15030050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10203 S PORTAL AVE CONTRACTOR:BAY AREA CUSTOM PERMIT NO: 15030050
BUILDERS INC
OWNER'S NAME: KAUSHIK SANDEEP AND SHARMA DEEKSHA 1002 S DE ANZA'BLVD STE Al DATE ISSUED:04/17/2015
OWNER'S PHONE: 4083387938 SAN JOSE,CA 95129 PHONE NO:(408)446-1200
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
ADD 492 S.F.TO SIDE&REAR TO CREATE(N)BEDROOM
License Class_ Lie.4 9 204 �1 �1 &(N)BATH,REMODEL(E)981 S.F.,REMODEL 100 S.F.
T
\3 ;\,%��5 r &REMODEL 120 S.F.KITCHEN.
Contractor�3��_AI/�oE C���tn,� bate
1 hereby affirm that I am licensed under the provisions of Chapter 9 5/18/15-REV#1-REVISE/CORRECT LAYOUT OF THE ADDITION AT
(commencing with Section 7000)of Division 3 of the Business&Professions RIGHT SIDE TO MEET(ACTUAL)SETBACK REQUIREMENTS. ISSUED
Code and that my license is in full force and effect. 5/28/15.
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. Sq.Ft Floor Area: Valuation:$140000
z• 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:36909001.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
Zcertify 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
granting of this permit. Additionally,the applicant understands and will comply Issued by;_� lRj�!T Date:
with all non-point source regulations er the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date G� 7 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)
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
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 25595 ZSD- and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: +��r Date: 2
G
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,l 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
918.
Signature Date
i
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building CcDcu gertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDmON ❑ ALTERATION/TI Ej4 REVISION/DEFERRED ORIGINAL PERMIT 4
PROIECf ADDRESS ; '' tI1 J��A� �a� APN# 2�%G�—a —�
OWNERNAME �Hj�f` ��1� f PVHONE /J Cyt' OE-MAIL �G _� CI ��
STREET ADDRESS
,AME-h fi l 1. kS A MV'f- • CITY u,�+f1 T) NO FAX
CONTACT NAME r��{``�+/`i"�l�Li /l L l� vA EJ IA` PHONE f��-(J.. 1 V '_f [ Xj E-MAIL 7�P11—V I` C rl/11
STREET ADDRESS ] y+�O l V�p p!M U�� _ CITY,STATE,ZIP �/►Y - /j FAX
❑ OWNER ❑ (OWNE(RfBUILDI ERVvU 3 OIAWERAGENTIII�i�lll ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRJI Y ri n� f&I/� h L9LICENSE NUMBER TLICENSETYPE BUS.LIC#
COMP(ANY NAME (�'\ E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE 1 C)(b „• ��)-/ -
ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC`# (J ^/ V
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
CFt� '� �S e-IL Y. i� ho i� S bUt Cay i la' s L&V ck
eyeh'u t f }'fie. C SA Y �k, Iv ,
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(5)
EMIT—G NEW FLOOR DEMO TOTAL
NET AREA
AREA AREA AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? [3 NO ADDITION? ❑NO
PRE-APPLICATION
❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES 6y D * " -_g "G`r � �; TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO I."i''sT'�".,""' r 5 s.
,,.;r..v ,a-�•...4 '`.ad'a�"grin°N.S��`S'1�:+
By my signature below,I certify to each of the followin I am the property owner or authorized agent to act o property owner's behalf. I have read this
application and the information I have Prov' d is corre I have read the Description of Work and veri ' I accurate. I agree to comply with all applicable local
ordinances and state laws relating to b onst cti I aut orize representatives
nof,Cupertino to nter the above-dent fieA property. inspection purposes.
Signature of Applicant/Agent:
� U ' Date
SUPPLEMENT FORMATION REQUIRED kr k Yea h
� t PZA�T CHEEK T,YEE� � �5KNO 3 ROUTIIyG SLIP
o or Multifamily lel ' Apirdemolitrmit for S��`'� �"k�❑F $p''S�`��=K„c�`'"t,�.'5�
�u'r� a
existing bulding() Demolition Permitisreluredprior
Oissuanofbuilding `- F
permit for new building
LANIvIIVCrPLAN v t <`
x 4 , P L'IGWORXS
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure DC7� x m xn 9 � e� � � u m,0R
L`�
form if any Hazardous Materials are being used as part of this project. a, k� �� w :
9 iT� aJv�7�hpr, ;s
_Copy of Planning Approval Letter or Meetingwith Planning prior to k �" m�f
P a5 � x I]�sAT� ]f sEwERIsxIC-I
submittal of Building Permit application. �u� ' oog yaF rtrs `.
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10203 S PORTAL AVE DATE: 05/18/2015 REVIEWED BY: MELISSA
APN: 369 09 001 BP#: 15030050 *VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK 5/18/15- REV# 1 -REVISE/CORRECT LAYOUT ADDITION TO RIGHT SIDE TO MEET ACTUAL
SCOPE SETBACK REQUIREMENTS
e
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... ;t.i-.,.•.: .J...::.. ..-..•.� s Yv�...tai}4.k'!_Y.t,s..T. ,.t_.r'`k F,tr�.y.+v.iA 5fi r�„��Y .,y„Y w+�v'.�.:� ...., ��-.��4.. .:Li�S:...1.k�k'�h.0 S� 3SR��..aEt.Y��i T9ygyYwtl ,.'.nr�e1� Fn��!t�.C����._T,..�..���}
lh•ch- t'larr Check i'lurrh. Nah,Cht,(:k Linc. Plat Choc!(
Ltca:ir. Pr>rntit f%'c>: !'Iamb. !'crmA Fee: F.'Iec. Prr yir Fete.
l:�;i;er.t/raiz Incl'' OcLe; Pr'r+mh h7'F'0. Urher l le:c:. hasp.
1•!c'<.h. lrr,li.Fec:: Nhuuh. Intl). Fce: Lskac.!nap. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn 7 info.
FEE ITEMS(Fee Resolution 11-053 G ..' 7.11/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 2 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $286.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Feee. Reg. 0 OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.-
Administrative Fcc: 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Plannin Fee: $0.00 Select a Non-Residential Q
Travel Doc tanewevion IWS: Building or Structure 0
A
Strong Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.001 $143.00 ISTINSP Inspection,Hourly
0.00
$ $429.00 $429.00
Revised: 05/07/2015