15060093 (2)�I
r-1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10320 LOCKWOOD DR
CONTRACTOR: SGK HOME SOLUTIONS,
PERMIT NO: 15060093
INC.
OWNER'S NAME: RAJESH SHENOY
3801 CHARTER PARK CT STE B
DATE ISSUED: 06/12/2015
OWNER'S PHONE: 4082898448
SAN JOSE, CA 95136
PHONE NO: (408) 264-6964
w LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REMODEL (E) UPSTAIRS HALL BATH, NO STRUCTURAL
# %f�
License Class//`
CHANGES (50 S.F.)
// Wig? -4—L5 -Lie.
Contractor,5q/—, Date C
—�- w
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: $15000
Performance of the work for which this permit is issued.
VI 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: 34215053 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
WITHII�LIBfY�� YS PFo E 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
ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, jud
=y:
costs, and expenses which may accrue against said City in cons equendFnMe
'
Date:
granting of this per . dditionally, the applicant understands and will comply
with all n n p nt so a regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature err. 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.
❑
L��NR-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 defin4by the Bay r A`quality Management District I
performance of the work for which this permit is issued.
will maintain compliance w t the Cupertino Muift�i ipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect s 25505, 25 3;"Ind2553" .
`�
Section 3700 of the Labor Code, for the performance of the work for which this
"✓ �/
Owner
permit is issued.
or authorizeent: Date:
ag`
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
O]Y_ G 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
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
0
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228• FAX (408) 777-3333 • building a(D.cuoertino.org 1.06 Oq
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n
PROJECT ADDRESS APNR
w }
1�f�
OWNER NAME iAPT� -MAIL
��r�J7J !� J �% � A PHOI�'E
!�
STREET ADDRESS / %%�1
/ �• h } CITY, STATE, ZIP FAX
CONTACT NAME�r� PHONE 2/_30 E-MAIL
�G •i / v (� [�
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-B=FR ❑ O'ANERAGENT 4YCONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME ClP�/A LICENSENUMBE 2®�`f� LICENS
O
BUS. LIC �o 7
COMPANY NAME�+6id ��C i f OLbI� E-MAIL
FAX
STREET ADDRESS ITY, STATE, Z1P f
PHONE Gi IL /
`d l-
(®/ 1®v
ARCHITECT/ENGL*IEFR NAME LICENSE NUNMER
BUS. LIC
COMPANY NA1,M
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
)� rA71tA
EXISTING USE
PROPOSED USE CONSTR TYPE
n STORIES
-
USE TYPE OCC. SQ.FT.
VALUATION (S)
F ISTG
NEW FLOOR,
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM.
KITCHEN..
OTHER.
REMODEL AREA_5
REMODEL AREA
REMODEL AREA
PORCH AREA
. DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
.
❑ ATTACH
.
n DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEINGADDED? C] NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑
- �' _ - - _
ABCEIVE - TOTAL VALUATION:
PLA*Ih4NG ADPL R []NO' PLANNING APPROVAL LETTER
EICHLER HO1.iE? O
By my signature below, I certify to each of the following: I am the property owner or auth ' agent to act oe prope -0Hmer's behalf. I have read this
application and the information I have s provided is correct. I have read the Description ork and verify i cu . acI agree to comply with all applicable local
ordinances and state laws relating to ding construe Io orize representatives of Cupertino to enter ove-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTA TFOR1,1j, QUIRED
TLA
o ,-F
E 4
-- :_ ,
V$ otlrII.csL� _` _
New SFD or Multifamily Apply for de olition permit for
O�-ER�H1rC(jUhTER
fl�BTvmGPLREYIEF;''
existing building(s). Demoliti ermit is re ui = riot to issuance of butldmg
4
K
x�~
oP
permit for new building.
a� ExPREss'
NI�LhGPL4N;,Py. W +
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
L srAt�4TtD ` $0
PugLwoRxs
form if any Hazardous Materials are being used as part of this project.'
7 ` r
LAIt�1
_ Copy of Planning Approval Letter or Meeting with Planning prior to
nzoR �, _r�'�IrYtsERR�s�Iuc
submittal of Building Permit applications
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
WE FEE ESTIMATOR - BUILDING DIVISION
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 haled on the nreliminary infarmatinn avai/ahlo and are anhy an octimato_ rnntart tho 1)ont fnr add" 11 infn
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
10320 LOCKWOOD DR
DATE: 06/12/2015
REVIEWED BY: MELISSA
JimADDRESS:
APN: 34215 053
BP#:
*VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (j) Reg. 0 OT0.0
PENTAMATION 1R3SFDREM
I PERMIT TYPE:
WORK
REMODEL E UPSTAIRS HALL BATH NO STRUCTURAL CHANGES 50 S.F.
SCOPE
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 haled on the nreliminary infarmatinn avai/ahlo and are anhy an octimato_ rnntart tho 1)ont fnr add" 11 infn
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
50 s.f.
$645.00
Remodel, Bath (<=300 sf)
/REMRESBAT
Suppl. PC Fee: (j) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.(E) Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative .Fee:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
�
i
7rcwel Doc umentalion Fees:
Strong Motion Fee: 1BSEISMICR
$1.95
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALSI.
$2.95
$645.00
TOTAL FEE:
$647.95
Revised: 05/07/2015
0
0
a ®�a3, __
Mir
q
i vii 7V # iMW 13d
Eive
'Mei alelS Jo aou - ,•
uolleloln ayl )o lenoJ , , of play aq
ION 1WHS SUOIIeayloads pue veld siyl jo 5uidwelS ay1
leioi 0 6uippq ayl wOJl lenojdde lnoyllM 'woajajagl
alelnap of jo `Owes uo suoilejalle jo sa6uey3
Aue Ww of lnpmelun si li-uollonllsuoo buunp ails qo(
ayl le lda� aq Ism suolmipoads pue sueld to las sly'
ONllb�3d(no - NOISInlO Oma -line
1NDINIl JdddCl 1N3UVdM3ADJO UNnWWOJ
MQ��1M
Is
I 7d.1-VQ�
cg s)o2
I `sem bnuW1.1-0
-,?9dod0VS
1-7 V 91 H- � r -V
��CO14V,51AAS�r 1L -Z -1A11\1