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15020115 (2) CITY OF CUPERTINO BUILDING PERMIT BUll.l)iNG ADllRESS 10396 FAR,ALLONE DR CONTRACTOR:PAIS CONSTRUCTION INC PERMITNO: 150201 15 DA- OWNER'S N:\�'IE. [LANGO GANGA&VLiI ILANGO"1'RUS'TEGS 2111G0 YlO\iF.S"I•IS:\D RU STP;216 DA"fE IS 15/2015 06/151?_016 O\VNER'S PRONE: 4082666709 CUPERTiNO,C'k 95014 PtIONE NO• j LICENSED CONTRACTOR'S )ECLARATION BUILDING PERMIT INFO BLDG ELECT j PLUMB LicensecimsLoc- -L1�' ---t --- MECII RESIDENTIAL COMMERCIAL, Contractor---_ � { Dates Q _A� '%''�'- JOB DESCRIPTION CONSTRUCT ONE STORY ADDITION(591 SQ 17T)WI'1 iI hereby affirm that I am licensed under the provisions of Chapter 9 COVERED PORCH(66 SQ FT);INTERIOR REMODEL(760 SQ (commencing with Section 7000)of Division 3 of the Business&Professions FT);ELECTRICAL PANEL UPGRADE(200 AMP);REROOF Code and that my license is in full force and effect. I herchy affirm under penalty of perjury one of the following two(1eclarations: 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 perti rmance 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 Sq.Ft Floor Area: Valuation:$260000 permit is issued. APPLICAN"f CER"1'IFiCATION APN Number-36931020 00 Occupancy"Type: I certify that I have read this application and state that the above information is correct. l 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 PERMIT EXPIRES IF WORD IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs.and expenses which may accrue against said City in consequence of the .ranting of this permit. Additionally,the applicant understands and will comply 180 DAY-,§ FROM LAST CALLED INSPECTION. with all non-point s urce eg dations per the Cupertino Municipal Code,Section !!�� // �+ 918 / ��'`I M Da Q 6—`��1S Issued by: „/I.G Da ) ! Si�rtannc _Date_ - ❑ �\'NER-f3U1LD[?R DI?C.LAi2A"PION' RP;ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. 11'a roof is the following two reasons: installed without first obtaining on inspection,i agree to remove all new matcnals foe I.as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&professions Code) Signature Dale. ofApplic:ml,_--_.-. _._-...--_ _ --___-.-- 1,as owner of the properly,am exclusively contracting with licensed contractors to -------- - consuuct the project(Sec.7044,Business&Professions Code). ALI,ROOF COVERINGS'f0 13E CLASS"A"OR RETfER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS NIATERIALS DiSCLOSURI I have anti 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 1 Californiahaveread the hazardous materials requirements under Chapter 4.95 of the pertormance of the work for which this permit is issued. alifoIlcalth&Safety Code,Sections 25505,25533,and 25534. 1 will nr•.tinutm 1 have and will maintain Worker's Compensation insurance,as provided for by compliance with tion Cupertino Municipal Code,Chapter 9.12 and the tial. & Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section I use eq should I store ce handle hazardous material. Additionally,should I use equipment or devices which emit hazardous all- permit irpermit is issued. contaminants as defined by the Bay Area Air Quality\4anagement District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9 12:in(] the not employ any person in any manner so as to become subject to the Worker's Ilcalth&Safely Code,Sections 25505,25533,and 25534 Compensation taws ofCalilitrnia. If,after making this certificate ol'exenlption,1 1 become subject to the Worker's Compensation provisions of the labor Code,I must Owner or, nth iz d fnrthwith comply with such provisions or this permit shall be deemed revoked. - Dstte:_'_�_v" i CONSTRUCTION LENDING AGENCY APPL[('ANT 01;12"TiFICATION i certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the perforntancc ul wvvl:'s rm correct.I agree to comply with all city and county ordinances and state latus relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name__-_-_,-_ upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against habilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the ;ranting of this permit.Additionally,the applicant understands and will comply ARCI[I'I'PCI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code.Section 918 1 understond my plans Shall be used is public records. Sr.nature _ Date._ Licensed Prol•essional _-__ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255f G�X26)) 5 Eg> (408)777-3228 • FAX(408)777-3333 • buildina(.cuoertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/yTI-,,,❑ REVISION I DEFERRED ORIGINAL PERMIT PROJECT ADDRESS J�� ,�°�' ./__,. j d � �,,1 Y APN I OWNERNAMEPHONE , C� ! f�p /l -„ AlI E-MAIL f csi C� /f IdRO �eY A STREET ADDRESS r d2 � .�Q$�- p CITY. S/T�ATE,Z1P IV 0 C 1 r I FAX L CONTACT NAME 13�_ E-MAIL ,30 5' a STREET ADDRESS CITY,STATE, ZIP FAX 1 13 OWNER ❑ OWNER-BUILDER ❑ O\1TTER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ ENF.N i CONTRACTOR NAME ( LICENSE NUMBER LICENSE TYPE I BUS.LIC COMPANY NAME E-M.AFI, I FAX —7 STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER N.AJ IE 411 .11SENUMBER BUS.LIC 9 COMPANY NAME E-M.AIL FAX STRFETADDRESS I CITY,STATE,ZIP PHONE DESCRIPTION OFWORK �"lr.�1�-'� t� ' �°'•., r� ��r"r�--•�' � r��!'J!T/1��/��L-°�`�� r'��lob��,��-'�_' �� ?�/Z„/lsYi`,c /1 EXISTING USE PROPOSED USE i CONS --1-[YPE k STORIES OPS C r� ORI USE TYPE OCC. SQ.FT. VALUATION(S) EXISTGp ,r� ,e NEW FLOOR DEMO TOTAL y r AREA / !- E1 AREA AREA NET AREA BATHROOM •/' TCHEN OTHER REMODEL AREA REMODEL AREA „f�ff}"� REMODEL AREA PORCH AREA DECK AREA TOTAL DECR/YORCH AREA GARAGE AREA: DETACH r ❑ATTACH D\4Et/LL/wING UATrr ISA SECOND UNIT ❑YES SECOND S'T'ORY ❑YES � 1 BEING ADDED? �C31"�'O ADDITION? PRE-APPLICATION ❑ FS IF YES PROVIDE COPY OF IS THE BLDG AN ❑YES E1VED�3Z^' -+ -- f < s ,"TOTAL VALUATION: TLANN'�TNG APPL .0 PL.A.NNTNG.APPROVAL L]TI'ER EICIILER HOME? yy{!{NO By In),signature below,I certify to each or the following: I am the property owner or authorized'agantto act orlS, ery owner's b half. I have read this application and the information I have pjny'ided is correct. I have`et d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to uilflh _consI I* t I aut*ize representatives of Cupertino to enter the above-id�tified property for inspection purposes. `� � • S i mature of Applicant/ >�ttf � �i Of d' /�a=-—` Date SLJPILEMLTAL/TNFORI¢`ATIO? QLJIRED .PL ctl CKT��E i iipvriNc sLH r nl New SFD or Apply for demolition permit forz. r a OVER-THEECOUNTER �t -Btr1 vr,�G PI AI\RE\'IE1� existin building(s). Demolition permit is required prior to issuance of buiIdirifi permit for new building. "❑g+EXPRESS$ ` ir,Ctiry ,� P '`mG PLAI\r.F\'IE I r VyI Q _Commercial Bldgs: Provide a completed Hazardous Materials DisclosureS�Israt DARD s rU tC\� 7tics form if any Hazardous Materials are being used as part of this project. f s �l� zstGE rrRD EPT 4 _Copy of Planning Approval Letter or Meeting\With Planning prior to I ` ❑ tAJOR vs - '`�� SAI\ITARY SIiA ER DISTRICT submittal of Building Permit application. 2a rs } a •3:.s��LhLaIROTA4ETALi-IDAlTA.. - BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10395 Farallone Dr DATE: 03/18/2015 REVIEWED BY: Sean APN: BP#: 15020115VALUATION: $250,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? 0 Yes ' No PENTAMATION 1 R3SFDADD USE: SFD or Duplex OTC? Q Yes )No PERMIT TYPE: d WORK I Construct one story addition 591 sq ft with covered porch 66 sq ft); Interior remodel 760 sq ft SCOPE Electrical panel upgrade (200 amp); Reroof(1800 sq ft). OCCUPANCY TYPE: TYPE OF FIR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) 11-B,111-B,IV,V-B 657 $2,654.00 IR3PLNCK $1,666.00 IR3INSP TOTALS: 657 $2,654 00 j;ris. `��a ��'` $1,666 00 �ilM!EGIIi;FLOU+RLQ,y J O"Yes Q NoRL,ITMB,HOURLY Q`Ycsf No �iIjEL'E'C; I3'' URL'i�' " 'Qi Y,es° Q No tt Elec.Plan Check 0.0 hrs $0.00 ,Aj,,.r, P,, .:,,;r- Pi: