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140701341) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 14233 OLD WOOD RD DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 SARATOGA, CA 95070 PHONE NO: (408)390-5577 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL 6-7 CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); License Class /� Lic. # %�C7- ATTACHED GARAGE (400 SQ FT). Contractors Date I hereby affirm that I am licensed under the provisions of Chapter 9 DEF # 1 - ROOF TRUSSES/CALC'S - ISSUED 7/27/15 (commencing with Section 7000) f Division 3 of the Business &Professions Code and that my license is in full force and effect. l REV # 2 - REVISE LOW ROOF FRAMING FOR TRUSSES - ISSUED 7/27/15 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $600000 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. APN Number: 35931038.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature / � Date RE- r ROOFS: any 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous 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 25 5, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. -- / y Owner or authorized agent• �1 Date: b 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 Lender's Address APPLICANT CERTIFICATION 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 CIlPERTItltO, (408) 777-3228 • FAX (408) 777-3333 • build ingancuuerlino.org ❑ NEW CONSTRUCTION n AnnTT,nN I ' I T T�4 % TT(IT.T runr LiC J_J V1ClUT1VAL Y1r1ZMIT PROJECT ADDRESS®� ,g A.PN R ' -7 / r 0 3 Y, OWNER NAME PHONE STREETADDRESS CITY, STATE, ZIP FAX E-14A]L CONTACT NAME I PHONE 4V,110V L/ STREETADDRESS CITY, STATE, ZIP FAX OW1ER ❑. OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGIMIMR ❑ DEVELOPER ❑ TENAN-r CONTRACTOR NAME LICENSENUTABERp�® LICEN � E� 524 BUS. LIC R A. COMPANY NA1,S E-MAIL I FAX STREET ADDRESS e ems/ CITY, STATE, ZIP _50 g sr•�� qyb P� ARCHITECT/ENGINEER NAME LICENSE MUMMER BUS. LIC,", COMPANY NAME __t E-MAIL FAX -- STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE STORIES Jf N fr { USE -%PAF 4�jG��Oy ),SQ, U:4LUATIOI,!•(5) EXLTG NEW FLOOR DEMO TOTAL � F AREA AREA AREA NET AREA OTBATHROOKN HER REMODEL�ARFA ML.4REA REAODELAREA J&PORCHAR _i , DECK AREA TOTALDECK/PORCHAREA GARAGE AREA; 0 DET - H ' ❑ ATTACi mDWELLINGUhTIS: ISASEGONDUNIT❑YES SECOND STORY ❑1ES Y BEING ADDED? 1_5 ONO ADDITION? ONO ALUATION: PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNINGAPPLR ONO PLANNINGAPPROVALLErTER I TS THE BLDG AN p .� EICHLERHOTIE? kss� - �.. By my signature below, I certify to each of the following: I am the property ol;mer or zuthorized agent to act on Iiy ov ner's behalf. I have read this application and the information I have provided is correct. I have read the Description of �TTork and verify it ' curate. I agree to comply;vith zll applicable local ction. I authorize rrepresentatives'of Cupertino to enter the above -identified property for inspection purposes. ordinances and state laws relating to buildW__ Signature of Applicant/Agent:10-11 a Date: SUPPLEMENTAL INFORMATION REQUIRED = 1YiHE_ — New SFD or Multifamily dNvellings: Apply for demolition permit for existing building(s). Demolition permit is required to issuance building -- OG RTICO[1IISER �BUIIDHIGP) AIQRE«;* a prior of permit for new building. k�SiES�s �� E� I1i�jI�GPLt�4�ZEW�. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosures�+�aRD� 4 1�PI�s c olixs.� form if any Hazardous Materials are being used as part of this project. _ 7 p �i�r azo S 4 _ Copy of Planning Approval Letter or Meeting nwith Planning prior toT ` t��{. submittal of Building Permit application. ' • 5- 524 �' ��SA�IIT3iRsE$SIs4 . I< �.. �_ Gam•. '?.��"_ `i�.,� MOM- axa�l�.4•�ia7. �vn � �I'i'Y.IItOIs'ME 2tiL HEATT'SIr. ��? Bldg-App_2011. doc revised 06121111 H CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 14233 OLD WOOD RD DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 SARATOGA, CA 95070 PHONE NO: (408)390-5577 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class q L'Lg Lic. # ��� CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); PQ- .52� ATTACHED GARAGE (400 SQ FT). Contractor Date /3 DEF # 1 - ROOF TRUSSES/CALC'S - ISSUED 7/27/15 I hereby affirm that I am licensed under the provisions Zf Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. REV # 2 -REVISE LOW ROOF FRAMING FOR TRUSSES - ISSUED 7/27/15 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: $600000 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. APN Number: 35931038.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. r �, Signature Date *% 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Z permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION, 61 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)_cupertino.crg LUPE T[NO NEW CONSTRUCTION ❑ ADDTTION ❑ALTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT # lYU.