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15030050-D10203 S PORTAL AVE 15030050 F KAUSHIK SANDEEP AND SHARMA DEEKSHA SCANNED BOX# 688 CITY OF CUPERTINO BUILDING PERNUT BUILDING ADDRESS: 10203 S PORTAL AVE CONTRACTOR: BAY AREA CUSTOM PERMIT NO: 15030050 BUILDERS INC OWNER'S NAME: KAUSHIK SANDEEP AND SHARMA DEEKSHA 1002 S DE ANZA BLVD STE Al DATE ISSUED: 04/17/2015 OWNER'S PHONE: 4083387938 SAN JOSE, CA 95129 PHONE NO: (408) 446-1200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �-T a '. A ( `.ate ADD 492 S.F. TO SIDE & REAR TO CREATE (1) BEDROOM � Licepse tlas Uc & (N) BATH, REMODEL (E) 981 S.F., REMODEL 100 S.F. rj,�a ongw "i,l�!�"- S Contractora'a �i�i?K<!�y 6'Dater i &RE MODEL 120 S.F. KITCHEN I hereby affirm that I am licensed under the provisions of Chapte'I•'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 Sq. Ft Floor Area: Valuation: $140000 erformance of the work for which this permit is issued. nave 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: 36909001.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION acertify 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the / / ��/V ��/�/y Issued by Date: 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. • s �. - r a n4� r yy;ytti'_ .fir �. � L �J 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 I, as owner of the property, or my employees with wages as their sole compensation, wiI I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, 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. I will I 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(a) should I 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 Municipal 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, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this hr 7.x 6ii1 ��, x Owner or audio"""rized`agent., � a.:�.-� permit is issued. . 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 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10203 S PORTAL AVE CONTRACTOR: BAY AREA CUSTOM PERMIT NO: 15030050 BUILDERS INC OWNER'S NAME: KAUSHIK SANDEEP AND SHARMA DEEKSHA 1002 S DE ANZA BLVD STE AI DATE ISSUED: 04/17/2015 OWNER'S PHONE: 4083387938 SAN JOSE, CA 95129 PHONE NO: (408) 446-1200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ ADD 492 S.F. TO SIDE & REAR TO CREATE (N) BEDROOM License Class Lie. # D y & (N) BATH, REMODEL (E) 981 S.F., REMODEL 100 S.F. � r� �� err IDa N. :TRUSS CALCULATIONS. ContraEtort EFERR DS SUBMITTAL #1 - ISSUED 8/27/15 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: 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: $140000 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: 36909001.00 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 DAY T 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 _ ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgme costs, and expenses which may accrue against said City in consequence o cy granting of this permit. Additionally, the applicant understands and will mp y ssued b Date: lS / with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 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 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 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. I will I 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(a) should I 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 Municipal 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, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date permit is issued. e7 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 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 CUPERTINO 6 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 0 (408) 777-3228 • FAX (408) 777-3333 • build ing(a)cupertino.org ❑ NEW CONSTRUCTION ® ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10203 S. PORTAL AVENUE APN# 369-09-001 OWNER NAMESAN DEEP KAUSHIK & DEEKSHA SHARMA PHONE 408-338-7938 E-MAIL KAUSHIK SANDEEP@HOTMAIL.CO STREET ADDRESS CITY, STATE, ZIP CUPERTINO, CA 95014 FAX CONTACT NAME SHARVILA PATADIA PHONE 408-410-5946 E-MAIL SHARVILA@GMAIL.COM STREETADDRESS 18801 WOOD DELL COURT CITY, STATE, ZIP SARATOGA, CA 95070 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT IR ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME k" �►W LICENSE NUMBER(? 