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131200364 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21061 GARDENA DR CONTRACTOR: HOMESTEAD PERMIT NO: 13120036 CONSTRUCTION INC OWNER'S NAME: KALIYAPORUMAL MUTHU AND KOTHANDAP 10080 STERN AVE DATE ISSUED: 10/16/2014 OWNER'S PHONE: 4086463286 CUPERTINO, CA 95014 PHONE NO: (408) 255-8999 51 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ / n 6 3 CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR License Class9 ' _ Lic. # b � 2043 <U (k SQ, 2ND FLOOR 1414 SQ FT, ATTACHED GARAGE 505 & Contractor �Z�R4A-t/ Date o [6 –� PORCH 34 SQ 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 Sq. Ft Floor Area: Valuation: $400000 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 APN Number: 32608085.00 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 FRO _ D 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 — /,Oz,/ granting of this permit. Additionally, the applicant understands and will comply Date: with all non -point source regulations r the Cupertino Municipal Code, Section 9.18. 6 RE -ROOFS: Signature Date 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 Applicant: Date: I hereby affirm that [ 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) 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. 1 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(x) should 1 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 Munial 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, a 255,4. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: /p I certify that in the performance of the work for which this permit is issued, I shal I 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d-)cupertino.org CION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS n �D / 1 oav�,pi� h �Y , C APN# 08_0.n�SI OWNER NAME /I/1C'I� l Y, _ /(-VWAY, PHONE (��� _ 6TO _✓0Y E-MAIL /�YI�1! OCG OO STREETADDRESS/ Z'D I /y���,p,,�a or , IJEt,^/n,�� CITY, STATE, ZIP Caper per 0 C) FAX CONTACT NAME / �lV' PHONE l E-MAIL f(a) STREET ADDRESS e2_10 / O C) rAeS1eAfi( id CITY, STATE, ZIP U, //� 95 FAX ❑ OWNER ElowNER-BUH.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME80 I� A� / EMAIL 6.2C FAX `' �/ (J,/J��` STREET ADDRESS �v,60 ? CITY, STATE, ZIP �1,. /%� G PHONE �v/�%�I/� DESCRIPTION OF WORK lobK4 MI 0fy 1i0VAA1e_" Ill ��✓ 2 S+ a EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) MSTG AREA NEW FLOOR AREA 3 DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: EQ I�WACH 3 _ [ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDE NO ADDITION? []NO PRE-APPLICATIO YES IF YES, PROV E COPY OF IS THE BLDG AN ❑ YES RE BY:°. TOTAL VALUATION: PLANNING APPL# ❑NO PLAQ;'j„(�P� OVAL LETTER EICHLER HOME? ❑NO 0 By my signature below, I certify to oo((eaach of thellowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infonnation I have provided r 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 buildingco stru i I authorize representatives of Cupertino to enter the above -identified property for inspecti n purposes. Signature of Applicant/Agent: Date: /3 SUPPLEMENTAL INF AT N REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ New SFD or Multifamily dwellings: App for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTER BUu.DING PLAN RE\'IENN permit for new building. ❑ EXPRESS LZNIING PLAN REVIEN\' _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureST:4NDARD PUBLIC WORKS Torn if any Hazardous Materials are being used as part of this project. e ❑ LARGE FIRED T _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. ALAJOR S:IMTARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121/11 `plvl am ,3 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: 21061 GARDENA DR DATE: 12/04/2013 REVIEWED BY: Mendez jigADDRESS: APN: BP#: "VALUATION: 1$400,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes • No I PENTAMATION 1 R3SFDW I PERMIT TYPE: WORK construct 2 story sfdwl to include 1 st floor 2043 sq, 2nd floor 1414 sq ft attached garage 505 & porch SCOPE 34 sq OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 3,996 $3,177.15 1R3PLNCK $3,386.60 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,386.60 Suppl. Insp. Fee -0 Reg. Q OT 1 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 3,996 $3,177.15 Construction Tax: 1BCONSTAXR $3,386.60 # new units 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 Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 a.' 711113) IVlech. Plan Check Plumb. Plan Check Elec. Plan Check Plumb. Permit Fee: F1ec. Permit Fee' Other Mech. Insp, Other Plumb Imp,Li Other Elec. Insp. Ucch Irr.cn, Vc Suppl. PC Fee: Q Reg. Q OT Fcc 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 Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 a.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,177.15 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,386.60 Suppl. Insp. Fee -0 Reg. Q OT 1 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR r1 1 # new units $650.84 [ra'trrarti rrtrtice F'cc: 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $559.44 Select a Non -Residential Building or Structure 0 i I'i-tn l 0octoricnf tlho; FF Strong Motion Fee: 1BSEISMICR $40.00 Select an Administrative Item Bld,Stds Commission Fee: IBCBSC $16.00 SUBTOTALS: $7,830.03 $0.00 TOTAL FEE: $7,830.03 Revised: 10/01/2013 Building Department Cit} Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CL PERTf NO CONTRACTOR / SUBCONTRACTOR LIST . I3/-� ;; AAI I it j01 '/o6L r .........-.._ �� fish' ' JOB ADDRESS: PHONE # b8") ! i i OWNER'S NAME: , USINESS .LICENSE # z g" S GENERAL CONTRACTOR: CITY%Z1PCODE;__�U1..G— --- ADDiZF.,SS: of Cupertino business license. *Our municipal code requires all businesses work ng in the PE to have a City BE SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INS- ' RAL CONTRACTOR AND ALL SUBCONTRACTORS HAti'E OBTAINED A CITY OF CUPERT[NO GENE .BUSINESS LICENSE. I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NA -ME Cabinets & Millwork Cement Finishing Electrical Excavation --- Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank _ Sheet Metal Sheet .Rock Tile S MA k f -E 10 Owner / .ractvr Signature VfA BUSINESS LICENSE # 0-� a Date F UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINB (408) 777-3228 •FAX (408) 777-3333 • buildingCtt2cupertino.0r9 PURPOSE For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www..cmpertino.ortz/ind.ex.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildinpLi )cupertino.ora 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): qpNp— BLDG PERMIT #: l 1 � Q Q'3 6 DATE: ................... . Dae:..f!�..�� j SITE ADDRESS: I © V l Q �1� OWNER'S NAME: PHONE #: FAX #: MAILING ADDRESS (if different from site address): CONTRACTOR: —PHONE* �_ c .� OytATI k J U PHONE* FAX #: - - CONTACT: PHONE M FAX #: I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occuoanev for the buildina. .. U1i1ilyRe1easeFonn_2011.doc revised 08109/11 40u4, • Pr'f ................... . Dae:..f!�..�� j 7 7 .T9']Contractor....... ... ...... •i,1................:e........... ..... U1i1ilyRe1easeFonn_2011.doc revised 08109/11