� vI y PROJECT ADDRESS �a�' APN # S'eZ-Glw OWNER NAME PHONGEdf IL E-MA�e h ���(.IkuG ,� ib �� GGG l STREET ADDRESS© CITY, STATE, ZIP o FAX 8 J CONTACT NAME fipt, V I PHO 6s r S J T i STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ ONWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / LICENSENUMBER ^L i LICENSETYPEqI6,C BUS. LIC# COMPANY NAME�S7 E MAIL �L FAX�bp ZI lives L% STREET ADDRESS /CN6� Lell CITY, STATE, 71P _ G A iO �/, (/N PHONE wog O�S� ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LICC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK L'cv CI%J 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 DECKJPORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEINGADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN 11YES VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO int By my signature below, I certify to each of the following: I am the property off or' to a - e property owner's behalf. I have this application and the information I have provided is correct. I have read the Description ork an r1 itis accurate. I agree to comply with all applicab e -local ordinances and state laws relating to building cons tion. I a thorize re sentatives of Cupertino to enter the above -identified property for inspection purposes: Signature of Applicant/Agent: Date: / SUPPLEMENT L INFORMATION REQUIRED P c Yr _ > _ � h 32ouTIIv S ,rW! : .� New SFD or Multifamily dwellings: Apply for demolition permit for ,�. rs' x 103..-!_"," '-: v-' y'k [.' }"'a kr. .8 i rr�.T p ovEx TH><Coun7 R"� fa + Y - UJLDAVGPLANI2EVIER ' existing building(s). Demolition permit is required prior to issuance of buildingx Rr { 3 v permit for new building, yC� xExPREss �> aliNAFivI> yv ryi k�' `fir `.I�'.��� 'f�hL'tia�" Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Cla AxD �e ; P�IIBC wo11ucsu � s g4 _ form if any Hazardous Materials are being used as part of this project. p .<{ I`I] �� �.rFiiiEA Ti,x�A Copy of Planning Approval Letter or Meeting with Planning prior to4ivni7oxs� 11RZi -y� IZ `•�f�t {Y Ll' � �� i Y,g�R ISTTci'h y _ submittal of Building Permit application.�� BldgAppjOl 1. drevised 06/21/11 d- CITY OF CUPERTINO If V V -V -Ucrrnvr A TnR _ RT TTI ,DIRT(,, DIVISION NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - - 1bl dare onl an estimate. Contact the DePt or addn'l info. District, etc.). These Ty are based on the rehmma FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) A. • J J "ii --- v Phinrb. Plan Check Elec. Plan Check a.9ech. Permit Fee: ADDRESS: 1102 STEEPLECHASE LN I DATE: 05/18/2015 REVIEWED BY: MELISSA lia APN: 359 31 038 BP#: 14070134 "VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex r— c....;mmj .V~,Pr District. School PENTAMATION 1GENRES PERMIT TYPE: USE: Permit Fee: Suppl. Insp. Fee:E) Reg. Q OT Q.0 hrs $0.00 $0.00 WORK 5/18/15 - DEF # 1 - ROOF TRUSSES/CALC'S PME Unit Fee: SCOPE PME Permit Fee: NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - - 1bl dare onl an estimate. Contact the DePt or addn'l info. District, etc.). These Ty are based on the rehmma FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) ilfech—Plan CheckILL Phinrb. Plan Check Elec. Plan Check a.9ech. Permit Fee: Plarmh. Permit Fee: Elec. Permit Fee: Other iilech. Insp. Other Plumb Insp. LJ Other Elec. Insp. �11�:ch. Insp. Fee:l Phmmb. Ins Tet:: Llec. Insp. P•ee: $0.00 ■d7-1— r— c....;mmj .V~,Pr District. School NOTE: This estimate does not include fees due to other Lepartmenis ( %L-. r�u.�.....�, Y K�..� .. �•,��, _ •• �. --- - -- - - 1bl dare onl an estimate. Contact the DePt or addn'l info. District, etc.). These Ty are based on the rehmma FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) [n ormation ava[ FEE a e an QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $286.00 Deferred Submittal 1DEFSUBM Suppl. PC Fee: Reg. Q OT 0.0 PME Plan Check: hrs $0.00 $0.00 . Permit Fee: Suppl. Insp. Fee:E) Reg. Q OT Q.0 hrs $0.00 $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,onsfit uetion Tax: Administrative Fee: E) Work Without Permit? 0 Yes ( Advanced Planning Fee: No $0.00 $0.00 Select a Non -Residential Building or Structure E) 0 A T raivl Docuinenlalion Fees: Strong Motion. Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS . $0.00 $286.00 TOTAL FEE 2 Revised. 05/07/201 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 21831 ALCAZAR AVE DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 CUPERTINO, CA 95014 PHONE NO: (408)390-5577 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL r_1 COMMERCIAL CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); License Class Lic. # �I �OS2' ATTACHED GARAGE (400 SQ FT). Contractor S ..n/ Date .P11 REVISION #1: RECONFIGURATION OF BATHROOMS AND 41 I hereby affirm that I am licensed under the provisions of apter 9 LOCATIONS; ADD COLUMNS AT COVERED PORCH; (commencing with Section 7000) of Division 3 of the Business & Professions REVISE WINDOWS IN GUEST ROOM. ISSUED 4/17/15. Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: �� � l/ 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: $600000 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: 35931038.00 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the B �� Date: granting of this permit. Additionally, the applicant understands and will comply Issued by: , with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. f 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. / 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 COMMUNI IY DEVELOPMENT DEPARTMENT • Br~UrIL�7DINMWFD.10y��1 10300 TORRE AVENUE • CUPERTMO, CA 95014=32'5 < (408) 7.77-3228 • FAX (408) 777-3333 ° buildino(cDcupertino.org. CUPERTIN n NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI IJ REVISION / DEFERRED _ _ ORIGINAL PERMIT 4 _ PROJECT ADDRESSI APN 4 �j r 3 i 0--2,'8 t�oa s �e- I ��s� �� OWNER NAME , PHUNE E-MAIL �r� r� :J Q A �GLd'�j 2a l� I G6 6 —6 m� Esc STREET ADDRESS' I CITY, STATE, ZIP. FAX ' i PHONE. E-. Ad _ CONTACT NAMEIL 'D +✓c: Olt- �� Glen ran 1 I t� c� )---;3.Q 6 � n -I nc�rri mall ry STREET ADDRESS--- CITY, STATE, ZIP FAX Loar1e__ C �C�So7� OWNER '` '❑ ONNER-BUft_DER"' ` ' Cl O\1INERAGENT' ❑ CONTRACTOR ❑ CONTRACTOR AGEkT ' ❑ 'ARCiITECT ❑ ENGINEER ..,.DEVELOPER ; ❑. TENANT COWDACTOR NAMEI LICENSE NTUMBER LICENSE TYPE �i3�ic4�y J �nc0� ot10 0 6 C.— BUS. LIC m COMPANY NAME I � i is _S 4"v [_ � I �'1 E-MAIL FAX STREET ADDRESS ® CITY, STATE, ZIP PHONE ARCHITECTIENGINTEERN.A.ME I LICENSE -NUMBER BUS. LIC' COMPANTTY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE yoV Q i DESCRIPTION OF WORK P�Y 3_v+e_ r i o r v t u-1 gv c-sfi 6c.,,�ro o ars � CjGs .moi a yj r�J oc_a_ti b-rN 1 EXISTP..GUSE PROPOSEDIISE CONSTRTYPE STORIES USE TYPE OCC. I SQ.FT. VALUATIONS) EXISTG AREA NEW FLOOR DE1d0 AREA AREA ---— TOTAL NET AREA TT BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCB 4REA DECK AREA TOTAL DECK/PORCH AREA GARAGE• AREA: ❑ DETACH ❑ ATTACH DIWELLD.GUITI'S: ISASECONDUNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRP•APPLICATION ❑YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ YES§nn F r _ Og - cam- g',mij RT TOT��?/T�11014; -E ORO PLA�'A7NGAPPL� E] NO PLAATTDSGAPPROVALLETTER I EICHLERHOME? ❑NO ff S'a_'� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o%vner's behalf. I have read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con ruction. I authorize rep sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: RED f HM PLAT\ CHECK YPE SUPPLE.MEN AI, II,rFORMA.TION REQUI0. x.3•.3° 2 _ p ar �1ti�r�'�`{Tp. '3. Y�'4•, ' New SFD or Multifamily dwellings: Apply for demolition permit for DESgirCOTJ�TE� 4I `BLILD'cL v y N �. existing building(s). Demolition permit is required prior to issuance of building s _ � z r RT ? r �abt6`,tp 4 F �ExP�tEss w ^�`-r 41tRE LER permit for neva- building. 6 — " Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ZBLi � x' 4 uff _ form if any Hazardous Materials are being used as part of this project. � � xs -- t 7REDEPT RKWO : ONO Copy of Planning Approval Letter or Meeting with Planning prior to _ o 11?AJOR� £` trams t--. submittal of Building Permit application. BldgApp 2011.doe revised 06/21/11 ������ CITY OF CUPERTINO 111<Y''�f//�il 1 F.F. FQT><MATn12 _ R1T11.D1rNC. DIVISION M1 ADDRESS: 1102 Steeple Chase Lane DATE: 04/17/2015 REVIEWED BY: Sean Plan Check Fee: Hourly Only? 0 Yes (j) No APN: BP#: �,� *VALUATION: $o *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex $0.00 PENTAMATION PERMIT TYPE: 1GENRE WORK REVISION #1: RECONFIGURATION OF BATHROOMS AND LOCATIONS' ADD COLUMNS AT SCOPE COVERED PORCH; REVISE WINDOWS IN GUEST ROOM. ;Lech, Plan Check Plumb. Plan Cheek I-lec—Plan Check ;Lleeh. Permit Fee: Other AIec•h. Insp. ditch. Insp. Fee: Plumb. Permir Fee: Other Plumb 7nsn. Plumb. he p. Fee: Elec. Perrnir Fee: Other- Llcac. Imp. Oec. Insp. Fee: NOTE: This estimate does not includefees due to other uepartments (tie. manning, ruotic Frorns, L'lre, ounuury ucwcr LLJLI.1., _ ___,�______ ___ ...,t., .,.. .._ __. ___� _.�,..:.,.. ,...,.a,.r.t,. ,..,,t nor;....,Ie !'nnlnrr the Aunt for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E{f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 1 hours Plan Check, Hourly $143.00 1STPLNCK Suppl. PC Fee: ID Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C) OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i.OMP'L1Ct10Y1 7 (TY: A.r:lrninistrative Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure � Travel Doc wnenlalh-)n Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALSc= $0.00 $143.00 ' TOTAL FE `' $143.00 Kevisea: u4mi/zu,5 CITY OF CUPERTINO BUILDING PERMIT —7 BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 21831 ALCAZAR AVE DATE ISSUED: O1/27/2015 CUPERTINO, CA 95014 PHONE NO: (408)390-5577 OWNER'S PHONE: 4086672446 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); License Class Lic. 4 l eros 2q ATTACHED GARAGE (400 SQ FT). Contractor L'Zq Date 1120-11 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 Valuation: $600000 erformance of the work for which this permit is issued. Sq. 