20 614,q LICENSE TYPE I' BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS /®Q S, Ae �, 2 a f 3 I V� fi CITY, STATE, ZIP J .' C O � I / ` PHONE Lla f_^ 414,1 /_ 12 O f7 ARCHITECTIENGINEER NAME SHARVILA PATADIA LICENSE NUMBER BUS. LIC#(. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE, /U,$ If DESCRIPTION OF WORK THIS PROJECT WILL EXPAND THIS 3 BED, 2 BATH HOUSE TO MAKE IT A 4 BED, 3 BATH HOUSE. THE ADDITION IS MAINLY PROPOSED ON THE RIGHT SIDE OF THE HOUSE WITH SOME ADDITION IN THE KITCHEN AREA. THERE IS SOME INTERIOR REMODELING PLANNED. EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOO A AREA Fo j DEMO AREA TOTAL NET AREA BATHROOM �\ REMODEL ARE V �f V KITCHEN RAn OTHER REMODEL AJtI�� 1./q8' PORCH AREA DECK AREA TOTALDEECCFJPORCH AREA GARAG/EIAREA: ❑ DETACH ❑ ATTACH 1)2,0 # DWELLING UNITS: IS A SECOND UNIT ❑ YES ;E,G SECOND STORY ❑ YES . ADDED? __QND ADDITION? $NO U' PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ,40 IL By my signature below, I certify to each of the following- I am the property owner or authorized agent to a n th a wner's behalf. I have read this application and the information I have pripv.ded is cone I have read the Description of Work and verify it is accurate. agree to comply with all applicable local ordinances and state laws relating to bus ing constructs . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of A b + -gc n . _ a0- 1qzex � SUPPLENTENW&INF gttION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 16 BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal Of Building Permit application. ❑ MAJOR ry/ l�l SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH L4 BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO FM-7 FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10203 s portal ave DATE: 03/06/2015 REVIEWED BY: Mendez APN: BP#: S0 3 D 'VALUATION: 1$140,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 2nd Unit? ` ; Yes '- No OTC? 0 Yes No PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK addition 492 sq ft to to side & rear of sfdwl to include 1 bedroom and bath • remodel kitchen 120 • bath SCOPE (100 sgft); and through out (981sq ft) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 492 r 6 0� IADDPLCK $1,323.00 IADDINSP TOTALS: 492 1 $1,626 00 11 $1,323.00 .. , MECH,,HOU'RLY ;� Yes No ��.. �.,. PLUMB, FIOURLY �. Yes No ELEC, HOURLY ®,Yes -No _ ti. Nfech. Plan (.'heck FT Plumb. Plan Check Elec..Plan Check :Lteclr. Permit Fee: Plumb, Permit Fee: Elee. Permit Fee: Other dlech. Insp. Other Plumb Insp. Other Elec. Insp. Adech. Insp. fee: Plumb. Insp. Tee: Elec. Insp. fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 fff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,626.00 120 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 F-9-8-17 s.f. $647.00 Remodel, Other IREMRESOTH i Permit Fee: $1,323.00 Suppl. Insp. Fee:(D Reg. Q OT 0.0 hrs $0.00 = s.f. Remodel, Bath (<=300 sf) $645.00 IREMRESBAT PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $68.88 Select a Non -Residential Building or Structure E) 0 i 7'rcwel Documentation Fees: Strong Motion Fee: IBSEISMICR $18.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS:' $3,042.08 $1,937.00 TOTAL FEE: $4,979.08 Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10203 S PORTAL AVE CONTRACTOR: BAY AREA CUSTOM PERMIT NO: 15030050 BUILDERS INC OWNER'S NAME: KAUSHIK SANDEEP AND SHARMA DEEKSHA 1002 S DE ANZA BLVD STE A I DATE ISSUED: 04/17/2015 OWNER'S PHONE: 4083387938 SAN JOSE, CA 95129 PHONE NO: (408) 446-1200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ADD 492 S.F. TO SIDE & REAR TO CREATE (N) BEDROOM License C �e r� Lic _ — & (N) BATH, REMODEL (E) 981 S.F., REMODEL 100 S.F. �Y-1 �, Contractor�� .a.F*r a r �'a"t� .