15110103-DP10684 S TANTAU AVE
15110103
F/P
VALLABHANENI HIMA AND
KUMARA
SCANNED BOX # 684
CITY OF CUPERTINO BUILDING PERMIT
guILDIPTG ADDRESS--; .-1084 Tt�NTAU AVE
CONTRACTOR: KENNY CONSTRUCTION
PERMIT NO: 15110103
DviAAND KUMARA
10227 BEARDON DR APT 3
DATE ISSUED: 11/16/2015
V'l OWNERSIP# 393 3,�
510 6 39
CUPERTINO, CA 95014
PHONE NO: (408) 318-2739
ICENQF-D �C �T 0*-�R'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
Lic
REMOVE (1) WINDOW AND ADD (1) EXTERIOR DOOR TO
# .1c 0
LAUNDRY ROOM; ENCLOSE COVERED ENTRY (112 SQ
ontraqtq Date
FT);
REMOVE AND REPLACE (2) WINDOWS IN LIVING ROOM;
I hereby it it a 'a 'ilk q d under the provisions of Chapter 9
(Comm 3 the Business & Professions
encing, i cc ongvision of
Code and tha,�__ .,kegnc;is'l libice. and effect.
I hereby it I in ender penalty66e6u`fry one of the following two declarations:
I have '6 %Xyi�1in-4iniql icate of consent to self -insure for Worker's
Conip&Wp6oa '.as r y ection,,*O' of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $25000
Ali
pbrfofifiah& f ic this peirnit is issued.
o S
have 'ib crisation insurance, as provided for by
'9 RTP
1 .
Section .�60,k �700 o theTI rformance of the work for which this
1 ii , .. �0� tbii P�
Isub
APN Number- 37537005.00
Occupancy Type:
pe ki
I 'AT4i CERTIFICATION
I certify that I a is,' lication and state that the above information is
�t
o ect I agree , " 1'; 1'
correct: it_c,. i all city and county ordinances and state laws relating
to building 'c6 "'s 6-prt, Hereby authorize representatives of this city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
uponi 0 . v e I r - c for inspection purposes. (We) agree to -save
180 DAYS FROM LAST CALLED INSPECTION.
indem6i ssl fC e!City,o Cupertino against liabilities, judgments,
costsj,,and e4&9cS!*fiiCh t6i4y.:arcrqe against said City in consequence of the
11-14�-Zl
granting of'.thi§ 0,"k�';41kdditi6iia1[1y,.the applicant understands and will comply
Issued by: Date:
with per the Cupertino Municip Code, Section
%
9.
RE -ROOFS:
igna re_ 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.
ILDEiD'9CLARATION
I hereby; it 1th9tJ-am4k6ipt*froni the Contractor's License Law for one of
Signature of Applicant: Date:
the follownii '9-1' ic. a"'s 6661 s;
. 11 1,, - , � 01
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L `0 erof �#ropil 6r:Ny:cmpIoyees with wages as their sole compensation,
q o -an th will j, d e':'i 111 -
will intended or offered for sale (Sec.7044,
Busmess:&RofdsidfisCode
1, as bivhef�ftfiefi�6rpea�'_ - I 3bxblulsively contracting with licensed contractors to
, T�1. ! I ..." ".. � I
� I
HAZARDOUS MATERIALS DISCLOSURE
1�*
consl�u'U' e project BusinessX Prof6ssions Code).
Sil
I have read the hazardous materials requirements under Chapter 6.95 of the
P,•
'penalty,
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby afflritli�iiilcr enal 4 pe'rjury one of the following three
- .1 1
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
11 I -,,' i. I " r I I
, l'
declarations"--
ill,mit i
'a it. fificateof Consent to self -insure for Worker's I have
Health & Safety Code, Section 15832(a) should I store or handle hazardous
4nd�'
Compeng tori,i' "Piloytded 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
T,
perilbrinan o 'fdri�vjtich thig'peimit is 'issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I hav and! I s Compensation Insurance, as provided for by
Sectiibli�?3ii. .
10 , IF C d6;1k,bi P�performanceperformanceofthe work for
which this i N1,
the Health & Safety Code, Sections 255h 25533, and 25534.
wrier or authorized agent: Date:_
p�
ermit is
I W i-be performance'of the work for which this permit is issued, I shall
not emplo'ylany ' as to become subject to the Worker's
•CONSTRUCT110LENDING
Compensation laftpfCaliffirnjii If, after making this certificate of exemption, I
AGENCY
bec6me subject to the'Work%;s Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith cotrip�y with'sucfi provisions , �viiions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
ICI%U. CERMCATION -l-,'APPLA
Lender's Address
I certify that f h-1 al olk, this application and state that the above information is
coq&l t,I �4 "i!��I;col ffilpiy"w4h all city and county ordinances and state laws relating
to bilidli nstruetion;' and hereby authorize representatives of this city to enter
'p-rop
i oye mentioned ehy for inspection purposes. (We) agree to save
indc' rr'4:N l'!1 'S"S`Ihe City, of Cupertino against liabilities judgments,
ARCHITECT'S DECLARATION
costs, and e. ses ichlirjay accrue against said City in consequence of the
I understand my plans shall be used as. public records.