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: 35931038.00 Occupancy Type: tp ermitt 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 WITIIIN IQn � �i Ei RMIT ISSUANCE OR to building construction, and hereby authorize r6presentatives of this city to enter Iii" 180 DAYS OM CPALLED INSPECTIO upon the above mentioned property for inspection purposes. (We) agree to save I. indemnify and keep harmless the City of Cupertino against liabilities, judgments, p costs, and expenses which may accrue against said City in consequence of the 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. RE -ROOFS: Signature Date 2 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1, 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 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 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 �lcontaminants compliance with the Cupertino it Qu pal Code, ality Management District I 2 and performance of the work for which this permit is issued. the Health &Safety Code, Sections 25505, 25533, and 25534. 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: In/Date:—% 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 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 nXT r__1_ AnnT7'7nXT n AITTZPA-rmTKT/TT n RFv1C7C1N/DEFERRED OPIGINALPERMIT4 r� .. PR IECf ADDRESS , I > • i - APN/ '5j / fi`�in 9' Cr H OWNERNAME F ( STREET ADDRESS �C I CITY, STATE, ZIP I FAX CONTACT NAME '. 3 \ J. PHOPI�I E-MAIL l T.R I F�YY HJT ' . STREET ADDRESS —A p g � G CITY S�i�^ �ZIP ` s' 1 P F �B' -3 33 — � i /O Ey Lr �F��- ' ❑ OWNER ❑ OVNER-BUILD�ERR ❑ ONT'ERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT M ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONRRACrOR NAME T6 9 I LICENSE NUMBER LICENSE TYPE BUS. LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE a ARCHlTECT/ENGINEERNA14E 1� LICENSE NUMBER � 13 •� BUS. LIC COMPANY NAME 113f94 @ E-MAIL FAX STREET DDRESS I ( �% CITY, STATE, ZIP }� t (frq PHONE �J}Qp{ �p�y L_q - V DESCRIPTION OF WORK E 1sn1\,G USE y PROPOSED i EE CONSTR. TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) AREA NEwFLOOR ` DEMO TOTAL AREA AREA � �,°!�o01 AREA NET AREA i !�. 0 BATHROOM KITCHEN OTHER AREA REMODEL AREA REMODEL AREA REA40DEL n PORCH AREA DECKAREA TOTALDECK/PORCHAREA GARAGEAREA: D ,ACH ATTACH m DWELLING UNITS: ISA SECOND UNIT ❑YES BEING ADDED? [1N� SECOND STORY ❑ YES ADDITION? ❑NO — —PRE-APPLiC-A-SON—B-I=ES—IF—YES,-PAOYIDE_COP10F LETTER I LDG. YES EICHLER HOME? 2E�EI EUs�Y' .,,"�..?i+*'� z =` s�' `,. -• b� �. ` TOTAL VALUATIONI: PLANNING APPL ❑ NO PLANNING APPROVAL .n �r,4 �.�• , ^', 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 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 relating building co stru Ion. I a�t!rizepresentatives of Cupertino to enter the�ab]ove-identified Operty for spection purposes. Signature of Appl icant/Agent: Date: T iv 4 1 ,-r „�r1 i,t^ vim. .. SUPPLEM TALINFORMATIONREQUIREDPLn�crcxT�� ROUTII�GSLTP_ `` r� yb i Rti ywa n4 t t't� k ..i uL+ 5 -J�.\'01 �"iL.1 , New SFD or Multifamily d,,vellings: Apply for demolition permit for bVER T co>JtyTER r mTivari.GPL R VIEPV K t s� i-rY T t� >t5 existing building(s). Demolition permit is required prior to issuance of building-mss,5drTy ryrl��� 5 , h if51 ermit for new building. '© �.rESS r , YJ4i�G PLI3REVIERi` P f�5x R -+� ��ti' tiT 'W— ra i• i St .h ri`Y _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �sTA�i,D'AxDL{R ' `moi ''� f rJ "` af" form if any Hazardous Materials are being used as part of this project. Y x� f is �, S a J} r y _ Copy of Planning Approval Letter or Meeting with PIanning prior to �'Tvi2';A32I.SEY�RD�ST.RI�t:T submittal of Building Permit application.i BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 21831 ALCAZAR AVE DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 CUPERTINO, CA 95014 PHONE NO: (408)390-5577 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] F-icenseClass CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); Lie. # �' �D� 2�_ ATTACHED GARAGE (400 SQ FT). Contractorn „ . i� i / Date 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: $600000 erformance of the work for which this permit is issued. 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: 35931038.00 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 WI1 RMIT 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=AS OM L ALLED 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 Issued by: Date: 2 �' 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. RE-ROOFS: g iatuz ' # _;c'3.� /'� Date /gm All roofs shall be inspected prior to an roofing material being installed. If a roof is P P� Y g g 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 (See.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(x) 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 �! s I?,dor Date: i 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: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 21831 ALCAZAR AVE DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 CUPERTINO, CA 95014 PHONE NO: (408)390-5577 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); License Classy _ ATTACHED GARAGE (400 SQ FT). Contractor191, REVISII+D 1 E.CONE � ION%OF B� - AND 10V I hereby affirm that I am licensed under the provisions of apter 9 ,HRQO LO TTO S'v VIR CO i7�A 3 O FRET) ©R ' (commencing with Section 7000) of Division 3 of the Business & Professions,*' " ` ' ' REVISE.WINT)O,�?1�5�''lNow"-�Swr O,:k 'ra S ED54(�1 /15. 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: $600000 Rerformance 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: 35931038.00 Occupancy Type: permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION �I e ' 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 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 �Gf� Issued b Y 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. - T' -RE t-:-,..�.1 - �.. _._ -_ - Ste-. -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 1, 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 b P P Y Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534., Owner_ox�altthorrzeilgent:rf '?+'{ Date -S 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. 1 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 E CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 14233 OLD WOOD RD DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 SARATOGA, CA 95070 PHONE NO: (408)390-5577 ' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ License ClassA, Lic. # 9� CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); ATTACHED GARAGE (400 SQ FT). Contractor SAui Date rl m S — *, a ID�O #' 1 dl 10 . , .. k SN711 GA C _ —«ISS ED 7/2ilY I hereby affirm that I am licensed under the provisions f Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions REV # 2 - REVISE LOW ROOF FRAMING FOR TRUSSES - Codc and that my license is in full force and effect. ISSUED 7/27/15 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: $600000 erformance of the work for which this permit is issued. 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: 35931038.00 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ~% RE -ROOFS: Signature Date r, 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 1 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, 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner `_ Date: 7 Z#= permit is issued. or authorized agent:_ 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: 1102 STEEPLECHASE LN CONTRACTOR: JBS CONSTRUCTION PERMIT NO: 14070134 OWNER'S NAME: RAJU KARTHIK AND KARTHIK INDUMATHI 14233 OLD WOOD RD DATE ISSUED: 01/27/2015 OWNER'S PHONE: 4086672446 SARATOGA, CA 95070 PHONE NO: (408)390-5577 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] License Class 04, - ' Z Lic. # 9 -foot G CONSTRUCT TWO STORY RESIDENCE (2540 SQ FT); ATTACHED GARAGE (400 SQ FT). Contractor,Date+r,2,oz/ :7 b/ c --- ;-.-, � ..,... • a , — , DEF # 1 - ROOF TRUSSES/CALL S - ISSUED 7/27/15 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions R�-T''_ WISE=�EOs�6!*>R,O®1F1INJF�DR&RSS,.B' Q 9 Code and that my Iicense 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: $600000 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: 35931038.00 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature / ,a % I'..• Date , = All roofs shall be inspected prior to any roofing material being installed. If a roof is �'TY �,.r installed without first obtaining an inspection, I agree to remove all new materials for inspection. r ❑ 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 255 5, 25533, and 25534. 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 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 CUPI_RTfO, (408) 777-3228 • FAX (408) 777-3333 • building9cupertino.org l� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI �Rr--ZIO DEFERRED r L - ORIGINAL PERMIT" 00 01-3� PROTECT ADDRESS APN R . / ` O 3 v OV NERNAMEA PHONE 1 t-i�aIL E �� U d r i STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME �� ✓ PHONE EMAIL d�-39d -ss� S� � ��- STREET ADDRESS CITY, STATE, ZIP FAX Il OWNSR ❑. OWNER -BUILDER ❑ OWNcRAGENT ❑ CON'RACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINTER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NU744BER �D LICEN EZ BUS. LIC R COMPANY NA1,4E E-MAIL FAX STREET ADDRESS (� /C CITY, STATE, ZIP �� /D / ^ ��� ry _ T vl `'''1 rQ PHOT 8 ���0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC R COMPANY NA-hM E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE DESCRIPTION OF WORK,,qZa s til J \ (� r f`� ic�C7 �• EXISTING USE PROPOSED USE CONSTR TYPE 9 STORIES USE Q. LUATttw'i5) E.XISTG NEW FLOOR DEMO TOTAL j AREA AREA AREA NET AREA 1 - ` XN_ \ BATHROOM KITCHEN OTHER \\\ REMODEL AREA REMODEL.AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DET H E] ATTA g 1 'J M1 m DWELLINGUI`7rS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES t�rJ BEING ADDED? NO ADDITION? No PP.E-.APPLICATION ❑ YES IF YES, PROVIDE COPY of IS THE BLDG AN I]$ - - _ TO ALUATION: PLANATNGAPPL4 nNO PLANNINGAPPROVALLETTER EICHLERHOME? _- By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on rty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it ' curate. I agree to -comply with all applicable local ordinances and state laws relating to building cc ction. I authorize representatives'of Cupertino to enter the above -identified property for inspection purposes. Si pature ofApplicant/Agent: Date: SUPPLEMENTAL D,1FOR1,1ATION REQUIRED HE 3i0UTOC'�SLIP::= New SFD or Multifamily dvvellings: Apply for demolition permit for —- ��BUIIDLr existing buildinQ(s). Demolition permit is required prior to issuance of building otER Talr�oulrTEl_ GPLNREVZEG x:-: permit for new building. _ED,- ExPrl ss Y t L� PL4isLnG2LAn R vow Commercial Bldgs: Provide a completed Hazardous Materials Disclosure jNg PuBicv oxT{s -, _ form if any Hazardous Materials are being used as part of this project. _ � _ � FlizEvEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to _ fl TC47oR 'SAi�'TTARYSESRDTSTRICT -� submittal of Building Permit application.- ,i } Bldg,4pp_2011.doc revised 06/21/11 V4 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (aDcupertino.org ;CUePETING ONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT 9 PRO.IECfADDRESS - APN# r3 J"-9 _ _? / _ OWNER NAME' PHONE E-MAIL 4 G v�./ STREET ADDRESS ® CITY, STATE, ZIP 7 FAX d CONTACT NAME ,} L , PHO E-MAIL �� rC b� J a b STREET ADDRESS ` CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � LICENSENUMBER LICENSETYPEA/LJ,6_ BUS.LIC# / /�OS2^� COMPANY NAME E-MAIL FAX / OjO14/- I N �q 14 O STREET ADDRESS /C� [ CITY, STATE, 7IP - -Vv (/N orf PHO ' `6 pl - O s� �t 74 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. 1 VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA _ - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH E] ATTACH # DWELLING UNITS: ISASECONDUNIT E] YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REP EIJW Do l , AL VALUATION: Fp PLANNTNG APPL # F-1NO PLANNING APPROVAL LEITER EICHLER HOME? ❑ NO MOW zm By my signature below, I certify to each of the following: I am the property oNI or' nt to a e property owner's behalf. I have this application and the information I have provided is correct. I have read the Description ork antg-Mfrily it is accurate. I agree to comply with all applicab 8 -local ordinances and state laws relating to building cons tion. I a thorize regvesentatives of Cupertino to enter the above -identified property for inspection purposes Signature of Applicant/Agent: fi/� Date: / SUPPLEMENT L INFORMATION REQUIREDri ❑ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER THEG0TIRTER� 4 ,}h F, 4�4 BUII,DING PLAN REVIEW ., „� T permit for new building. k i r. ❑,Pa AIaT�GrLA1VREv�EW Commercial Bldgs: Provide Hazardous Materials Disclosure ,f D' ❑ruBLlcwoRxsc a completed srANnaxDyf, r form if any Hazardous Materials are being used as part of this project. L �f Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. wag, B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 1102 STEEPLECHASE LN DATE: 05/18/2015 REVIEWED BY: MELISSA rltech. Permit Fee.' APN: 359 31 038 BP#: 14070134 "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Plumb. hrsp..Fee: PENTAMATION PERMIT TYPE: 1GENRE WORK 5/18/15 - DEF # 1 - ROOF TRUSSES/CALC'S SCOPE .e e NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the prefinmdina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 M. 711113) illech. Plan Check /'110. Plan Cheek Elec: Plan Check rltech. Permit Fee.' Plumb. Permit Fee: Rec. Permit Fee: Other Hech. Insp. Other Plumb Insp.Li Other Elec. Insp. E1_L__ :Llech. Imp. Fee: Plumb. hrsp..Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the prefinmdina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 M. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: 0 Reg. 0 OT, 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(j) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .Tax: Administrative Fee: 0 E) Work Without Permit? 0 Yes 0 No $0.00 Advanced Planniniz Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS,: i $0.00 $286.00 w TOTAL•.FEE" $286.00 Revised: 05/07/2015 g -A ICUPERTINO I NFW CONCTRT]C' CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT' DEPARTMEN BBUILDI§IDIV IO 10300 TORRE AVENUE • CUPERTINO, CA 95. 13355 — B. .(408) 777r3228 • FAX ((408) 777-3333 • buildiinn,gCcDcupertino.org MON I. I AT)T)MnW I AT.TFRA-rinW/TT IVI RRVTSTnN/T)FFFRRED OR]CTTNAT.PFRMT7T V PROTECT ADDRESS. -i (O APN R 7 3 �j C a. ii OV,NNERNAME , PHONE E-MAIL , �a►�-� kro- Q i v 6 d -6 v �, STREET ADDRESS' I CITY, STATE, ZIP. FAX ... CONTACT NAMEPHONEE-., AIL `D2_i� clan actin 1 3 -Z3a 6 e o�erri mai ' STREET ADDRESS -' r rg-- Lo,- CITY, STATE,,, ZIP -gSo-71D FAX 13 6.9 S. �_ S.q n o r� C OWNER '` '❑ OWNER-BUI-DEI "" ' ❑ OWNERAT.NT ❑ CON RACTOR ❑ CON7RACTORAGENT'' '13 ARCHITECT ❑ ENGINEER ...•,tVDEVELOPER- ❑. TENANT CO?viRACTORNAME J n� LICENSE NUMBER LICENSETYPE °t BUS. LIC 4 �r1 GF C) 5 L - COMPANY NAME 3'•a s C-0-6) sfiry C rt i a -r) E-MAIL FAX ® STREET ADDRESS CITY, STATE, ZIP PHONE j ARCHITECTIENGINEERNAME LICENSE NUMBER BU'S. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK F'Q-y I S i 0-Y) E xte- r \ o Y- — c—v l V YY\ n 5— C z C A OQ ) ayx+e-rior - �e,ln�1ic-,--J 5,ves-t a1�room dnSk1 r-0-10c��itrn a-rNJ b' vii •In� o\nr –�o r -1-�I 5 rda W1 :.. .. EXISTING USE PROPOSED USE CONSTR TYPE 4STORIES USE TYPE OCC. SQ,FT. VALUATION (S) — _— EXISTG NEW FLOOR I DEMO TOTAL IT AREA AREA AREA 7 NET AREA BATHROOM KITCHEN OTHER REMODEL AREA RE -MODEL AREA REMODEL AREA I PORCH AREA _ DECK AREA TOTAL DECK?ORCH AREA GARAGE AREA: []DETACH ❑ ATTACH m DWELLING UNIT IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES ' BEING ADDED? ❑ NO ADDITION? ❑ NO PRF -APPLICATION ❑ ITS IF YES, PROVIDE COPY OF I IS THE BLDG AN ❑ YES _-Cgj PLAN?7NGAPPL: ❑NO PLAlt�*nK' GAPPROVAL LETTER EICHLERHOA4E? ❑i�0 € By my signature below, I certify to each of the following: I an the property owner or authorized agent to act on the property owIier's behalf. I have read this application and the information I have 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 relating to building co ructia. I authorize rep sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofAppl Y- gen .Date: SUPPLEMEINTT7AL INFORMATION REQUUtD - _ �OZERTfI1rCO7I�TERBLIID�GPL4i�ERE��\y New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ExrREss j Y r� ar.rnGPixE«Eti; Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sT1.DARD 'PUBLrcivofixs3 �F _ form if any Hazardous Materials are being used as part of this project. K 1' } Copy of PJanning Approval Letter or Meeting dlith Planning prior to ❑ y �>SAI�TTARY'.SEF)'ERDISTRICT `� submittal of Building Permit application. MAJOR F �_.:.�� > n`4s`��.._.r-_ s..:�:- �..� _ •L� E2r�'IItON'T1EI�TA�HE'�I1A_, _U ._�. BldgApp-2011.doc revised 06/21/11 Y) CITY OF CUPERTINO FEE ESTIMATOR — EUILDING DIVISION imADDRESS: 1102 Steeple Chase Lane DATE: 04/17/2015 REVIEWED BY: Sean Plan Check Fee: Hourly Only? 0 Yes (j) No APN: BP#: l3 "VALUATION: iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GEnIRE PERMIT TYPE: WORK REVISION #1: RECONFIGURATION OF BATHROOMS AND LOCATIONS; ADD COLUMNS AT SCOPE COVERED PORCH; REVISE WINDOWS IN GUEST ROOM. Mech. Plan Check blech. Permit Fee: 0/her Hech. Insp. ..9<lech. Ince. Fee: Phvnb. Plan Check Plumb. Permit Pipe: Oilier Plumb Insp, Phinib. Insp. Tee: Elec..Plan Check Vee. Permit Fee: Odwr Glee. Imp. 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 haled an the nreliminary information available and are nnly an estimate_ I'antart the Dent for addn'l info_ FEE ITEMS (Fee Resolution 11-053 E.(f.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 0 hours Plan Check, Hourly $143.00 1STPLNCK Suppl. PC Fee: Q Reg. 0 OT 10.01 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :fax: Administrative Fee: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building Building or Structure 0 Travel Docrcrnentaticrrr Fees: Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission .Fee: $0.00 SiTHTOTALS. ' $0.00 $143.00 TOTAL FEE. $143.00 Revised: 04/01/2015 CITY OF CUPERTINO IM -7, FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 1102 Steeple Chase Lane TYPE OF CONSTR. DATE: 07/30/2014 REVIEWED BY: Sean APN: BP#: e ® *VALUATION: 1$600,000 -PERMIT TYPE: Building Permit PLAN CHECK TAPE- New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes (D No PENTAMATION PERMIT TYPE: 1R3SFD i WORK Construct two story residence 2540 sq ft • attached garage 400 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) II-B,111-B,IV,V-B 2,940 $3,067.05 IR3PLNCK $3,012.15 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,012.15 Suppl. Insp. Fee:(D Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 2,940 $3,067.05 Construction Tax: 1BCONSTAXR $3,012.15 #new units NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, sanitary sewer District, school n:atri,;t otr) Thoco fooc aro hacod nsn tho nroliminaru infnrmatinn available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711,113) FEE P1,11!117b. 11100 (hc:!'A i7ri:. N( 1, C.'r11iA Plan Check Fee: $3,067.05 r)(1.11. 7a; F!!1i'; ;r?5';' E3 Suppl. PC Fee: Q Reg. 0 OT 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, sanitary sewer District, school n:atri,;t otr) Thoco fooc aro hacod nsn tho nroliminaru infnrmatinn available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711,113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,067.05 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,012.15 Suppl. Insp. Fee:(D Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 #new units $667.63 Work Without Permit? 0 Yes Q No $0.00) Advanced Planning Fee: 1PLLONGR $411.60 Select a Non -Residential Building or Structure Select an Administrative Item 0 0 Strong; Motion Fee: 1BSEISMICR $78.00 Bldg Stds Commission .Fee: 1BCBSC $24.00 SUBTOTALS F$7,260.43 $0.00 TOTAL FEE: $7,260.43 Revised: 07/10/2014 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408).777-3228 • FAX (408) 777-3333 •.building ,cu ertino.org CION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGII,TALPERMIT 9 PR ]ECT ADDRESS dol -266 clwt-et o APN / 0 3 -1p, / OWNER NAME qe yy P 1 I ` r— L 13� t lI ,CIIT tY, STREET ADDRESS STATE, ZIP FAX CONTACT NAME � 1 J� � 11 sy PHONE E-MAIL., &q � STREET ADDRFss7V; CITY, STATE, Z A 'tK 1 1 2- F VS -A :�.33 / - ❑ OWNER ❑ 01AINER-BUMDERR ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT N' ARCHITECT ❑ ENGWEER ❑ DBVELOPER ❑ TENANT CONTRACTOR NAME ✓� I LICENSE NUMBER LICENSE TYPE ,7 BUS. LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME 1` e LICENSE NUMBER � � l� [ BUS. LIC � COMPANY NAME fn �I` �„j, E-MAIL FAX STREET D���� CITY, STATE, ZIP PHONE feY��4�1 o DESCRIPTION OF WORK a n 1 e � e E ' STING USE 'VZ PROPOSED � j CONSTR TYPE '� STORIES USE TYPE OCC. SQ.FT. VALUATION + { e a the+ f�V IDEMO i v (S) EXISTG NEW FLOOR AREA AREA -1 ,yD AREA TOTAL NE'rAREA v BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREA REMODEL AREA -76 V VVV j PORCHAREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA:D�r"fACH ATTACH m DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? [ed0' ADDITION? EDNO —PRE-APDLIGA3ION—❑1'-ES—IF—YES,-PROMDF-COE]_OF PLANNINGAPPL: ❑NO PLANNING APPROVAL LETTER �-JS,CHE'.LDG AN YES EHOME? 'CEIlrE �m Y's -; `' -: -- TOTAL VALUATION: RE � u f 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 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 relating building coi Stru ion. I aut rize epresentatives of Cupertino to enter the above -identified operty far spection purposes. 72'7 SignatureofApplicanUAgent: Date: SUPPLEMYNTAL INFORMATION REQUIRED '� °� pig, csEcx ,siiPj.: TVPE New SFD or Multifamily dwellings: Apply for demolition permit for .�'�'OVEIZTAIrCOU1tTER4wr 3a BUII,bL\GPS,4TRE�'SE�v��."`-��y existing building s). Demolition permit is required prior to issuance of building x r permit for new building. 3'4 gQF_`r''v S"-2•,TL�' d,�tr �i� i`�5. � r' �� �.� ,�1�• rr �iS 4�5 � _Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure form if Hazardous Materials are being used as ofthis �s nrtyD ��'Y�a,� pusLT�cwocsX f any part project. � U." zx J _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 4„i�p�[AJDR $ ��i SA2�ITAT2I sERERDIST.RICn BId.-App_2011.doc revised 06121111 CITY OF CUPERTINO WE FEE ESTIMATOR — BUILDING DIVISION imADDRESS: I IOUteeple Chase Lane TYPE OF CONSTR. DATE: 07/30/2014 REVIEWED BY: Sean APN: BP#: / *VALUATION: 1$600,000 `PERMIT TYPE: Building Permit PLAN CHECK T PE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes E No PENTAMATION 1 R3SFD i PERMIT TYPE: WORK Construct two story residence 2540 sq ft • attached garage 400 sq ft). SCOPE 1 hrs $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 2,940 $3,067.05 IR3PLNCK $3,012.15 IR37NSP Permit Fee: $3,012.15 Suppl. Insp. Fee:Q Reg.© OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 #new units $667.63 llehnirdstra ive Fee: Work Without Permit? 0 Yes Q No $0.00 TOTALS: 2,940 $3,067.05 "I'rovel Dociunenleuiori roses: $3,012.15.'' Stroma Motion Fee: IBSEISMICR _,. L ech, Flan Cher:k Phurrb, Plan Cheek E/ec.. Plan Check ILIec;Jr. Permit Fee: Plumb. Peimi! Fee: fa<eC. Perl?dt haze: OAer lvlecrh. h -up. Other Plumb Insp. 01her Elec. Insp. Vlech, Insp. Fce: Plumb. h,?sp. Fee: EiCc, Insp, FC: 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 teased on the oreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E,f: 7f 11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,067.05 Select a Misc Bldg/Structure or Element of a Building A Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,012.15 Suppl. Insp. Fee:Q Reg.© OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 #new units $667.63 llehnirdstra ive Fee: Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $411.60 Select a Non -Residential Q Building or Structure 0 i "I'rovel Dociunenleuiori roses: Stroma Motion Fee: IBSEISMICR $78.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $24.00 f ° .zST7BOTALs:$7,260.43 $0.00 TOTAL FEE' $7,260.43 Revised: 07/10/2014 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /pi Ibq1C PERMIT # f OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSI7VESS LICENSE # oZ�U7 ADDRESS: jk2,4g P pD CITY/ZIPCODE: ,,�q *Our municipal code requires all businesses working in4 ie city to have a City of Cupertino 6 sinedlicense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: / l Signature ate Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing2,7O Electrical Excavation �' C Fencing C Flooring / Carpeting Linoleum / Wood S Glass / Glazing Heating 34101 Insulation Ji IfIl Landscaping S Lathing / S 0 Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile l O er / Con ractor Signature Date