� l & REMODEL 120 S.F.KITCHEN. . -�...� I hereby affirm that i am�hcensed under the provtsrons of Chapter 9 3 Rat- R3�:•� 4, _..,r.J..� 5/18/15-- REV 1- RE SE%CORRECT3LA YOU$��FfT t4DD)A 1XiIr SIDI 4-S (commencing with Section 7000) of Division 3 of the Business & Professions IG ICO. II R (e�' �U'�L') r1aB �` v`Qo -T RUED Code and that my license is in full force and effect. 5/ 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 Sq. Ft Floor Area: Valuation: $140000 pe ormance of the work for which this permit is issued. ave 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: 36909001.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION $>c ify 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 WIT�IIN 180 DAYS OF PE T 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 'S/ 3 . ,� / /� granting of this permit. Additionally, the applicant understands and will comply •� Issued by; _ �j�i'! T Date: f / _ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ° - Signature. "-..: a1 Krr< ?>;` == '-.Date 'fp•' " — `� 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 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. I will I 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(a) should I 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550 , Section 3700 of the Labor Code, for the performance of the work for which this -'= y T ° b =;" - '' r '' Owner or authorized agent: Date: U L permit is issued. 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 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 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ° BUILDING DIVISION 10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 ° building( a�cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI W REVISION / DEFERRED ORIGINAL PERMIT 4 f 5 0 3 �f7SQ PROJECT ADDRESS 16 -TAU ,%� /,jam' (i (� 61 APN # � & q —0 q —f/10 I vMAI/L P�JHOLNE QR .� �j����� OWNERNAME _1 4l �fl�`� U �V �� 3 8®1 1� STREET ADDRESS �� .j J � J�l` A-01) E ° CITY TA T a y� o FAX CONTACT NAME i IIAPVI LA- PAM-DI A PHONE 0B^ +10 - ` % E-MAIL 11 J _A @ L� 1`•�/Il V (� 6 r Way i )44 ( / [ STREET ADDRESS 10861 v1❑/ U CITY, STATE, ZIP � /� yah . � `rj C9 VVV❑ FAX ❑ OWNER ❑ OWNER-BUIIAER OWNEERRAGENT ❑ CONTRACTOR ❑ CONTRACT•ORRA/G`EINT(((///��111 ARCHrIECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTR�Tp�tNk� �n I ^ q O LICENSE NUMBER ((ANY�J((N���� ((A (� (� f \ LICENSE TYPE BUS. LIC # COMP E E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONEQ (� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK CA S �Jelt J c �� �i Q, 0t r`0'11� Q CA4 �II Q_ i 4 w, lU4,ha71 -�k � EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATrACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDrrION? ❑NO PRE -APPLICATION ❑1BS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - D' - s. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNIIJG APPROVAL LETTER EICHLER HOME? ❑ NO W By my signature below, I certify to each of the f0llowin I am the property owner or authorized agent to act o properly owner's behalf. I have read this application and the information I have prov' d is corre . I have read the Description of Work and veri accurate. I agree to comply with all applicable local ordinances and state laws relating to b const cti I aut orize representatives ofCupertino to nter the above�-'dent fi property inspection purposes. " J Signature of Applicant/Agent: Date: SUPPLEMENT FORMATION REQUIREDPLANc>cxTYP 1] OVER TH�CO17t�TER ��� ❑ B PL ,REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 4> permit for new building. ExPRssA 'w x❑ rP� �IEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �i sTANnARD x �Q t form if any Hazardous Materials are being used as part of this project.