'en i ;
granfin 'of this, permit;�_dijiiioriidly; the applicant understands and will comply
" 11—t "I
with I no omtsource regulationspil the Cupertino Municipal Code,'SectiOn
Licensed Professional
9.18.;
j.
Sigitatur Date
1.4. -jk
CUPERTII O
CONSTRUCTION PERMIT APPLICATION
COM11%4UNl I Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildino(alDuoer<ino.org �✓ 1 d�0 3
❑ NSW CONSTRUCTION LE ADDITION . LK ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PER T
PRO;iCf ADDRESs l ®b O `f" �j a jc F� �'!$'l APN R 2f�% A; �,7 s 00 ry
OWNER NAIZE d - (M rY Y �LL��/r'J!! �iZi/ ° / PHONE 16 2J (� 6 - ,�l ], �- M AIL
STREET ADDRESS j o r, oy S �-�� I Cri7', STATE, ZIP n,{LooJ�FAX
l/�
CONTACT N.SN,E PHOl\c H�l� �b�j� E-N,AIL �! a �L r3�GG 16G//t''Ve
STREET ADDRESS 5 I P2 C. +t'Ff�I riW (L
CITY, STATE, ZIP Mf t'T4,5 ct}- S 0 3�j`
FAX We O -7 `7
*C"l-"
❑ 011RdFR 0)'NERAGFNT C:TOR ❑ CONrI?,,ACTOR?.GTT ❑ PRC=i-CT ❑ ENGLN cR ❑ DES_LOPEn ❑ ILN/hT
CONTRACORNAI I LICBN''SENU)✓,BER I LICENSE TYPE �r C
BUS.LIC14
C01✓3ANYNATM /^�/ s-NAIL
FAX
STREET ADDRESS IIR-97-,7 (�'7 CITY, STAin, ZIP ��
PHOI Ti
Ci�1TECTrNGINEERNAJ✓,E IS M%! �` � . 1 I LICENSE NUhSER C>r Z-7 1'7
I BL'S. LIC 'IC01
ANY NAT E , S �V 1i1 I S ' NG
v
c-1viASL S 0 �D � 7 P7iivl ��%C
FAX 4O9- 70-{ -V
l3
STREET AMI)KESS �(� r �,p 0?,yy� �2L� �i +�i
/ a�`t�As�� �V "
CITY, STATE, ZIP �./ / 'FA f e'/I � -1-03 J�
of
PHONE 408- 74 S- 6-3
)
/
V
DESCRIPTION OF WORK
�xw br "IS AA -r&-/4� A16� �r �I1A61 arl"444 Tb og
5-1 -A-P- Ncl Witi)DOws N G C cc CFn ytt lv�V4,Lr 1;-b�`C-t� feM,. ,
lm? [60 7h-j-') N s Q Ar t-h) J G. s jzt to C,a--rc-5-v (o) Cc q-*G
EXISTING USE PROPOSED USE C NSTRTYPE �'STORIES
0 o4 [�, p 9w -Gt,
USE
TYPE I
OCC.
SQ.FT.
VALUATION(S)
EXISTG yy
AREA
NEW FLOOR
AREA ()
DE?`40
AREA
TOTAL
I\=AREA 2Z�
,-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
RE,SODEL .AREA
PORCH AREA
DECKAREA
TOT.�I. DECKIPORCH fi.REA
GARAGEAREA: D=IACH
❑ AT
�DWELLINGUNTTS:
15ASECONDUNrr ❑YES
SECONDSTORY ❑YES
BEING ADDED? ❑N•0
ADDITION' []No
PRE,kPPLIC.ATION ❑ YES IF %`E_S, PROVIDE COPY OF
PLANIKNIG.4PPL2 ❑No PLANNING APPROVAL I.-I-ITR
IS THE BLDG AN ❑ 1:S
EICHLERHOME? ❑NO
� �� - �. �� -
TOT. VALUATION:
_
By my signature below, l cct ti-ry to each of the following: I am the property owner or authorized agent to act on the propefty owmer's behalf. I have read this
application and the information I have provided is cor, ect. I have read the Description of Work and veriiy it is accurate. I agree to comply -with all applicable local
ordinances and state laws relating to buiidin struction. I authorize representatives -of Cupertino to enter the above-identifiedfor inspection purposes.
