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1212006210418 S TANTAU AVE 12120062 F LAKSHMANKUMAR MUKKAVILLI SCANNED BOX #598 II CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 10418 S TANTAU AVE I CONTRACTOR: BG CONSTRUCTION INC I PERMIT NO: 12120062 1 OWNER'S NAME: LAKSHMANKUMAR MUKKAVILLI OWNER'S PHONE: 4087300255 'ISM LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # 656 4' 1l L Contractor Cry l 1 tJ C Date 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 7 Compensation, as provided for by Section 3700 of the Labor Code, for the �90 performance of the work for which this permit is issued. �� I have and will maintain Worker's Compensation Insurance, as pro, or by Section 3700 of the Labor Code, for the performance of the work foT'which th' 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 sand will corn with n-point source regulations per the Cupertino Municipal Code, 9.1 __.A. G Date C (3 ❑ 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. l 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, l 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 l 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. 850 W SUNSET BLVD DATE ISSUED: 06/04/2013 HAYWARD, CA 94541 PHONE NO: (510) 432-6249 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL DETACHED NEW GRANNY UNIT(796 SQFT)AND ATTACHED GARAGE (242 SQFT) DEFERRED - GRAY WATER SYSTEM PLAN & SPECS- ISSD OT /20/2013 .� Area: I Valuation: $110000 APN Number: 37508057.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM INSPECTION. F/7--4// 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 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(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined b rea Air Quality Management District I will maintain complia with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safetyode, Sections 25505, 25533, and 25534. Owner or authorized agent: 7 �—� x C Date: R-71 i C 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 Date I CITY OF CUPERTINO BUILDING PERMIT I 3f.I BUILDING ADDRESS: 19099 TILSON AVE OWNER'S NAME: LAKSHMANKUMAR MUKKAVILLI OWNER'S PHONE: 4087300255 ❑ LICENSED CONTRACT/OR''S DECLARATION License Classp _ Lic. # er/ t S �, t/ Contractor Date y— / b — 2617 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 e as -provided for by Section 3700 of the Labor Code, for the perform 1ff Al 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 grantin u . i iona licant understands and will comply all non -point source regulations per the Cupertino Municipal Code, Section 9. Signature Date - ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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) 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. CONTRACTOR: BG CONSTRUCTION INC PERMIT NO: 12120061 850 W SUNSET BLVD DATE ISSUED: 06/04/20I3 HAYWARD, CA 94541 PHONE NO: (5I0) 432-6249 JOB DESCRIPTION: RESIDENTIAL u COMMERCIALU NEW TWO(2)STORY HOUSE(4176 SQFT)INCLUDING I HREE(3)CAR ATTACHED GARAGE(631 SQFT) REVISION #1- REPLACE WINDOW W/ DOOR ON BEDROOM #5 & M.SUITE-ISSD OTC 9/9/2013 Sq. Ft Floor Area: Valuation: $600000 APN Number: 37508057.TILSON I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Zate `/a 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 DISCL SURE 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(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as define the Ba Area Air Quality Management District I will maintain compl' ce with the Cupertino ++cipal Code, Chapter 9.12 and the Health & Safety e, Sections 25505, 25533, and 25534. Owner or authorized agent: l* Date: /L)— 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 Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10418 S TANTAU AVE CONTRACTOR: BG CONSTRUCTION INC PERMIT NO: 12120062 OWNER'S NAME: LAKSHMANKUMAR MUKKAVILLI 850 W SUNSET BLVD DATE ISSUED: 06/04/2013 OWNER'S PHONE: 4087300255 HAYWARD, CA 94541 PHONE NO: (510) 432-6249 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic. # 6 p S 1(1L DETACHED NEW GRANNY UNIT(796 SQFT)AND ATTACHED Contractor � �o r's.e.C� l,tN XZV 'J:U Date G GARAGE (242 SQFT) 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: 1 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. 1 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 gran us permit. Additionally, the app R derstands and will comply wit all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 6- (1- 2 c13 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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 1 certify that 1 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. Sq. Ft Floor Area: I Valuation: $110000 APN Number: 37508057.