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15060093 (3) 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 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] REMODEL(E)UPSTAIRS HALL BATH,NO STRUCTURAL License Class //` // Wig?-4—L5-Lie.# % f� CHANGES(50 S.F.) 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 ,Performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$15000 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 APN Number:34215053 00 Occupancy Type: permit is issued. 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 WITHI�L��O D��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 costs,and expenses which may accrue against said City in cons equendFnMe granting of this per ' . dditionally,the applicant understands and will comply =y: Date: 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 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) 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 or authorizeent: Date: permit is issued. 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building a(D.cuoertino.org 1��060Dq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS 3 C � OWNERNAME MAILHI— � O r } STREET ADDRESS /VCF CITY, STATE,ZIP FAX CONTACT NAME PHOI\'E 2/_30 E-MAIL STREET ADDRESS �G•i /v (� /•` [� CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-B=ER ❑ O'ANERAGENT -1ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME CYC l � �� P�/A LICE1dSENUMBE ®y`f� LICENS� BUS.LIC SJ�7 COMPANYNAME�+6 ��COLbI� E-MAIL O FAX STREET ADDRESS ® ` ITY,STATE,ZIP f PHONE ARCHITECT/ENGLNEFR NAME LICENSE NUNMER `d l_ BUS.LIC COMPANY NAI�M E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ` `-�' EXISTING USE PROPOSED USE CON'S TR TYPE n STORIES USE TYPE OCC. SQ.FT. VALUATION(S) • EXISTG 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 DWELLD4GUNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? C]NO ADDITION? ❑NO PRE-APPLICATION [I ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN AI CEIVE - TOTAL VALUATION: PLANNING APPL R []NO' PLANNING APPROVAL LETTER EICIILER HO1.iE? O a.z- _ /v) 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 entertheove-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTA TFORM4TION QUIRED {. �� E�-F , E4 V$ otlrII.csL� _ New SFD or Multifamily �v'ellings: Apply for de olition permit for �BTvmGPLREK O�ER�H1rC(jUhTER existing building(s). Demoliti ermit is re ui = rior to issuance of butldmgUPx �~ P 4 E. permit for new building. a� s xPREss ' � NI�LhGPL4NREViEW + _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L srAt�4TtD `$ 0P %MaugLwoRxs form if any Hazardous Materials are being used as part of this project.' � LAIt�1 7 ` r _Copy of Planning Approval Letter or Meeting with Planning prior to 5 f 4 `"� submittal of Building Permit applications nz oR �, _ �Ir YtsER R51srIuc BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10320 LOCKWOOD DR DATE: 06/12/2015 REVIEWED BY: MELISSA APN: 34215 053 BP#: *VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: I PERMIT TYPE: WORK REMODEL E UPSTAIRS HALL BATH NO STRUCTURAL CHANGES 50 S.F. SCOPE Uech. Plan<dK:ek Plumb. Plan Check Elec.—Plan Check F1111F111111 P IWI Fee: Phamb.Permit Fee: Elee.Permit 11 / other Alech. Ins). Other Plumb Imp. LJ Other Elec.Insp. Li Mech,Irish./fee: Phanab. Insp. Fee: Elec.Insp.hire: NOTE:This estimate does not include fees due to other Departments(i.e.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 De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 50 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (j) Reg. OT 0.0 hrs $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.(E) Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation fees: Building or Structure i Strong Motion Fee: 1BSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS'.` $2.95 $645.00 TOTAL FEE: $647.95 Revised: 05/07/2015 Q i b�7d p Pamai�s �� 90 # iMW 13d Qoa Eida � 'Mel alelS Jo aou ada Allyuo11eloln aye jo lend D 6 of play eq !Ppoa h- ION 1WHS suogeoyloads pue veld siyl jo 5uidwelS ayI leiaip 6uiplln9 aya wOJI Ienoidde anoyalM 'woajajaya alelnap oa jo `Owes uo suoiaeja;Ie jo sa6uey3 Aue Ww oa Inpmelun si 11 •uol;onljsuoo buunp awls qo( ayj le jda� aq ism suolaeol�loads pue sueld;o has slyl Cl _' ONllb�3d(np - NOISInlO ema-line 1NDINI�jdd3Cl 1N3UVdM3ADJO J.11N moo 1 .4 .40 /ndd-d LQ� MQ ry l nn >, --6rJ -ng 19 Iv -2-9 do MS,-)7/ , 9dOVS r 1-7V91 H- �r-V X61N w �ti�o,a ��CO14V,51AAS�r JOS p eg ed��. 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