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1409021119854 BAYWOOD DR 14090211 I RIYAZ PUTH IYAPU RAYI L SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19854 BAYWOOD DR CONTRACTOR: LISAC CONSTRUCTION PERMIT NO: 14090211 INC OWNER'S NAME: RIYAZ PUTHIYAPURAYIL 573 PATTON AVE DATE ISSUED: 02/11/2015 OWNER'S PHONE: 6503212871 SAN JOSE, CA 95128 PHONE NO: (408) 355-4238 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL �j 3 S ti n ADDITION TO REAR OF SFDWL (159 SQ FT); REMODEL License Class Lie. # d KITCHEN AREA (150 SQ FT); NEW ROOF STRUCTURE Li 2 OVER Contractor S L (/i'N S'v1.% rpate KITCHEN AND FAMILY ROOM (612 SQ FT). 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: [ 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: $125000 performance 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 permit is issued. APN Number: 31631013.00 Occupancy Type: 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 WpPHIN 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 ST 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. Additi nall a applicant understands and will comply Issued by: Dat ! J withal] non -points r r 10 a Cupertino Municipal Code, Section 9.18. Signature Date 2 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. ❑ OWNER -BUILDER DECLARATION : Signature of ApplicantDate: 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 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) 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. I will 1 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 Cu er ' unicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sec ' 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this i permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY became 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 perfornance 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 Lender's Address 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, 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 CUPERTINO I —I ..___. __-._....., CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333' building okupertino.oro l—I f1 �r TCR nrrnM lTr n RFVISVIN/DFFFRRF.D �a\\ B ORIGINAL PERMIT!! L_J Ntw COO llcuui!ONu,,...1..,..,•••••••, •• ,� ---.._.__. ___—__- �OM PROJECT ADDRESS 1111 80 W W APN # 27 v : I O I OWNERN P '3Tjl. ��I EMAB. L w 1YUI�t�`SIL STREET ADDRESS., CITY, STATE, LP FAX � j `' C W.V N \ T,V IND TREET ADSROS� CITY, TAT, ZIP �YL '7O 3✓I I'1D ' ❑ OWNER ❑ OWNER -BUDDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHnicr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS. LIC# h COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHIC((FiNG, NAMH .� \ ( N LICENSENUMBER I j ^ O 9-4 BUS LIC # MP ME E-MAIL �D FAX r \ V` STREET ADDRESS CRY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTRTTYYPE v #STORBiS I USE TYPE OCC. SQ.FT. VALUATION(S) � O EXISTG NEW Fl.00R A� DEMO TOTAL NETAREA��w��`��fff�I AREA�'123�1� AREA Iiok ` AREA BA MCBEN OTHER REMODELAREA REMODEL AREA N I REMODELAREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWEU.WGUMTS: IS A SECOND UNIT ❑YES SECOND STORY LJYES 1 BEING ADDED! 81No ADDMON! CqNO PRE-APPUCATION ❑YES IF YES, PROVIDE COPY OF ISTNEBLDGAN OYES RECEIVED BY: TOTA}.rsl¢.370N: PLANNINGAPPL# WHO PLANNING APPROVAL LETTER EICHLERHOME! NO L/L7 II(e By my signature below, I certify to each of the following: I am the property owner or authorized agent t owner's behalf. I have read this application and the information I have provided is come xt 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 t ilding conswcti . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTA FORMATION REQUIRED PLAN CIJECK TIDE ROUTING SLIP ❑ OVER-TTIECOUNTER HB DING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ Ex PRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ foml if any Hazardous Materials are being used as part ofthis project. ❑ LARGE ❑ FIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ M OR ANITARY SEWER DISTRICT _ submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121. 11 �,��CITY OF CUPERTINO I Y o FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19854 HAYWOOD DR DATE: 09/30/2014 REVIEWED BY: MENDEZ APN: BP#:60— al 1 `VALUATION: $125,000 FPERMITTYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No I OTC. Q Yes (F)No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK ADDITION TO REAR OF SFDWL 159 SQ FT m REMODEL KITCHEN AREA 150 SQFT SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 159 $1,091.00 IADDPLCK $1,057.00 IADDINSP F- TOTALS: 159 $1,091.00 1 $1,057.00 MECH, HOURLY O Yes G No PLUMB, HOURLY O Yes (F) No ELEC, HOURLY Q Yes Q No Phmrb. Play C4tr� Other Plumb zo'.. Phmrb_ brsp. Fea: Frac- Im/_ f, NOTE: This estimate roes not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. err_ ). These lees are based an the nreliminary information available and are only an estimate. Contact the Dent for aeldn't info. FEE ITEMS (Fee Resolution 11-053 Eli ' 1'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 150 s.£ $645.00 Remodel, Kitchen (<=300 sf) iREMBEsKrr Suppl. PC Fee: Q Reg. () OT 0.0 Ins $0.00 PME Plan Check: $0.00 Permit Fee: $1,057.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 e C: Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $22.26 Select a Non -Residential Building or Structure E) O vulinn rev c Strong Motion Fee: IBSEISMICR $16.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $2,191.51 $645.001 TOTALFEE: $2,836.51 Revised: 07/10/2014 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax:408-777-3333 JOB ADDRESS: %14 PERMIT # OWNER'S NAME: na PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting D fn l09,rs Linoleum / Wood Glass / Glazing Heating Insulation (Tm so l fihan 3tAq-2- Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Q ID .330Z Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature -)q- 15 Date