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRO CALLED INSPPECTION. Date: 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 Appl 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.I2 and the Health & Safety Code, Section 25532(a) 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 25505, 25533, and 25534. Owner or authorized agent: U-f--4J Gyt-16Y2e5z— Date: CONSTRUCTION LENDING AGENCY 1 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10418 S TANTAU AVE CONTRACTOR: LAKSHMANKUMAR PERMIT NO: 12120062 MUKKAV ILLI OWNER'S NAME: LAKSHMANKUMAR MUKKAVILLI 915 ALMADEN AVE DATE ISSUED: 06/04/2013 OWNER'S PHONE: 4087300255 SUNNYVALE, CA 94085-3426 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class Lie. # DETACHED NEW GRANNY UNIT(796 SQFT)AND ATTACHED Contractor Date GARAGE (242 SQFT) 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 Sq. Ft Floor Area: Valuation: $110000 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: 37508057.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 DAY F M 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 61 9.18. RE -ROOFS: Signature Date 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 1 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 1 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 �y / Owner or authorized agent: Date: permit is issued. 1 certify that in the performance of the work for which this permit is issued, 1 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 1 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 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 W b`"A 16 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10418 S TANTAU AVE I CONTRACTOR: BG CONSTRUCTION INC I PERMIT NO: 12120062 1 OWNER'S NAME: LAKSHMANKUMAR MUKKAV1LLl 1 850 W SUNSET BLVD i DATE ISSUED: 06/04/2013 1 OWNER'S PHONE: 4087300255 1 HAYWARD, CA 94541 1 PHONE NO: (510) 432-6249 1 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 61I'DS� —I y t { Contractor A Date � C(jiaSR�LTtO�% "ZO— 20( 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. 1 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. 1 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 grantin o understands and will comply xAth-alT-non-point source regulations per the Cupertino Municipal Code, Section -00 9.18. > Date t{"2G_Ted 11 ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 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 1 have read this application and state that the above information is correct. 1 agree to comply with all city and comity 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. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL DETACHED NEW GRANNY UNIT(796 SQFT)AND ATTACHED GARAGE (242 SQFT) REV # 1 - ADD CEILING FANS/SWICHES (3) TO 2 BEDROOMS & TO LIVING ROOM- ISSUED 4/21/2014 Sq. Ft Floor Area: I Valuation: $110000 APN Number: 37508057.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS ISSUANCE OR 180 DAYS LAST INSPECTION. h, Date: i000` 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 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use a ui ment or devices which emit hazardous air contaminant y re Bay Area Air ua i Management District 1 will m ' n compliance with the Cupertino Municipal Code, Chapter 9.12 and the ealth & Safety Code, Sections 25505, 25533, and 25534. Owner or an �gent: — �' G Date: 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 1 understand my plans shall be used as public records. Licensed Date Zpi..�(oZ CUPERTIN© NFW CONSTRI ICTION CONSTRUCTION PERMIT APPLICA ON Z COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION n 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingOcuyertino.org 1 t I I ADT)ITION I I AI.TFRATION / TT I I RF.VTSI(_)N / nF.FFRRF.n ORIGINAL PFRMTT # PROJECT ADDRESS 04(� rtAN1� +� �v� APN # ass_ OWNER NAME "T.? , MU t<k•AV(L.L I PHONE 1-4dao 2 E-MAIL STREET ADDRESS (a -4-1 8 T F%Y to (i t-) uE CITY, STATE, ZIP FAX C- PP -PT -(Xi 6 C-q - q h 1¢ CONTACT NAME Cy1t1 A2cl-I1T�c'� PHONE ^798 E-MAI Ci rv� C� Ir<c.(,tt1,►1 STREET ADDRESS 1 0 �68 F• IqA Direr Dv—'tceZ CITY, STATE, ZIP C�= MOT 6 cA .. q ,_ZZ6E4 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT �v ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # ^ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME �Q pp l ICENSE NUMBER C `_i. \ --; '( BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK co �--� TQ 2 • 'L�� Ty9c (y ic'D '? � � � N t T' EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES � i� � c? � ^ 8 O r-A �L USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR AREA AREAq DEMO AREA TOTAL NET AREA Al / Z U /•L_ G 2� 2 ( BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH #DWELLINGUNITS: IS A SECOND UNIT ❑YES ''ram" SECOND STORY ❑YES BEINGADDED? O ADDITION? �'NO 7�❑•.YES PRE -APPLICATION S IF YES, PROVIDE COPY OF IS THE BLDG AN *�(NO RECEIVED BY: TOTAL VALUATION: PLANNING APPL # O PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: I am the property owner or authorized agent to ad 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 rela ' building co struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agen Date: SUPPLEMENTAL WFORMAT UIRED PI.ANCRECICTYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building , permit for new building. t: � iv O P �' I� F EEXPREss .