15110184CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10494 MA-r->koN L! CONTRACTOR: LOS ALTOS BUILDERS PERMIT NO: 15110184
OWNER'S NAME: NEHA VIBHALKAR 131 E EL CAMINO REAL DATE ISSUED: 11/25/2015
OWNER'S PHONE: 6503909615 MOUNTAIN VIEW, CA 94040 PHONE NO: (650) 390-9615
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
,, /
KITCHEN REMODEL (220 SQ FT).
`icense Class � � � L-fc. #� � k�
ntractor J
L'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.
1 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: $55500
�I have and will maintain Worker's Compensation Insurance, as provided for by
r Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 34260021.00 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 WORD 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: '_ /--ter v �} G/ Date: L
with all non-pour i.sas rce regulations per the Cupertino Municipal Code, Section
9.18.
/ �� ~ t� RE-ROOFS:
V (Signature �� Date All roofs shall be inspected prior to any roofing material being installed. If a roof is
a' installed without first obtaining an inspection, I agree to remove all new materials for
J inspection.
BIER<1BUILDER 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
1, 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. 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 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, Sec ' s 25505, 2553 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
is issued. 4! '1k)wner or authorized agent-
permit_,- Date:_
1,
1 certify that in the performance of the work for which this permit is issued, I shall',r
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
1. certify that 1 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, ARCHITEC_'T'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
(408) 777-3228 • FAX (408) 777-3333 • building(Wcupertino.org
I :I
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATI / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 7APN# Fe-10.biqft^ 6 O
OWNERNAME e J Q .' �(��/ E ,(1V6 �rLa ho�rn�+L
STREET ADDRESS ^^ 1 CITY, ST E, ZIP FAX
CONTACT NAME V C �, !� P}I N"E y � ' L?O-O E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �' LICENSE NUMBEF f /.3J063_FJj
SE TYPE BUS. LIC #
COMPANY NAME 4 as 1i+I VI �� F MAIL A /i't'���I'� 4 `•/„ �n FAX
STREET ADDRESS /cJ / L.. `V �, , - `�!/ [ 0 CITY, STATE IP �- PH N
ARCHITECT/ENGINEER NA ' LICENSE NUMBER BUS. LIC #
G
COMPANY NAME E-MAIL FAX
STREET ADDRESS2/ CA11414 CITY, STATE, ZIW� Q �a � I, PHONE] n, I � J
DESCRIPTION OFWORK � U V,
IF
EXISTING USE PROPOSED USE CONSTR TYPE # STORIES
USE TYPE OCC. SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER ,
REMODEL AREA REMODEL AREA r> REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES
BEING ADDED? []NO ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REQEI D BY OTAL VALUATIQoN:� J
PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO
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 pro vi 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 bp construction. I authob'Z& represe ves of Cupertino to enter the above-identi ed prope �)inspection purposes.
Signature of Applicant/Agent: Date: 'r //hpS"
SUPPLEMENTA IRED PI Ary cHEGK LYPE ; .. s ztoUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
OVER THE COUNTPRt,19MDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ 't XPREss PLANNING PLAN tjM '
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 'STANDARD ❑ WpiJBLlewoRKS
form if any Hazardous Materials are being used as part of this project.
❑ 'LARGE ❑.'FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ :MAJOR ` ❑ SANITARY SEWER DISTRICT
submittal of Building Pen -nit application.
=ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
q
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1. These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef . 7,7113)
ADDRESS: 10494 Madrona Ct
DATE: 11/25/2015
REVIEWED BY: Sean
A.PN:
BP#:
*VALUATION: 1$55,500
„PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY. SFD or Duplex
USE:
Suppl. PC Fee: (j) Reg. 0 OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE: A
WORK
Kitchen Remodel 220 sq ft).
SCOPE
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NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1. These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef . 7,7113)
FEE
QTY/FEE
MISC ITEMS
C'1w u
$0.00
= s. f.
$645.00
Al'zgj),-b. A,"rv1
Cfii'C'
Suppl. PC Fee: (j) Reg. 0 OT
0.0
E/ec, .1 c:tr:
$0.00
PME Plan Check:
F'W/:.
pr. t 1rZ:. F£:£'.'.
1 tl31if3. Nle:
$0.00
Suppl. Insp. Feer Reg.OT
1 1.%3£'i'7tZ !`%'%:
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NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc 1. These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef . 7,7113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s. f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Pen -nit Fee:
$0.00
Suppl. Insp. Feer Reg.OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i`_�£37iSft'FlL'ti�C3ii f.��1•.
lclf"1?7ii:S°ti'Frivi' Ft's':
Q
G
Work Without Permit? (D Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
A
l rzvU!
Strong Motion Fee:
1BSEISMICR
$7.22
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$10.22
$645.00
TOTAL FEE:
$�jy
Revised:10701/2015
70 • cU
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2013 CALIFOFNIA F. 51PMAL COPS
2013 C&IFOPNIA 13UILPIN6 COPS
2013 CALIFOMIA MECHANICAL COPF
2013 CALIPOMIA PLUMC % COPF
2013 CALIPOMIA PIPE COPS
2013 CALIPOMIA FL�CTQCAL COPS
2010 CALIFOPNIA ftP,6Y COPS
2013 CALIFOMIA GP,�FN 13UILPING 5rAN12AFT5
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Vibhakar Fesidence
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BY
DA
PEE
Y
DATE:
1.
11242015
2.
3.
4.
5.
6.
SCALE 3/8" =1'0"
DESIGNER: Sylwia Pichola
Julie Binik
ARTISTIC KITCHEN
DESIGN
Approved Date
DRAWN BY:
Julie Binik
Los Altos Builders DBA
Artistic Kitchen Design
131 E. EI Camino Real
Mountain View, CA 94040
PROJECT:
Vibhakar Residence
10494 Madrone Ct
Cupertino, CA 95014
A. 1
KITCHEN
MAIN FLOOR
AVCH�N FLOOF FLAN - rFOF05Fn
Vibhakar ke5idence
DATE:
1.
11 242015
2.
3.
4.
5.
6.
SCALE 3/8" =1'0"
DESIGNER: Sylwia Pichola
Julie Binik
ARTISTIC KITCHEN
DESIGN
Approved
Date
DRAWN BY:
Julie Binik
Los Altos Builders DBA
Artistic Kitchen Design
131 E. EI Camino Real
Mountain View, CA 94040
PROJECT:
Vibhakar Residence
10494 Madrone Ct
Cupertino, CA 95014
A.2
KITCHEN
MAIN FLOOR
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DATE:
1.
11 242015
2.
3.
4.
5.
6.
SCALE 3/8" =1'0"
DESIGNER- Sylwia Pichola
Julie Binik
ARTISTIC KITCHEN
DESIGN
Approved Date
DRAWN BY:
Julie Binik
Los Altos Builders DBA
Artistic Kitchen Design
131 E. EI Camino Real
Mountain View, CA 94040
PROJECT-
Vibhakar Residence
10494 Madrone Ct
Cupertino, CA 95014
A.3
KITCHEN
MAIN FLOOR