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15120205rt+l CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21867 SHATTUCK DR CONTRACTOR: AMERICA'S DREAM PERMIT NO: 15120205 HOMEWORKS OWNER'S NAME: SREEKUMAR PARMESWARAN & BEENA DAS 4181 POWER INN RD STE C DATE ISSUED: 12/23/2015 OWNER'S PHONE: 4082429774 SACRAMENTO, CA 95826 PHONE NO: (916) 739-0996 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F] REMOVE WOOD SIDING ON FRONT OF RESIDENCE AND icense Class Lic. # REPLACE IS FIBER CEMENT SIDING (1000 SQ FT). ontractor Date 12 2 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 Sq. Ft Floor Area: Valuation: $13828 performance of the work for which this permit is issued. 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: 35614003.00 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 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 _ 2 Issued b �LrT/ �' !n! G Date: �� "�7 y' granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations the Cupertino Municipal Code, Section 9.18. p Z 3—RE-ROOFS: V Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is V installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 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. 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 I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. /7— —� Section 3700 of the Labor Code, for the performance of the work for which thisI �wner or authorized agent: Date:permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 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 9.18. Signature Date CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I1p03 1•Ig�' (408) 777-3228 • FAX (408) 777-3333 • buildingCcD_cupertino.org F- NEW CONSTRUCTION F- ADDITION e ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # � n 1�Me /� /�� PROJECT ADDRESS a/06 :� S APN # , OWNER NAME /� PHONE j�0� ^ 7/�Z� -7� AIL — s Tr. nn K/ STREET ADDRESS flea. CITY, STATE, ZIP �J �r FAX CONTACT NAME /� PHONE 9// i -M IL `�f�/yG•�i1' ®fO��/YJ - W •�/1 • STREET ADDRESS J�,Q/ �0, - _n _ CITY, S TE, ZIP n� Q y� FAX /?// I2/� ��J_ n991 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT L1 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBEROg�� LI N ®PE�/ BUS. LIC # cjD001 /� COMPANYNA E l� D I, E -M IL edya hO��. STREET ADDRESStq/ J�O�r /' CIT , STATE ZIP n �s~Q �f /� G PHONE9i6 X39- 09.x,6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS, LIC 41 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK _ ` 1 `keY EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USETYPE OCC SQ.FT, VALUATION($) EXTSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEI.:ARF A REMODEL AREA PORCH AREA 'DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING KNITS. TS .A SECOND IJNTT ❑YES ECOND STORY OYES BEING ADDED. NO ADDITION? E]NO PREAPPLICATION []YES IF YES, PROVIDECOPY'OF IS-111EBLDGAN 0YES RECEIVED BY, OT.ALVALVAI10N; PLANMNG.APPL # ONO PLANNING APPROVALTETTER EICHLER HOME? ❑ NO JI 'Ry my signature below, l,certify to each of the following: I am tete property 'owner or anthorized agent to scat on'the pprop'erry owner's hchalf. have read ]]a(siT/ application and the information I have provided is eonec rea the Description of Work and verily it is accurate I agree locomply with all applicable local 'ordinances and state laws aelatina to building ,c ' action. I authorize representatives of Cupertino to ,cuter the abovee-idenrif ed property !for Yli ,pe¢t on piirposes. Signature o:f.Applicant'/Agent SUl'PT EM1 ' NTA: ! F'ORIVI.A"TION REQUIRED PLAN CHF-K'TYPE 'ROUTING SLIP tOVER-Ti7E=COUNTER R' BUILDING PLAN REVIEW _New SpD Or Wtlfantily dwellings Apply foT'demolition pennit for XistingIT1IdiTIg(S�. 1De1nDlSGion pernn111.S meclaired prior 10 iSsl1a11'oe of bu / pelnnit for new building. EXPRESS 10 PLANNING PLAN REVIEW lConnlnercial Bldg: Provide a coil�pleted Hazardous Materials Disclosure D STANDARD '❑ PUBLIC WORKS form, lf'any H-azardoas Ma"te'rl'als are being used aS par t'Of i111S project� IQ. LARGE F1TI2EUEPT C'Opy'O,f iPlanlning Ap,prOVal Letter Or IMeeting with Pl'anlning prior tO .jL] 1VIA90R ID 'S 4NITARYSER ER DISTRICT ;sublTaittal ofBTlnldnng Pemnit appincation. I❑ ENviRoNmENT. m, HE'A'LTH IBldgApp 0J1 fl.. oc n eI'ii�ec7 (06%211;/1111 V7 CITY OF CUPERTINO . WWI FFF. F,,IRTIMATO-R — RI'TILDING DIVISION ialADDRESS: 21867 Shattuck Dr FEE DATE: 12123/2015 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$13,828 *PERMIT TYPE: Building Permit 1,000 S.f. w1,00 PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION I PERMIT TYPE: 1GENRES WORK Remove wood sidinq on front of residence and replace is fiber cement siding (1000 sq ft). SCOPE $0.00 a FI"?ct1I,..,; i 4 1''8{'„ ,Vech. h J1,,wrfb. A'iww'i Fee" F-1 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 preliminary information available and are only an estimate. Contact the Dept for addn't EL FEE ITEMS (Fee Resolution .1.1-053.Lff._7�1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,000 S.f. w1,00 Siding 1. ISIDEOTHER All Other Suppl. PC Fee: (j) Reg. 0 OT"00 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -E) Reg. 0 OT"00 hrs $0.00 PME Unit Fee: PME Permit Fee: _$0.00 $0.00 T E) Work Without Permit? 0 Yes (j) No Advanced Plaqnjq&_E�ge: _$0.00 $0.00 Select a Non -Residential E) Building or Structure 0 Strong Motion Fee: I BSEISMICR $1.80 Select an Administrative Item Al Bld,t,, Stds Commission Fee: IBCBSC $1.00 F SUBTOTALS:, $2.8 0 P1,0 $ 0 I's $.,8�. 8 01 411*1 .11 Revised: 10/01/2015