�' LJ� 'LANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �l DARD (PiJBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE IRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ 'SANITARY DISTRICT submittal of Building Permit application. MAJOR , SEWER ENVIRONMENTAL HEALTH BldgApp_201 ].doe revised 06121111 CITY OF CUPERTINO FRO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10418 s. tantau ave. DATE: 12/12/2012 REVIEWED BY: larrys APN: ' �� U . v `� BP#: 'VALUATION: j$110,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? • Yes No PENTAMATION 1 R3SFD2ND PERMIT TYPE: WORK[a[ann unit and garage 796 sq ft. 242 s . ft garage SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 1,038 $2,487.18 IR3PLNCK $1,617.73 IR3INSP TOTALS: 1,038 $2,487.18 $1,617.73�' NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Morirt otr ) Thoeo foot aro hacod nn tho nroliminary infnrmntinn availahlo and aro nnhy an actimato_ Cantart tho Aont far addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef : 7/f 1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,487.18 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.73 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $629.29 zldinini.til ativv 1"cc: Work Without Permit? ® Yes (F) No $0.00 Advanced Planning Fee: 1PLLONGR $134.94 Select a Non -Residential Building or Structure 0 i True cl Dcc:z.waentution F(A' ,. Strong Motion Fee: 1BSEISMICR $11.00 Select an Administrative Item Bldg St_ds Commission Fee: IBCBSC $5.00 SUBTOTALS; $4,885.14 $0.00 TQTAL FEE: $4,885.14 Revised: 10/01 /2012 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a1cu ertino.org / j;,2 4:200Q ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PrOJ CT ADDRESS _ _ _ r .y�l• APN # WNERS 4 f �IvIGViM� � uttq W La PHONE IA0lI1L� `13D aZ,S� SNMA'� STREET ADDRESS 41TY, STATE, ZIP r � JAD FAX ;u y c� Iv g. CONTA NAME EHON� E A©N J K IZ C Tm STRE A ESS CITY, STATE, ZIP FAX C vN W ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK , EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH I # DWELLING UNITS: FIS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VA ATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �q y/ 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 infonnation 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 Iaws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ve Date: O17'U (ai e) SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTERHUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 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 project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DNiiIlldiN # 1 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 " (408) 777-3228 • FAX (408) 777-3333 • building6lcupertino.org LJ NEW CONSTRUCTION Lj ADDITION LJ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # 1 PROJECT ADDRESS APN # 3_Ts OWNER NAME M V k fl `l I L L. f PHONIC G - C �S E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX (40gcf `r(LSCGN '�lIj C c/ z-RTim a C--1 4S� 14 CONTACT NAME PHONE a �� E-MAIL L�¢�V (jam Flip 04 �j%�3S tf'Y'Y7G c bncct (,CC STREET ADDRESS CITY, STATE, ZIP FAX f 8 13 � W D Lt­r z 6a2 c C') �� �7J q �4 � ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ l2(, CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME I E-MAIL FAX 1 STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME TYD7C'S`>IQhR� �t�Si�� E-MAIL �Y-17 VLtCa.l.�d FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ci C Vy C C10 W %� dt a i/1 Fa 4' I O 0 f�►, S Sd T � -5,� ' R T 'r � 2 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA ,LJ �",' / AREA AREA (is1 NET AREA /i I -y "-f f G BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: Ll DETACH "ATTACH I BEING ADDED? �1 1 70 ADDITION? O PRE -APPLICATION S IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES IV $ ?- 1 TOTAL VALUATION: PLANNINGAPPL# NO PLANNING APPROVAL LETTER EICHLER HOME? O f •'� O e. d By my signature below, I certify to each of the following: I am the property owner or authorize a t to act on the property owner's behalf. I have read this application and the informatioULhave 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 ng c ruction. I authorize r resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent_ Date: 13T ­�i " I ->. t -. 