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15100213CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11139 SUTHERLAND AVE I CONSERTRACTOR: AAA CONSTRUCTION I PERMIT NO: 15100213 I OWNER'S NAME: UPPULURI VENKATA N AND ROHINI K OWNER'S PHONE: 4087188412 ❑ LICENSED CONTRACTOR'S DECLARATION L.,ense Class S Li,. # "(p '1 tot Contractor `�S�Ir„ra �grR Date G I hereby affirm that I am licensed under the provisions of Chapte 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: t. I have and will maintain a certificate of consent to self -insure for Worker's �erfbrmance ompensation, as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued. IN have and will maintain Worker's Compensation Insurance, as provided for by kki Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Datez (D ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 2. 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 whi4h this s ` permit is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date. PO BOX 110971 1 DATE ISSUED: 10/26/2015 CAMPBELL, CA 95011 1 PHONE NO: (408) 510-9382 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CREATE UTILITY ROOM IN GARAGE (100 SQ FT) AND RELOCATE EXISTING WATER HEATER AND FURNACE TO NEW UTILITY ROOM; ADD ADDITIONAL 2X6 CEILING JOISTS SANITARY Sq. Ft Floor Area: I Valuation: $12500 APN Number: 35617064.00 1 Occupancy Ty pc: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner Dater � CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professio CONSTRUCTION PERMIT APPLICATION COMNUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 85014-3255 j CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building()cupertino.org / QO� f !! v( ` ❑ NEW CONSTRUCTION LJ ADDITION ❑ ALTEP-kTION / TI ❑ REVISION / DEFERRED ORIGTN .L PERMIT PROTECT ADDRESS Lj ke- I APN # �2 p-) /rte OWNER NA �` . G 1-ka I P 'E f1 10 STREET A.DD S 1� n I Y NATE IP I FAX CON TACT NA}QE PH E-MAIL STREET ADDRESS CITY, STATE, ZIP I FAX 0 OR7EER 11 OWNER -BUILDER ❑ OVRdER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGDQEER ❑ DEVELOPER ❑ TF -NAI OR N �� v .. ) a -' itE SE TYPE (SUS. LIC # C:OMff ANY NAME ) � � Cg� E MA]L � ` ��. C I •J FAX r ZIP ( I HO 0 ARCHITECT /ENGINEER NAME I LICENSE NFLIPSER BUS. LIC # COMPANY NAA E E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF eAi�.Q Sktse sF"mce EXISTING USE PROPOSED USE CONS -111- TYPE I STORIES I USE I TYPE I OCC. I SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH I ❑ ATTACH n DWELLING UNrrS: ISA SECOND UNrr ❑ YES SECOND STORY ❑YES BEING ADDED? E] NO ADDITION? ❑NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING ADPL R ❑ NO PLANI.TDN'G APPROVAL LETTER. IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO CSI\: B��" "' _ TOTAL VALUA O By my signature below, I certify to each of the following: I am the property o»mer or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided i acct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lays relating to b ' cion. I authorize representatives of Cupertino to enter the above -I ntified property for inspection purposes. S i smature of Appl icant/Agent: Data: �� SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily d-wellings: Apply for demolition permit for existing building s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BIdgApp_2011.doc revised 06/11111 FM-7 CITY OF CUPERTINO 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 based on the relimina information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef 7iU13) ADDRESS. 11139 Sutherland Ave DATE: 10/26/2015 REVIEWED BY: Sean Mech. Permit Fee: 1MPERMIT APN: BP#: 'VALUATION: 1$12,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 0.0 PENTAMATION PERMIT TYPE: 1 R3SFDRE A WORK Create utility room in garage 100 sq ft and relocate existing water heater and furnace to new utility SCOPE room; add additional 2x6 ceiling joists and install gyp board on ceiling in garage and install attic accesse 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 based on the relimina information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef 7iU13) Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: 1EPERMIT Other Mech. Insp. 0.0 hrs $48.00 $48.00 Other Plumb Insp. LL Other Elec. Insp.hrs $48.00 Elhrs Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs 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 based on the relimina information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef 7iU13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. ✓$431.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00200 amps $48.00 Electrical 1 BELEC200 Services Permit Fee: Hourly Only? ® Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. ()OT 0.0 1 hrs $0.00 0 # Plumbing ✓$29.00 1PRWHEATR Water Heater PME Unit Fee: $0.00 PME Permit Fee: $144.00 # ✓$143.00 Mechanical IMFR=<100 Furnace, Forced -Air 0;1 rcr.r:F7 1 Administrative Fee: IADMIN +$45.00 24 s.f. -/$645.00 Remodel, Bath (<=300 sf) 1 IREMRESBAT E) Work Without Permit? Yes O No $0.00 Advanced Planning Fee: $0.00 0 hours ✓$143.00 Inspections ISTINSP Inspection, Hourly E) 0 Travel Documentation Fee: 1TRA moC ✓$48.00 Strong Motion Fee: IBSEISMICR ✓ $1.63 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $239.63 $1,439.00 TOTAL FEE: $1,678.63 Revised: 10/01/2015 ri 1!6?� & e).c iz� COMMUNITY DEVELOPMENT Ur,, i I 13UILDING DIVISION - CUPE I'lTI NK APPROVED This sit of plans andispecificptions -% UST be " I t the job sit'p during cons uction.,'It is un;,a.%fi,,1!to 4*J any OFFICE C oPY K A RE�EIV ED Chan es or alter tions on sanie, Qrfl-.to-dev!ate therefionn, wit lout a proval!from the Buil'ping Official. The Stamping of this dan andspeciflcat!ons�l SHALL NOT be hel J to permit oro be ark approval of the violation A of any provisionsof r Cit dinance d State Law. BY (0) 1- DAT.EI-1 PE M[T--# v5i OFFICE C oPY K A RE�EIV ED �q) F��-ozrom 5 0