�M Copy of Planning Approval Letter or Meeting with Planning prior to , submittal of Building Permit application. Ivrax <� *� " sTRrcT -�k�,k T xr O . N1x.',�IFA' WI' BldgApp_2011.doc revised 0 612 1/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10203 S PORTAL AVE DATE: 05/18/2015 REVIEWED BY: MELISSA APN: 369 09 001 BP#: 15030050 *VALUATION: Iso %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: A WORK 5/18/15 - REV # 1 - REVISE/CORRECT LAYOUT ADDITION TO RIGHT SIDE TO MEET ACTUAL SCOPE SETBACK REQUIRENIENTS ,leech. Plan Check Plumb. Plan Check- flee. Plan Check Mech, Permit Fee: Plumb. Permit Fee: Elec, Permit Fee: Other Alech. Insp. Orleer Plumb Insp. Other Elec. Insp. 14ech. Insp. Fee: Plumb. hasp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. 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'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 10.01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Contraction Tax: Administrative Fee: Q G Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel Documentation Fees: Strong Motion Fee: $0.00 1.0 hrs Inspections $143.00 ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 $0.00 $429.00 AL FEE. $429.00 Revised: 05/07/2015 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aQcuuertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION SIONJ95ERM ORIGINAL PERMITn S 50050 PROJECT ADDRESS' a RD APN # ' V/fa kAx"� OWNER NAME PH O � c/ 7 � 1E^�IL �—fin `7N� 3 v�f1 �17 *'r N STREET ADDR;:'Z'z + t CITY, STATE ZIP FAX CONTACT NAME „( % PHONE E-MAIL ! FLU STREET ADDRESS•, CITY, STATE, ZIP FAX ❑ OWNER ❑• OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑'ENGNTEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /Iy LICENSENlRdBE ^LICENSETYPE BUS. LIC4�` qQ l (� A'Y if i, 6 ` COI,fPANYNA,S E-MAIL J r FAX ✓e o ' +1 © G t C P a 1" STREET S CITY, STATE, ZIP PHONE ,L + t 03e— 6 ( ac ARCHITECT/ENGINEFR NA ME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EMS71NG USE PROPOSED USE CONSTR. TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA •- BATHROOM KITCHEN OTHER REMODELAREA REMODEL.4REA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDFTACH ATTACH m DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YESBEING ADDED? NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN [-].YES g TOTAL V TION: PLANMNGAPPL: ❑NO PLANNING APPROVAL LETTER EICHLERHOAIE? ❑NO 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 have pr ," " correc . he Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating -to ']ding construction. I authorize re r entatives'of Cupertino to enter the above -identified property for inspection purposes. SigrlatureofApplicant/Agent: Date: (j — SUPPLEMENTAL INFORMATION REQUIRED rP%Ax eclr� PE _ NICE New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building k� �*04ERTE��OUhTER _ n : c BUIIDLM1�GPL4NREVIEFit. w st �� r permit for new building.fl > xrxEssi -� ❑ Prnn1T.G€Lt�R> YrEFy _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure it DARDs ;` r ❑ rltcyR6�xs k` form if any Hazardous Materials are bein.c, used as part of this project. ' t} � �` t �� Copy of Planning Approval Letter or Meeting with Planning to �`2t-R(i1•r��� � � 4 P'1� �IRE'DEP� r � ey. ;�' �+ _ prior fl�Mti70R F 1]�SAnTP}LRYSERRDISTRI submittal of Building Permit application. ,;1� _EI�FurlioxASENr4txEav'T�t��� LZT Bld,aApp_2011.doc revised 06121111 WN, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION s� ADDRESS: 10203 S Portal Ave DATE: 07/21/2015 REVIEWED BY: Sean APN: BP#: 15030050 -VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 GENRE WORK Deferred Submittal #1: Truss Calculations. SCOPE Ifech. Plan Check Plumb. Plan Cheek Elec. Plan Cheek rbtech. Permit Fee: _L��j Plumb. Permit Fee: Elce. Permit Fee: h• rllech. Insp. [14'e,l'e 011ur Plumb Insp, Other Elec. Insp, :. Insp. Fee:P_ Plumb. hup. Fee: Elec. Insp. Fee: I NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addh7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Deferred Submittal I $286.00 IDEFSUBM A Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 2 Building or Structure i Trcwel Docuinentallon Fees: Strong; Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 - SUBTOTALSry " $0.00 $286.00 TOE AL EEE,': $286.00 Revised: 07/02/2015