2 BldgApp_201 1. doc revised 06121/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 9 REVISION / DEFERRED ORIGINAL PERMIT it 1 _2A Z 00 (0 2 PROJECT ADDRESS I O 4) S S 54 N-T► I U A V E N U� APN k �� S—o Q � n OWNERNAMELARSHMANkUMAR MUKKf}V11,L( PHONE(tog 7O�S� E-MAIL+oG(I<$hM6Ln-)-Lukkavi(Ii@ 00-43 STREET ADDRESS 5 � A. CITY, STATE, ZIP v oKR Cam/ I 4�. p?l1 FAX if CONTACT NAME � � PHOX(5 O) 4 3 a - L ^ ` 1 o�C E-MAIL�I(� (� Co NSrI � I Iv c f STREET ADDRESS Q , � 1 0 1 UO\�,�NER-BUILDER CITVTZE, ZIP ' C FAX ❑ OWNER ❑ ❑ OWNER AGENT ❑ CONTRACTOR ❑ CO'TRACTORAGENr ❑ ARCHITECT ❑ ENGLNEER ❑ DEI�ELOPER ❑TENANT CONTRA NAME x LICENSE NUMBER LICENSE PE BUS. LIC At-.\t l3 \ l -2 COMPANY NAME 3k COoS�u>`Tk0tJ S?.1C E-MAIL FAX sid- 4a T6i9 STREET ADDRESS ?s� cnrs Ivv CITY, STATE, ZIP wthe' 4­11 PHONE ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQTT. 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 DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH mDWELLINGUNITS: ISASECOND UNIT ❑YES SECOND STORY El YES BEINGADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN E] YES RECEIV .�,'�,� AL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME?❑ NO By my signature belo a, I certi o the following I am the property o��mer or authorized agent to act on the pr ovmer's behalf. I have read this application and the inf tlon I have rovided is correct. I have read the Description of Work and verify it is a I agree to comply with all applicable local ordinances and state ws relat� uil i g construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Age —" 6 Date: — _Z) �bl SUPPLEMENTAL IMF ATION REQUIRED � go l� ��V��pIIATE� � � suutprncP � ,� New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building �i� '��� tt G permit for new building. CIS ExPs rr>\ PLAIVRE �* Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _� � ST { n�nx� k rays T 4 PU13iIC\ QFQ, k form if any Hazardous Materials are being used as part of this project. LARGT:.; yt �* _ Copy of Planning Approval Letter or Meeting with Planning prior to a � � �� Q 11iAJt �e "` u � ��� �W SAN TT AR SE\ VER DIST3tICT submittal of Building Permit application, Ilr�IWI EmIRONMENTAY"HEA-THt¢sz, B1dgApp_2011.doc revised 06121117 CITY OF CUPERTINO Fm_ft FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10418 S TANTAU AVE DATE: 04/21/2014 REVIEWED BY: MELISSA APN: 375 08 057 BP#: "VALUATION: Iso -PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: A WORK REV # 1 - ADD 3 CEILING FANS/SWITCHES 2 FOR BEDROOMS & 1 FOR LIVING ROOM - ISSUED SCOPE 4/21/14 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff: 7'l 73) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $139.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7 0 G Work Without Permit? 0 Yes (2) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 Strony, Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $139.00 TOTAL FEE: 1 $139.00 Revised: 04/01 /2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E R'f I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ` 4- v - I AW PERMIT # Z' I Cn 42 I Z OWNER'S NAME: LAWjjN p j #0%., k�vt -i' PHONE # — GENERAL CONTRACTOR: t3 etc 'S` IrL, BUSINESS LICENSE # 301t) - ADDRESS: 19jp tk, Jc,US� 131Uc1 a�� C CITY/ZIPCODE: C %S�t *Our municipal code requires all businesses worft in the city to have a City of Cuper-ino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing �e �NI cov TIA �� 2 Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City OI'Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777- 3228 Fax: 408-777-3333 JOB ADDRESS: fOLjje PERMIT#- �. OWNER'S NAME: PHONE #— GENERAL,, CONTRACTOR: BUSINESS LICENSE # 3✓j� Lj ADDRESS: CITY/ZIPCODE: T - *Our municipal code requires all businesses workhit in the city to have a City of Cupertino Business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. am not using any subcontractors: — Signature Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing —� Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing CC VRIW Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date i Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: February 15, 2013 RE: New/Change of Address APN #375-08-057 Please note the following address change: A new house and detached 2nd unit is being built on parcel 375-08-057. The address for the new house will be 19099 Tilson Ave and the detached 2nd unit will remain 10418 S Tantau Ave. See attached map. The new address will take effect in 30 days. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk