The URL can be used to link to this page

15080165I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20387 GILLICK WAY CONTRACTOR: PERFECT HOMES PERMIT NO: 15080165 CONSTRUCTION CORP OWNER'S NAME: AM13ATKAR PARIKSHIT AND GADEPALLI PA 382 LASSENPARK CIR DATE ISSUED: 08/26/2015 OWNER'S PHONE: 4086700580 SAN JOSE, CA 95136 PHONE NO: (408) 600-8033 fp J? LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] License Clas,— s Lic. # b Lj �% CONSTRUCT (N) COVERED PORCH (174 S.F.) Contractor �� ?JAM Date �% —1� 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: $20000 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: 36936018.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAS D 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 -� Date: with all non -point source regulations per the Cupertino Municipal Code, Section�- 9.18. RE -ROOFS: Signature, Date A Q� `Lj 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 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 5505,2 1 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this f V Date: drip permit is issued. Owner or authorized agent: , 1 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 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 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCa�cupertino.org ❑ NEW CONSTRUCTION F-1 AT)T)TTI(')W F-1 A T -rim A TTn T 111 1 I n BldgApp_2011.doe revised 06/21/11 WMR e W ,c,` 0 rtr Vialkily ( 1Jrrr.KJ1IhL) UFJUINAL PERMIT #� PROJECT ADDRESS 1APN'3�eq - 3Com- e � OWNER NAME PHONE OS E-MAIL 14L_Lf'yV1 � C nnraLG t STREET ADDRESS -3 9'1- CITY STATE, ZIP /' FAX CONTACT NAME HOS E-MAIL (( C. (CL. r STRE DRESS CITY, STATE, ZIP FAX IJP �S f ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ff_;�CHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 3 LICENSE NUMBER LICENS> YPE BUS. LIC # 6_/ J COMPANY NAM n� E-MAIL FAX STREET ADDRESS p CITY, STATE, ZIP �7 PHONE p� ARCHITE /EENQNEER NAME LICENSE NUMBER BUS. LIC # COMPA AME g_ P1L FAX STREBTI�oDRESS t , 8oy �. C TY, STATE, ZIP � —'o— DESCRIPTION OF WORK L EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA7 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH /�rj—' �f ❑ ATTACH #DWELLINGUNITS: IS ASECOND UNIT DYES SECONDSTORY OYES— BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OFIS PLANNIDIGAPPL# 0 N PLANNING APPROVAL LETTER THE BLDG AN ❑ YES EICHLERHOME? ONO y,.j TOTAL VALUATION: t� 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 relating to buil 'ng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ""l7_57— SUPPLEMENTAL INFORMATI QUIRED PLAN°GHECICTYPFr _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition OYER THE COUNTER r f+ Q $iTHDINGP� ANREViEW `r ` permit is required prior to issuance of building permit for new building. ❑ `ExPREssY [] PLANREVIEW 2�y ANlvnvG _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAIVDATiDC71 ` form if any Hazardous Materials are being used as part of this project. x' PUBLTCwoRxs ❑f `URGE ti 5 7 xr * '� / f { s ❑ ,FZRE pEP�' ' � i Copy of Planning Approval Letter or Meeting with Planning to _ prior submittal of Building Permit application. -IVIAaoRa SANITARYSEwER�I$TRrCT 4 BldgApp_2011.doe revised 06/21/11 WMR e W ,c,` 0 CITY OF CUPERTINO IqDwI65- r FEE ESTIMATOR — BUILDING DIVISION lalADDRESS: 20387 Gillick Way DATE: 08/24/2015 REVIEWED BY: PAUL ,1-/cch. Permit Fee: APN: 369 36 013 BP#: *VALUATION: 1$20,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 11 or Duplex USE: Plumb. Insp. F ce: PENTAMATION 1GENRES PERMIT TYPE: � WORK Construct N Covered Porch 174 S.f. SCOPE NOTE: This estimate does not include fees due to other Departments (f. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 Ejf. ZI 13FEE 11ec1r..Plun Cheek 1'hurrb. flan t:l:eck Flee. Plan Check ,1-/cch. Permit Fee: Plumb. /'unit Fee: Elec. Permit Fee: 011:er _1lecit. hast?• Other Plumb Insp.Li Other Flec. Insp. Week hrsp. Fee: Plumb. Insp. F ce: Elea Insp. Fire: NOTE: This estimate does not include fees due to other Departments (f. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 Ejf. ZI 13FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $1,003.00 Covered Porch ICOVPORCH Suppl. PC Fee: Q Reg. O OT0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: _4(ZTninislrative Fee: 0 (D Work Without Permit? O Yes (D No $0.00 Advanced Planning Fee. $0.00 a Select a Non -Residential Building or Structure 0 0 A arrcvc l l�ocrrmc'ralutz(�rr I'ee s: Strong Motion Fee: 1BSEISMICR — $2.60 - Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 -SITBTOTALS. $3.601$1,003.00 - - TOTAL EEE $1,006.60 Revised: 07/02/2015