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15050069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15050069 21947 LINDY LN CUPERTINO CA 95014 (356 25 029) OWNER'S NAME: SHESHA KRISHNAPURA DATE ISSUED: OWNER'S PHONE: 408-893-9926 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor Date _ BLDG —ELECT _ PLUMB COMMERCIAL RESIDENIAL MECH T 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. JOB DESCRIPTION: INSTALL 4' RETAINING WALL (32 L.F.) I heteby Affirm under penalty of perjury one of the following two declarations: 1. 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 11/10/15 PERMIT APPLICATION EXTENDED TILL 2/8/16 by Section 3700 of the Labor Code, for the performance of the work for which Sq. Ft Floor Area: Valuation: $3700.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county 356 25 029 356 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. Issued by:T- 41 Ual�/I01 Signature Date Date: ' OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for following two reasons: 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous permit is issued. material. Additionally, should I use equipment or devices which emit hazardous It rtify that in the performance of the work for which this permit is issued, I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Se 11 25505, 25533, and 25534. 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 Owner or authorized agent: be deemed revoked. Date: 2 (� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Date 2 � (� Professional Signature CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT 9 P JECf ADDRESS r w I APN 2–S--_ 02— �j OWNERNAME PHONE 972_G E-MAIL Sa4ts . KR�S►nP�I�� �nq� STREET ADDRESS CITY, STATE, ZIP FAX 1-kJ"b c(S-D1 21 T tiO� CONTACT NAME K D l S t� ` l i� Iv �jCA/- P rlO &C(ONE �p C1 11 C7 E-MAIL f1 r ` f �� STREET ADDRESS CITY, STATE, ZIP qSL�I FAX q J <6R -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME O, •W/V v�n � LICENSE NUMBER 7SETYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/F.NGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ��-- L� N C w� EXISTING USE PROPOSED USE CONSTR TYPE #$TORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG FLOOR DEMO TOTAL AREA INEW AREA AREA NET AREA 3 '1s�©•'1 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH 9 DWELLMIG UNITS: IS A SECOND UNIT ❑YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEI TOTAL VALUATION: 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 ag property owners have read this application and the information I have provided is correct. I have read the Description of Work and veri-fy it is accurate. I agree to comply with a 'cable local ordinances and state laws relating to building con ctio I authorize rept tatives of Cupertino to enter the above -'dentifed property for inspection purposes. Date: )— Signature of Applicant/Agent: Ic SUPPLEMENTAL INF TION UIRED r BUIIDINGPLAPIREYIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ovER co04.r u " permit for new building. ru' 0� EXPRESSr z s ❑4rLAlvlv>IVG PL� �* _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STnxDARD rr �a Q, ruIJIJ WORxs y g c form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior toi�� �� 0 LARGTti* t r ro: _ submittal of Building Permit application.�y, 3' aI NTAL'AEAL.. EldgApp_2011.doc revised 06/21/11 ('q CITY OF CUPERTINO T. UV Ti QT1M A 9rnl2 — RTT11 .n1NC_ nIV> g10N NOTE: This estimate does not include fees due to other uepartmenrs (/.e. r/unntng, Iru0111- .. u'n., 1 11.,�•...,,•y �� - ____ _ _ tbv Pont far nddn "l info. Dtstrtct, etc). mese ees are uuseu un /ne preuiiu I", FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/132 ADDRESS: 21947 LINDY LN DATE: 05/12/2015 REVIEWED BY: MELISSA 161 APN: 356 25 029 BP#: `VALUATION: $3,700 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p 0.0 PENTAMATION 1 RBCRW PERMIT TYPE: WORK INSTALL 4' RETAINING WALL 32 L.F. SCOPE NOTE: This estimate does not include fees due to other uepartmenrs (/.e. r/unntng, Iru0111- .. u'n., 1 11.,�•...,,•y �� - ____ _ _ tbv Pont far nddn "l info. Dtstrtct, etc). mese ees are uuseu un /ne preuiiu I", FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/132 ... FEE -•-- -• -- QTY/FEE _.-_ _._ ________ MISC ITEMS Plan Check Fee: $0.00 L_12_j I.f. $859.00 Retaining Wall IRETSTN Standard Retaining Wall Supp/. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(F) Reg. ® OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Plannin& Fee: $0.00 Select a Non -Residential Building or Structure T---=- E) 0 i i',C, "A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg* Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $1.50 $859.00 TOTAL FEE: $860.50 r1%CV1bzU. v�i� iicv i.� OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildino(a.cugertino.org Dear Property Owner(s): i'1 GSI' r� 1�tS Ifi'' A 9 k An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ►�Y wi C -U -R1) APN �S G �S^ O 1 BP#' 5.05 OV / Q b 7 OWNER NAME SM_US f4 Ko I&lt,jf&Lttt} OWNER ADDRESS . 2 �4 41.i1� Ln� C�Pt�ILi1(j DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) }!lunderstand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. V 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may 4rect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. understand Contractors are required by law to be licensed and bonded in California and to list their license nu bers on permits and contracts. understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the �tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for af�lfinancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 VA 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal R enue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I v- arg the party legally and financially responsible for proposed construction activity at the site address listed above. 411 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by applicable laws and requirements that govern Owner -Builders as well as employers. 1? Lagree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint._. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verifv the orooertv owner's signature. A A Property Owner's Signature: I(_, 4 � 1-- Imo/ _<_- Date: 1 11 145g�z - -------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 PERMITS View Properties: Primary. 21947 UNDY LN CLPERTINO CA 95014 (356 25 029) Issued Permit # 15050069 Status: 10pen Permit App # 15050069 Submittal Date: 05/122015 Issue Date: Last Inspection: Expiration Date: Permit Type: 1GENRES Permit Subcases: No configured subcmes. ojec a ua V" I 3700.00 I Scope of Work: INSTALL4 RETAINING WALL (32 L. F.) LOCATION: B10 i Zoning: Specific Plan Area: Lot Type: Fire Severity Zone: Seismic Zone: Landslide Area: Sanitary District: i Historical Designation: - Land Use: Lot Area: Light Air Easements: Flood Hazard Zone: Liquefaction Area: Water Service Area: Heritage Trees: Annexation Info: Seri -Rural Deferred Exemption: - Agreements: Permits (15050069) Type: 1GENRES Start Date: 05/12/2015 Status: Open Fee Charges (4) Item: 1BCBSC © Amount: $1.00 Fee Assessed By: Legacy Item: 1 BSEISMICR © Amount: $0.50 Fee Assessed By: Legacy Item: 1RETSTN © Amount: $859.00 Fee Assessed By: Legacy Item: 1ADMIN 0 Amount: $45.00 Fee Assessed By: Legacy Total Amount: $905.50 Amount Paid: $905.50 Amount Due: $0.00 Applicant SHESHA KRISHNAPURA 21947 LINDY LN CUPERTINO, CA 95014- 4810 Email: W Property Owner SHESHA KRISHNAPURA 21947 LINDY LN CUPERTINO, CA 95014- 4810 Email: Properties (1) [356 25 0291 21947 LINDY LN CUPERTINO, CA 95014- 4810 Water Service Area: SAN JOSE WATER SERVICE Sanitary District: CUPERTINO SANITARY DISTRICT School District (Unified): Land Use: 1 Seismic Zone: Fault Rupture Lot Area: 20482 Concrete: Past Public Works Projects: 52291.00, type: SUBDIVISION, created by JOANNE on 2011-12-14 52526.00, type: SFDW L, created by NICK on 2011-05-12 Specific Plan Area: Flood Hazard Zone: 0.2 PCTANNUAL CHANCE FLOOD HAZARD Storm Drain Fee Payment: Fee Rate: 1290, Fee Rate Derived From: Acre, Amount Paid: 606.29 Zoning: R1-20 Maintenance Zone: 1 Liquefaction Area: No Historical Designation: Past Planning Projects: M-2011-06 (2011), type: M, created by GEORGE on 2011-11- 18 MCA -2011-03 (2011), type: MCA, created by GEORGE on 2013-08-20 TM - 1977 -30 (1977) type: TM, created by NICK on 2011-02-17 TM -2001-01(2001), type: TM, created by NICK on 2011-02-17 TM - 2005 -05 (2005), type: TM, created by NICK on 2011-02-17 TM -2005-11(2005), type: TM, created by NICK on 2011-02-17 TR - 2014 -29 (2014), type: TR, created by GEORGE on 2014-07-13 Z-1967-19 (1967), type: Z, created by NICK on 2011-02-17 Annexation Info: 1899-12-30 1966-04-21 Lindy 65-5 Deferred Agreements: School District (High School): FREMONT UNION School District (Elementary): CUPERTINO UNION Stream Side Permit Required: Heritage Trees: No Lot Type: R1