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15120035 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:VARGAS PERMIT NO:15120035 BUILDING ADDRESS: 20085 NORTHWIND SQ CONSTRUCTION OWNER'S NAME: MALUNJKAR SANJAY C AND KOTHULE JAYA 664 RED ROME LN DATE ISSUED:12/04/2015. OWNER'S NE: 6505213938 BRENTWOOD,CA 94513 PHONE NO:(925)437-9468 JOB DESCRIPTION:RESIDENTIAL `Q COMMERCIAL LICENSED CO NTRAC/T'OOR'SbECLARATION INSTALL 5 SKYLIGHTS AND 4 SOLAR TUBES License Class Lie.# Contractor � � l ate L12 I hereby affirm that I am licensed under theprovisionsof 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 Valuation:$2000 S formance of the work for which this permit is issued. 9•Ft Floor Area: 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:31638009.00 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. �N indemnify and keep harml he City of Cupertino against liabilities,judgments, �L t Date: costs,and expenses whi y accrue against said City in consequence of the Issued by: granting of this permi, itiona plicant understands and will comply with all non-points r g on Cupertino Municipal Code,Section 9.18, RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Dat installed without first obtaining an inspection,.I agree to remove all new materials for inspection. 171 OW BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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) HAZARDOUS MATERIALS DISCLOSURE i,as owner of the property,am exclusively contracting with licensed contractors to under Chapter I have read the hazardous 5 of construct the project{Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 2550559 25533,and 25534, I will er 9.12 I hereby affirm under penalty of perjury one of the following three Health i&Safety Code,Section 25532(a)shout n compliance with the Cupertino MunicipalItoreoor handle thazardou d the 'declarations: to ous I have and will maintain a Certificate of Consent of theLaborCodef-insure for, the s air contaminantstas defined by the Bay equip Air Quality Management Distrr devices which emit ict ct I Compensation,as provided for by Section 370will maintain compliance with the u i o M icipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sections 2 ,25 I have and will maintain Worker's Compensation Insurance,as provided for by Date: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall Worker's CONS rRUCTIO NDING AGENCY not employ any person in any manner so as to become subject to the 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 hereby foraffirm hich this hpermit is issued sued(Sec.3097, e 7,CrvC)for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above in 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 ARCHITECT'S DECLARATION upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Tans shall be used as public records. costs,and expenses which may accrue against said City in consequence of the I understand my p 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. Date Signature �_— - ---- CONSTRUCTION PERMIT APPLICATION CCIAIrWNI 1 Y DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300TORRE AVENUE•CUPERTINO,CA°5014-3255 f (408)777-3228 FAX(408)777-3333•buI1ding5.cuneriino.orct CUPERTINO 15 1 " N'EW CONSTRUCTION ❑ ADDTTiON ❑ ALTER..ATION/TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT 4 PROJECT ADDRESS APN36-00 OWNER NAlS ��- PHONE C I� �i��j I t.t✓k IL Ili STREET ADDRESS LJV1ll�WW/l11/// CITY, STATE,ZIP CL, �rXO �` F j CONTACT NA111M S tA. PHONE STREET ADDRESS CITY,STATE,ZIP FAX AN OW1m, 0:OGVNER-BUILDER OV,'h�AGENT CONTRACTOR ❑CONIRACTORAGENT ARC=zCT EN IN, ❑ DE�Z-LOPER ❑ T'T CONTRAC,QR7 ( LI 'S' T3ER I LICENSE TYPE I SU T coiaAN•Y NA1✓E E-NAIL ,� � F •" � �"..i - ST RE T ADDRESS ,, CITY STATE,ZIP . I PHONE ARCHITECT/E.NGINEFR NA3%1M I LICENSE NMYSER SUS.LIC R COMPANY NA11E E-MAIL FAX STREET ADDRESS CITY,STATE;ZIP PHONE DESCRIPTION OF WORK EMSTLNGUSE I PROPOSED USE I CoNSTRTYPE I ISTORIES USE I TYPE I. OCC: I SQ.FT. I VALUATIONS) EXISTG NEW FLOOR DEMO I TOTAL I �. AREA I AREA AREA NZEAREA BA HROOM KITCHE 1 OTHER I I REMODELAREA PE40DELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKlPORCH AREA G.�,ItAGE AREA: C]DETACH AT TACH I �. nWDEENGUNCTs: ISASECONDU1'IT ❑YES SECOND STORY ❑]r5 11 BEING ADDED? []NO ADDITION? []NO I I PP.E•A.°PLICATION ❑1 tS IF 1'ES,PROVIDE COPY 9F IS THE BLDG TOTAL VALUATION: E E3*O Ji1rCR' Il BI --. _ PLANNrNGAPPL9 ❑N0 PLANNTII,'GAPPROVAL LETTER EICHLERHOhIE? ' By my signature below,I certify to each of the fol, ving: I am the property ONN—r or authorized agent to act on rope, owner's beha_. I have read this application and the information I hay>e prov' correct. I have rea _ nption of Work and vent'rt Is accurate, I agree to comply with all applicable local ordinances and state laws relating to bu" ng' =st 10 o zesentatives'of Cupertino to enter the above-identlfie�property for in doses. DateSi--nature.of Applicantl4ent: __ SUPPLE_ NT L Ili ORIS IO_ QUIRED .ruA�cI xE _ ollrinGSLri v= NO MI NY SFD Or Ivlultifz-rnily d��'ell1P.�S: A• y fOr demolition pe,:nit for � R THIrCOU ITER X � �rBIIbD�G�rLiN1�<�E�i existing building(s).,Demolition permit is required prior to issuance ofbuilding _ .EX'P12E"'S5- _r-�"�"-.. �.� - _®�P�..A°i'I'P,tl;•4"TQ`,LtE43E�, - permit for new building. - _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure S6�ARD Porn ifa nyHazardous b6aterials are being used as,part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to �_ nYs Rvisaluc�x submittal of Beildir_g Pernit application. ........... � _nnRo1� z�rsa I?E4zTst. B1d&App_�011.doc revised 06121/11 I CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20085 Northwind Sq DATE: 12/04/2015 REVIEWED BY: Phuong ' APN: 316 38 009 BP#: EVALUATION: $2.,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPES Alteration f Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 GENRES- WORK Install 5 skylights and 4 solar tubes SCOPE �3El 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 De t or addn't info. FEE ITEMS (Fee IZ.esalutinn t 1-053 F..'f. Z 1;"13? FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001 # Skylight Suppl.PC Fee: (E) Reg. Q OT OA hrs $0.00 $788.00 1SKYL>10SF >10 s.f. PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feer Reg. 0 OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (j) No $0,00 Advanced.Planning Fee: $0.00 Select Select Building or Structure Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldjz Stds Commission Fee: IBCBSC $1.00 IBTOTALS�` $9.50 $788.00 TOT Ft $789.50 Revised: 10/01/2015