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B-2016-1415 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1415 10422 SAN FERNANDO AVE CUPERTINO,CA 95014-2867(357 12 019) BAY LAND CONSTRUCTION SAN JOSE,CA 95126 OWNER'S NAME: CHAUDHARY VIJAY AND PUSHPA DATE ISSUED:05/04/2016 OWNER'S PHONE:650-576-5660 PHONE NO:(650)787-7144 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie.#943131 Contractor BAY LAND CONSTRUCTION Date 02/28/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONVERT(E)GARDEN ROOM TO FAMILY ROOM(392 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: i. 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. 42V 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. Sq.Ft Floor Area: Valuation:$8000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 357 and state laws relating to building construction,and hereby authorize 357 12 019 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS7ALLED INSPECTION. f Signature r,bate 05/04/2016 Issued by:PAUL,O'SULLIVAN (_`w ,f Date:05/04/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF.-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole, installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Scc.7044,Business&Professions Code). Date:05/04/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:05/04/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 05/04/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228- FAX(408 7-3333•building a-cupertino.org �IJPf=Et'TEFVQ El NEW CONSTRUCTION ❑ ADDITION ALTERATION!TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJE T�A'DDRE1 n C-��n ��VO I AFN# )R !(l/�� L.-. t'� V G�r� �' ! I OIVNERNAME q .n /t PHONE ` f E p n ' �TREETADDRFSSC( )_2- s I \ �COZ�l g RDC ,1�T CITY, STATE ZIP FAX lb 6��i 1 /� V C?Pc /��/m© C CONT CT 4� P' (��E��' 64G—O� W ©` r Q Ct' �J �/`LCal4 C'SM o ETAD2�SS 1^L _�7N1� v CIVV �i .�N 0 C.A FAX OWNER L3 OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEN BER LICENSETYPE y+ BUS,LIC# A J COMPANY NAM E-MAIL FAX STREET ADDRE S /� CITY,STATE,ZIP �J PHONE ARCHITECTIENGINEER NAME LICENSENUMBEV BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PFIOI�TE DESCRIPTION OF WORK �� a P���r,•r ��� �a���.. � n��t��t �a� �® ��-��� . (31a xm�J —11:11- _a EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPI OCC. SQ FT. VALUATION($} EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA RFMODEI.AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH - 0 ATTACH #DWELLING UNITS: ISASECONDUNIT []YES SECONDSTORY ❑YES BFINGADDED? ANO ADDITION? []NO PRE-APPLICAT]ON ❑YES IF YES.PROVIDE COPY OF V IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNINGAPPL# nNO PLANNING APPROVAL LETTER EICHLERHOA4E? No r yyrf��,..,rryq��yy lJ�J lJ ��•�. By my signature below,I certify to each of the following: I am the property owner or authoriz d 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 ocal ordinances and state laws relating tb ldI t orize repre ntatives ert ing construction. ino to enter the above-identified propert} for Inspection purposes. Signature of Applicant/Agent: Date: 02-- LIN _- - - SUPPLEM F R I SUPPLEMENTAL MA ON RB U RED QAn, - - pli.1N:CHECK<TY ;-_::�::��;::=4--�;'.-_`;s:;.ROUT)\G:SL1P3'1�=;`-',-i=;<�< ..-- -- _..__._ .... ._._.., _. .... New SFD or Multifamily dwellings: Apply for demolition permit for ;.-_;- :., :_:_..::...-..:....: r, .; .. ,_:__ __,..._..;.,..:_ D;QVETtcTHE-COU\TER;-;=' BUILDI�G'PSA7�.RE�'FE}1'. 's existing building(s). Demolition pernut is required prior to issuance of building r Permit for new building. _ m;t>;-NcrL�iti��rE��ti��=���'>= Comniercia13Id s: Provide a completed Hazardousr ous Materials ais Disclosiie '��.❑°'�'"'`;�` - - - .S foTn if any Hazardous Materials are beim used as part ofthis - - - - =-- ---- - _LARGE.._ FIRE DEPT _Copy of Plaimmg Approval better or Meeting with Planning pi ror to submittal of Building Permit application. MaloR ❑ SA\ITd.RYSERERDISTRIGT _._......... .... ._...:•..- ENVIRO\MENTAL.HEALTH._._. .. BldgApp__2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10422 SAN FERNANDO AVE DATE: 02/23/2016 REVIEWED BY: PAUL APN: 357 12 019 BP#: "VALUATION: $$,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex PENTAMATION 1GENRES USE: P PERMIT TYPE. WORK CONVERT E GARDEN ROOM TO FAMILY ROOM 392 S.F. SCOPE l,,--c"'t.fiat t E heel• pholt/8- pigm-,Check f.i'z 1't.r=t Ch i z 1'0•. n tt +r?3'nriZ r.4:w. �,inrhr. )'Pt`pi�%:1 1�. ziTi'• t';'f��i.t`t'."{'.' �.ic'i' c:. E)�rC i'fFt:iil.i`tJ"f3, E1--t- ej'f'f#'»�;fttgpt. [�Jite't'::1-E:. Jii.t1;, x F �rlct:%t.I22Sjt Fee: I'i�;r.:l'. ii:.:j>.�t-i, liu.•c. �,:.Sj,. f..e: NOT:This estimate does not include fees Atte to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School. District,etc.. These ees are based on the prelindnar information available and are only an estimate. Contact the De t or aildn'l in o. ]FEE ITEMS(Ree Resolution I1-053 Eff 7/1/13)7/1/13) ]FEE QTY/FEE MISC ITEMS Plan.Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly Suppl.PC Fee: 0 Reg. 0 OT 0,0 hrs $0.00 $286.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(E) Reg. Q OT 0.0 hrsf $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �r?`tftl�li:Slre7LLi'e'. e.'f3: Q Work Without Permit? C) Yes (S No $0.00 Advanced Plannin l w. $0.00 Select a Non-Residential Travel t::}r"u r: Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RTI N O Telephone:408-777-3228 Fax:408-777-3333 CONTRACTOR_/SUBCONTRACTOR LIST JOBADDRESS: PERMIT# OWNER'S NAME;—,f—,, - PHON # GENERAL CONTRACTOR: - �,�, BUSINN-S LICENSE# �^ C (� ADDRESS: a ITY/ZIPCODE: *Our municipal code requires all businesse orking in the city to have a City of Cupertino business license. 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. r I am not using any subcontractors: _ Signature ate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing - Roofing Septic Tank Sheet Metal Sheet Rock, Tile `� Owner�t n ro t actor Signature /Date