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15090069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10067 JUDY AVE CONTRACTOR: JAHAN CONSTRUCTION PERNIIT NO: 15090069 OWNER'S NAME: KHANNA SANDEEP AND TARUNA TRUSTEE P O BOX 2494 DATE ISSUED: 09/23/2015 OWNER'S PHONE: 6507766304 MORGAN HILL, CA 95038 PHONE NO: (408) 375-9694 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ License Class— j Lie. # 1/1 9-0 k9_0 CONSTRUCT ONE STORY ADDITION (225 SQ FT); INTERIOR REMODEL (325 SQ FT); DETACHED GARAGE ADDITION (173 Contractor n ,aq_arjut, S.F.) 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: t. l have and will maintain a certificate of consent to self -insure for Worker's Sq. Ft Floor Area: Valuation: $80000 Compensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 36507048.00 Occupancy Type: 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is WITHIN 180' DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating to building construction, hereby 180 DAYS FROM LAST CALLED INSPECTION. and 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 Cupertino , Issued by: it /✓ 43190 of against liabilities, judgments, Date: 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. Signature_ Date q,9 33 1f— 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 Applicant: Date:. 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 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 (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: permit is issued. Date: 3. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City inconsequence 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. Signature Date CUPERTINO n NEW (_0VJRTRTIrTTn'nT CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 -building (a)cupertino.org n \Trrr_ r i r—I --- ,_, ­" , 11 u rc mvIJTv1v / L)I-IkhEyx ) UkAiINAL PERMIT 9 PROJECT ADDRESS j j rtlt0 J ! elU L' Avee APNR 3&1;-`o? —o7S 0WNERNAME11 S I _ PHONE ]^ r-1 ry ` �r r� 6 17l 6 —el 7v� EMAIL �� � i 7 R e f C STREET ADD S CITY, FAX !J d- lug C'<I CONTACT NAMEr'�- PANE E_a II A tJt� 14 2 J D t) f I ij 7 — �' Gti.!' o �`i -?Co }YIeL� e' a STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑, OWNER-B=ER ' ❑ Ou'NERAGENT LI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑-ENGA*EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME w LICENSENUh4BER LICENSE YPE J��#4 f�,�l�°a BUS.LIC COMPANY NAME y E-MAIL gAX STREET ADDRESS, f� CITY; STATE, ZIP r e > /p //{} PHONE N'03W_-'7671 ARCH[TECT/ENGI1,MER NAME LICENSE NIJ1,11BER BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHOT tE DESCRIPTION OF WORK P 140 Q1 W., it v li7 ° a - E)aSTINaYSE PROPOSED.14SE - j%� CO�NS�TTZ TYPE 9 STORMS - - USE - TYPE ( OCC. I SQ:FT. VALUATION (S) AREA/v.�� AREA �Cd 5 EMO DARER TOTAL NETARF_.4�l-y ✓. BATHROOM KITCHEN OTTMR _ REMODEL AREA REMODEL AREA REMODEL AREA 3� f� 03 F ar 32 -j PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - I [] ATTACH I DWELLING UNITS: IS A SECOND UNIT l]YES SECONDSTORY []YES BEING ADDED? NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANM'G APPL # L?P0 PLANNLNG APPROVAL LM-rER IS THE BLDG AN ❑ YES EICHLER HO ME? ❑ NO OEj Y� _ 0 TOTAL VALUATION: 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 have read this application and the information I ha-ve provided is 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 relaf Q to building construction. I authorize representatives -of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant Agent: ` ^ Date: • SUPPLEMENTAKATFORAiATION REQUIREDgg .� ��PIrAhCHECFZ�S�E���� I����'� .. 320UT�GSL�,�;=,. ;_�r New SFD or Multifamily d«>ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building_ IF O��RTH?lCOTJvTER T3T7ILDL�GPL4NREVZEEY� permit new building II it f • Commercial Bldg: Provide a completed Hazardous Materials DisclosureH �T4ADARD > TaBLTc�o , _ form if any Hazardous Materials are being used as part of this project. GG7 F_ D�I�zr Copy of Planning Approval Letter or Meeting with Planning prior to Building Permit zR�=zIS ptr 15 ©���R DEQ. submittal of application. �...... ._.�,r--,:�� Bldg.4pp_2011.doc revised 06/21/11 a CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10067 Judy Ave DATE: 09/1112015 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHEC9 TYPE:, Addition PRIMARY SFD or Duplex 2nd Unit? 0 Yes Q No PENTAMATION IR3SFDADD USE. OTC? 0 Yes (F) No PERMIT TYPE: WORK C nstruct one story addition (225 sq ft); interior remodel (325 sq ft). SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA ( S -f) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-8,111-B,IVY-B 225 $1,091.00 IADDPLCK $1,057.00 IADDINSP —A $0.00 Permit Fee: $1,057.00 Suppl. Insp. Fee -.ie) Reg. C)OT " 0.0 hrs $0.W PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 225 $1,091.00 $1,057.00 Iilfecb. Plan CAteck Alech. Peralil Fee: I 011ier Alec/ -I. frup. Plumb. Plan C'hedli Plumb. Pernfif Fee: Other Plumb frisp. '14ech. fils'p. Fee: I Plumb. h7sp. Fee: NOTE.- This estimate does not include fees due to other Denartments &e. Planning. Elec, Plan Check E-lec. Permil Fee: 0 't il.er I1-'lec. linp. Fee: Works, Fire, Sanitary Sewer District, School T•➢otrJnt osn 1 716— f— —11 "rO A"117 "" OC61"OtO rn"h7l-t the DOW far addnl iHio. FEE ITEMS (Fee Resolution 11-053 gE 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 F —3-2-5- - 1 s. f . $503.001 Remodel, Other IREMRESOTHI Suppl. PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,057.00 Suppl. Insp. Fee -.ie) Reg. C)OT " 0.0 hrs $0.W PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consio-I'letion T-71 Administrative Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $31.50 Select a Non -Residential Building or Structure G 0 TraVel Doeuineniahor if ecus`: Strong Motion Fee: IBSEISMICR $10.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 $2,193.90 $503.00T(1<TAL FEE $2,696.90 Kevisea: ut/u/-//-u10 „F S U'VA. September 8, 2015 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014-3255 Subject: 10067 Jody Avenue, Cupertino, CA 95014 To Whom It May Conc rn: i Please be advised that the proposed main dwelling unit as referenced above will not have an adverse impact on the City of Sunnyvale sewer system. Please call me if you have any questions at (408) 730-7285. Very truly yours, Manuel Pineda Director of Public Works 'I I Marjorie C. Estavillo Casual Professional