rproperty
Simature ofApp1icant/Agent: S Date)h I sZ0 f
ZIFORM kTION REQU ED
SUPPLE? I NT(nj
a L
��7 R T)COL tTE}2
4BT7ILDL�GPLAT�t
New SFD or Multifa Lilyllings: Apply for denolition pe„nit for
bui]dinQ{s). De it is d to iSSliance
existing t olitie,,. require prior
ofbuildingpenp-it for -ew building,
i11E rEss
Commercial BldeS: Provi cornpleted Hazardous Materials Disclosure
DeD
PT BiTewoliics _
forn if any Hazardous Materials are being used as part of this project.
_
_ Copy of Planning Approval Letter or Neetirg with Plann ng prior to
submittal ofBuilding Permit application,
oR a
�A�,�rA�Y saTRTcr
=.
...............
B?dgApp_2011. doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10684 S Tantau Ave
DATE: 11/16/2015
REVIEWED BY: Sean
APN:
BP#:
*VALUATION: 1$25,000
*PERMIT;TYIPE:'-. Building Permit
PLAN CHECK TYPE: Addition
PRIMARY..
: � : FD* or Duplex
s
USE:
_411
PENTAMATION
PERMIT TYPE. IR3SFDREM
WORK
Remove (1.) window and add (1) exterior door to laundry room; enclose covered entry (112 sqft
SCOPE
remove and replace (2) windows in living room; center garage door.
109
l M
Arr
PI .
01 R1
111ron". I'lew (`.heok
b;7ec. I'lan Check
ernn't
Fec":
of"Ier 11"m1b jn,sP.
0.rrher h7ec. his!). Ll I
.Afech, lnsvxv
11himb,hisp. Fee.-
lisp. Fe
NOTE: This:estlmate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Oiitrh*42-i4n E t:'foot are hated an the nrpfiminary informatinn availahle and are an1v an intimate- rnntart the Dent fnr addh 11 info"
FEE" IT-EMS'(Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan, Ch6ckFee: !
$0.00
112 s.f
$431.001
Remodel, Other
IREMRESOTH I
Suppl. PCT . e , e:, (D. Reg. 0 OT
0.0
hrs
$0.00
PME Plan'Check:
$0.00
3 #
$431.00
Window Sliding Glass Door
1 WINREP Replacement
Permit F66: i Hourly Only? C) Yes (E) No
$0.00
Suppl. lri' .*Felie'.(D'Reg. 0 OTFo.o
Thrs
$0.00
PME Unit'Te'e:,'
$0.00
PME'jPe r�itFeel;
$0.00
T
_T_
J11
,elthninisfr'qtiie Pe'e..,
hours
$286.00
Inspections
ISTINSP Inspection, Hourly
0
WorkW out.1`6rmit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
(E)
0
? n1fil ieZga0qn leas:
Stroni'L,-Motion F'O'e'l:,,- I BSEISMICR
$3.25
Select an Administrative Item
Bldg St& Commission Fee: IBCBSC
$1.00
A ..... .. . ........
$4.25
$1,148.001
TOTAL
"F �
_TJ,S7
04 ,EN
55;j;
I.
li - -
io.
Revised: 10/01/2015
CUPERTENO
119 06
PURPOSE
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE 0
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 a building(cDcupertino.org
PERNUT CANNOT BE F'INA QED AND COMPLETED UNTIL THIS CERTMICATE
TIAS B_EEN N �; D ANDMIMX M, TO THE BLTILDIING DIVISION
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alanns which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
l have read and a4ree to comply with tha terms and conditions of this statement
90-6i- or•. W�erRgen&s),Name: 1
I- - cr 2�0 ✓6
�B1 il`►C( �$j . atRf e..........................................................................................................'DateE/..................
Gofiff cfor<Name:I v f �e3
_, �-z�
Siga�f&..............
tIL v,r. L✓ a ..... ..........LEG.?#..I.lC�o..................D`aCe: l%
Smoke and. CO forni.doc revised 0311,811.4
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@-cupertino.or-g �I j � 0
Owner Name lk y� Permit No. it
Address (d 6 ll 15 AC"'b, Q
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
1 No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
/ )qNo Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non -compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non -compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non -compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non -compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the followine naee. _ I
Owner or Owner Agent's Signatures , .2�= Date O Z/ o z//6 1
Upon completing and signing this Certificate, please r tyn it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115