom Bedroom
�m
Entry
30'
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DMSION-CUPERTINO
APPROVED
is set of plans and specifications MUST be kept at the
j b site during construction. It is unlawful to make any Ism
changes or alterations on same, or to deviateI AO&E Ur
erefrom, without approval from the Building Official. OFF
.e Stumping of this plan and specifications SHALL NOT
e held to permit or to be an approval of the violation
W any Provisions of any gity Ordinanc.a or Stete Law.
TE
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Comments:
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LOCATION MAP
Borrower:Shukia Sunil&Rinkan File No.: 10227 S Foothill
Property Address:10227 South Foothill Blvd Case No.:150205005
City'Cupertino State:CA Zip:95014
Lender:First Technolo-gy Federal Credit Union
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