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15020024-F CITY OIF C UP ERTINO BUILDING PER I T BUILnRNG ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR:UNIK HOMES INC PERMIT NO: 15020024 OWNER'S NAME: RANGASWAMY GOPI K AND NAGARAJ SUSHM 15185 ALONDRA LN DATE ISSUED:04/09/2015 OW ER'S PHONE: 3108490146 SARATOGA,CA 95070 PHONE NO:(650)240-8483 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL CONSTRUCT TWO STORY RESIDENCE(IST FLOOR-2270 License Class_ Lic.# SQ) FT)AND(2ND FLOOR-1667 SQ FT); ATTACHED GARAGE Contractor � �iS Date (689 SQ LFT);PORCH AREA(426 SQ 1F'). 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 -performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$550000 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:32608028.00 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 ��HN fl�0�� ,�ISSUANCE®� 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 CAILILIEIID 1<NSIP]ECQ✓T 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. Addition ly,the applicant understands and will comply Issued by: ➢Date: with all non-point source regula ns per the Cupertino Municipal Code,Section 9.18. (t�J 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertii Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code Sec' 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 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 COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION v -' �j 10300 TORRE AVENUE°CUPERTINO,CA 95014-3255 GMp[ G°3�Uf�1® (408)777-3228 o FAX(408)777-3333 o building0cupertino.ora \ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 106g15(J� 'A VIs7A AV EN Ue q�pl� APN# 7�to_O3_07 b L7 C. G I i 7 !� �r(/ OWNER NA.MEPHONEA10 E•MA1L 9°P V@(np,C&YJ G r44&A.SWAV,1Yql, STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME k�)MMp CNKIS ff ,I, PHONE E-MAIL-7 1 — 1� ,_f (vSD 23�i STREET ADDRESS 2061 Av, A vent ?, CITY, ATE,ZIP FAX ❑OWNER ® OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT NGINEER NAME L''fI•R K/vmd LICENSE NUMBER BUS.LIC# COMPANY NAME CVA AF+ 4t1�G'� E-MA.II, GI_P 1� Q �..I .0�-w FAX STREET ADDRESS f_a Q 1 A V A`rente CITY,STATE,ZIP PAR W�� V l PHONE K CA YEN DESCRIPTION OF WORK NE V LS-TU f29WE kil l" A '�Trkfft` AMSTING USE PROPOSED USE �/ CONSTIL TYPE #STORIES tte 1 ,Q '1 -I USE TYPE OCC. SQ.Fr. VALUATION(S) AREANEW FLOOR DEMO- 11"10 NETTOTA AREA AREA �yr AREA t IO NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA /1 .� f I_'I-7 PORCH AREA DECK AREA TOTALi DECKIPORCH AREA GARAGE AREA: DETACH �1 /l!/�Wf Ghhi' "1�� ATTACH ,e�CVZf #DWELLING UNITS: 1SASECONDUNIT ❑YES SECOND STORY ❑YES _l BEING ADDED? MNO ADDITION? ❑NO t!7 -f2-6o PRE-ARrLICATION FSYES IF YES,PROVIDE COPY OF Is THE BLDG AN ❑YES RECEI Y: TOTAL A ION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? M NO SCA4i,1 AI-0 By my signature below,I certify to a the following: the property owner or authorized agent t ct o e property owner's behalf. I have read this application and the information I h e provi disco Vit. I e read the Description of Work and verify itis accurate. I agrec to comply with all applicable local ordinances and state laws relating buil ' on ction. uthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: '? . a 1 04!xS _ SUPPLEMEN ION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OV ER-THE COUNTERBUILDING PLAN REVIEW emsting building(s). Demolition permit is required prior to issuance of building permit for new building. ;11 EXPRE PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDAxD PuaLlc woRKs. Form if any Hazardous Materials are being used as part of this project. ❑ LARGE _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MMOR JSANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUP ERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10585 flora,vlsat ave DATE: 02/0412015 REVIEWED BY: Mendez APN: BP#: ��00a 'VALUATION: 1$550,000 FPEI81yIi IT TYPE: Building Permit PLAN CHECK TYP : New Construction PIBRMARY SFD or Duplex 2nd Unit? Yes °' No PENTAMATION 1R3SFD USE: PERMIT TYPE: W®I8Kconstruct 2 sto sfdwl 1st floor 2270 2nd floor 1667 attached gra a 689 porch area 426 sg ft SCOPIE OCCUPANCY TYPE: TYPE OF F LR AREA PC FEES PC]FEE ID BP]FEES BP EEE IID CONSTR. s.ff. R-3(Custom) II-B,111-B,IV,V-B 5,052 $3,358.03 IR3PLNCK $4,159.23 IR3INSP TOTALS: 5,052 $3,358.03 $4,159.23 I L /eul. Pian(�'r�rck Plan+b. Plan Checb Elec..Plari Check' .11ech ]'email bee Plumb. Per mit Fee: tsl tc. Permit Fee: vihc; 11cch. Inas LED Of/er Ph+mh lnsp. C Other Elec.Insp, h c h 1;,V7. Fre' Lphillih, hep. Fee: lilec.It,sP. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 in o. FEE ITEMS(Fee Resolution 11-053 E(f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,358.03 Select a Misc Bldg/Structure Supp]. PC Fee: E) Reg, C OT 0.0 firs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $4,159.23 Suppl. Insp. Feer Reg. COT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR #new � units $670.76 Adillil iStr-WAV Fee: Work Without Permit? C) Yes Q No $0.00 0 Advanced Planning Fee: IPLLONGR $707.28 Select a Non-Residential E) Travel Doclalnen/ation Fees: Building or Structure 0 Strong Motion Fee: IBSEISMICR $71.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $22.00 SUBTOTALS: $8,988.80 $0.00 TOTAL FEE: $8,988.80 Revised: 01/06/2015