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B-2016-1159 (15070165)CITY OF CUPERTINO BUILDING PERMIT DING ADDRESS: DEXTER DR CUPBRTINO, CA 95014-1317 (326 41 071) OWNER'S NAME: 1ITHENDER MADIGA OWNER'S PHONE: 408-802-2559 11-IDLIXW-9190 I M at. t FOR License Class Lic. # Contractor OWNER/BUILDER Date 01/25/2016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ,Ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is In full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r. 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, 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 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. r s . 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 (See.7044, Business & Professions Cade) .Itlfgliyg I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. 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 Cade, 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 which this permit is issued. V;h..1r1,1 tify thatin the performance of the work for which this permit is issued, I not employ any person in any manner so as to become subject to the er'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 CER11FICATION 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. CONTRACTOR: PERMIT NO: 2016-1159(15070164) OWNER/BUILDER DATE ISSUED: 01/25/2016 PRONE NO: BUILDING PERMIT INFO: X BLDG _ ELECT _ PLUMB _ MECH X RESIDENTIAL_ COMMERCIAL JOB DESCRIPTION: Revision #1 to 15070164 - Change location of Skylights and windows at East Elevation; Garage shearwall changed from 18' to 12; Shearwall at cast wall changed; Floor addition changed to 2 / 2"x6" Sq. Ft Floor Area: Valuation: $37000.00 APN Number: Occupancy Type: 32641071 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRS+AST CALLED INSPECTION. 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. tare of Applicant: 01/25/2016 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 Cade, Chapter 9.12 and the Health & Safety Code, Seectio�nss225505, 25533, and 2255534. )wner or authorized agent: late: 01/25/2016 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance f work's for which this permit is issued (Sec. 3097, Civ C.) .antler's Name ARCIHTECT'S DECLARATION I understand my plans shall he used as public records. Date 0112512016 CUPERTINO CONSTRUCTION PERMIT APPLICATIONBa(3&1190 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 85014-3255 (408) 777-3228 • FAX (408) 777-3333 r buildinD(Douoertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT; PROJECT ADDRESS f1WF-&� riQG U� I APNs 3ZD J C)•y T •��%� OtiT'ERNAt� "�J rCKC�a�UfO/C Z A440,7 A PH � $a2—Z; � P-MATE "c.�lu qG1oo'c STREET ADDRESS e I CRY, STATE, ZIP FAX CONTACT NAME '�� �Hc��LN'ZUeJ Gt1� lLE "� PHONE e- STREET ADDRESS CITY, STATE, ZLP FAX OWNER O. OWNER -BUILDER ❑ OWNR AGENT ❑ CONrRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGAEER '"'Dg\'m_LOI'ER CONTRACTOR NAME LICcTSEN11M9ER I LICENS C01✓PANY NAME E-MAIL - STREET ADDRESS CITY, STATE, ZiP—'-""l -"--'--- PHONE ARCPINECTrN _..Rp'N'FJ,SE ' LICENSENUI,^uER n n©�,,,,�( BUS, LICk t�lJ L COMPANY NAME �p I EMhf���(--�'I`GtI'�t�(� FAX STREET ADDP,ESS IhC � ,/e �- C1N 5 ATE, ZIP I PH lE DESCRIPTTDN OF wom /�„ 9 /.. ICAJ r14) 1f `e,0Cc_ S4(G4M t, &c A, CfrYrLrKe G P,4" -FaAfii :5&(a A-( L�,AV &'Sate- (f mff4 ev . FLOG L ':2'0 1S-r UST^ c 2 2�C 6 EXISTING USE PROPOSED USE CONSTR TYPE I 10STORES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG HEW FLOoR DEMO TOTPY AREA AREA AREA I NrT'AREA BATHROOM KrTCHEN OTHER REMODELARE.S RE1,40DELAREA REMODEL AREA PORCHAREA DECKAREA TOTAI.DECrJPORCHhREA GARAGE AREA: DETACH I TAes AT m DW1,11NG UNUS: Is A SECOND UNIT DYES SECOND STORY ❑YES D BEING ADED? ENO A➢➢ITIoN? [DNo PRE -APPLICATION ❑YTS R YES, PROVIDE COPY OF ISTHEBLDGAN ❑13 may- Dom} TOTAL 710N: PA'MNG APPL. MHO PLANNmGAPPAOVPL No W_ I By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf, I ha e read this application and the information I have provided is correct, I have read the Description of Work and varijN it is accurate. I agree to comply with all applicable local ordinances and state laws Tel ating to b ildi CD etion. I authorize representatives of Cupertino to enter the above-i enti*le property for inspection puTposes. SirnztureofApplioznt/Agent Date: SUPPLEMENTAL INFOIU\ ATION REQUIRE New SFD or Multifamily dwrellings: Apply for demolition pemit for existing building(s). Demolition permit is requD ed prior to issuance of building-- - permit for new building-`LI�Ek"PHF$ _ Commercial Bides: Provide a comA4 pleted Hazardous aterizls Disclesve Torn if any Hazardous Materials us being used as pert of this project. ri _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Pemit application.-"rt;�. �g�"`TrhYsERVTsrrcg Pict B/a'gA-pp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21354 Dexter Dr APN: 326 41 071 BP#: DATE: 01/12/2016 15070164 REVIEWED BY: PAUL VALUATION: $0 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #1 - Change location of Skylights and windows at East Elevation: Garage shearwall changed SCOPE from 18' to 12'; Sheanvall at east wall changed; Floor addition changed to 2 / 2"x6" lfecir. Plan CheckPhollb Plan Check E(cr. 1'lori CLcek vle(A Per;rir Perm rer 1=ise. Pervr;tt fae: Oiher _tf, oh btrli Ofhar 1'I1fnr b Tns,:�. 0thee Oe6. ,Wech. Insp. Fee, Phfneb. Tarp,=. fi<�e. E;iee insp. Fee: 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Tee Resolution 11-053 j J 7Li//3i FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes (E) No $0.00 = hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Ktv: AtIministrafive, Eee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or. Structure E) 0 d 7imvel Documentation fees: Strove, Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.001 $286.00 TOTAL FEE: $286.00 Revised: 0110112016