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13080122CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13080122 22635 SAN JUAN RD (342 17 019) RED ROAD CONSTRUCTION PLEASANTON,CA 94566 OWNER'S NAME: SUMINA VERMA DATE ISSUED: 06/20/2014 OWNER'S PHONE: ( PHONE NO: (925) 398-8460 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lid. #428842 Contractor RED ROAD CONSTRUCTION Date 07/31/2017 _ BLDG _ ELECT _ PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL-1 ST FLOOR 1589 SQFT; 2ND FLR I hereby affirm under penalty of perjury one of the following two declarations: 1668 SQFT; BASEMENT 2110 SQFT; DETACHED GARAGE r. 1 have and will maintain a certificate of consent to self -insure for Worker's 427 SQFT, OPEN COURTYARD 300 SQFT. Compensation, as provided for by Section 3700 of the Labor Code, for the REV #3 - REVISE INTERIOR FLOOR PLAN AT THE BASEMENT performance of the work for which this permit is issued. LEVEL, 1 ST LEVEL, AND 2ND LEVEL; ADD (N) 2-200 AMP SUB- z.i I have and will maintain Worker's Compensation Insurance, as provided for by pANELS; CHANGE INTERIOR STAIRWAY DIRECTION Section 3700 of the Labor Code, for the performance of the work for which this REV #2:03-21-2017 - CHANGE RETAINING WALL FOOTINGS TO permit is issued. PIERS - ISSUED 5/5/2017 APPLICANT CERTIFICATION REV #1: RELOCATE BATH 1; REVISE MASTER BATH AND I certify that I have read this application and state that the above WALK-IN CLOSET CONFIGURATION; REVISE STRUCTURAL information is correct. I agree to comply with all city and county ordinances FRAMING - ISSUED 2/23/2016 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for BIN A-6 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which Sq. Ft Floor Area: Valuation: $1000000.00 may accrue against said City in consequence of the 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. APN Number: Occupancy Type: 342 17 019 Signature //.�- -_- Date 5/9/2017 PERMIT EXPIRES IF WORK IS NOT STARTED OWNER -BUTT DER DF,CLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION. following two reasons: 1. 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 Issued by: ABBY AYENDE sale (Sec.7044, Business & Professions Code) Date: 06/20/2014 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RF, -ROOFS: I hereby affirm under penalty of perjury one of the following three declarations: 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 r. I have and will maintain a Certificate of Consent to self -insure for Worker's inspection. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. z. 1 have and will maintain Worker's Compensation Insurance, as provided for by Signature of Applicant: Section 3700 of the Labor Code, for the performance of the work for which this Date: 5/9/2017 permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the Labor Code, I must forthwith comply with such provisions or this permit shall California Health & Safety Code, Sections 25505, 25533, and 25534. I will be deemed revoked. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION material. Additionally, should I use equipment or devices which emit hazardous I certify that I have read this application and state that the above information is air contaminants as defined by the Bay Area Air Quality Management District I correct. I agree to comply with all city and county ordinances and state laws will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health & Safety Code, Sections 25505, 25533, and 25534. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, City in �� j or authorized agent: � judgments, costs, and expenses which may accrue against said of the of this Additionally, the applicant understands�-Date: ,Owner 519/2017. consequence granting permit. CONSTRUCTION LENDING AGENCY and will comply with all non -point source regulations per the Cupertino Municipal 1 hereby affirm that there is a construction lending agency for the performance Code, Section 9.18. of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Signature Date 5/9/2017 Lender's Address CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13080122 22635 SAN JUAN RD (342 17 019) RED ROAD CONSTRUCTION PLEASANTON,CA 94566 OWNER'S NAME: SUMINA VERMA DATE ISSUED: 06/20/2014 OWNER'S PHONE: ( PHONE NO: (925) 398-8460 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lie. #428842 Contractor RED ROAD CONSTRUCTION Date 07/31/2017 —BLDG _ ELECT _PLUMB MECH RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL-1ST FLOOR 1589 SQFT; 2ND FLR I hereby affirm under penalty of perjury one of the following two declarations: 1668 SQFT; BASEMENT 2110 SQFT; DETACHED GARAGE 1. I have and will maintain a certificate of consent to self -insure for Worker's 427 SQFT, OPEN COURTYARD 300 SQFT. Compensation, as provided for by Section 3700 of the Labor Code, for the REV #3 - REVISE INTERIOR FLOOR PLAN AT THE BASEMENT Verformance of the work for which this permit is issued. LEVEL, 1 ST LEVEL, AND 2ND LEVEL; ADD (1) 2-200 AMP SUB - z. I have and will maintain Worker's Compensation Insurance, as provided for by PANELS; CHANGE INTERIOR STAIRWAY DIRECTION - ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 5/9/2017 permit is issued. REV #2:03-21-2017 - CHANGE RETAINING WALL FOOTINGS TO APPLICANT CERTIFICATION PIERS - ISSUED 5/5/2017 1 certify that I have read this application and state that the above REV #1: RELOCATE BATH 1; REVISE MASTER BATH AND information is correct. I agree to comply with all city and county ordinances WALK-IN CLOSET CONFIGURATION; REVISE STRUCTURAL and state laws relating to building construction, and hereby authorize FRAMING - ISSUED 2/23/2016 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the BINA-6 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Sq. Ft Floor Area: Valuation: $1000000.00 Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. APN Number: Occupancy Type: Signature .' � e 5/9/2017 342 17 019 OWNFR-BU DER DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 180 DAYS FROM LAST CALLED INSPECTION. 1. 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) Issued by: ABBY AYENDE i. I, as owner of the property, am exclusively contracting with licensed Date: 06/20/2014 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I have and will maintain a Certificate of Consent to self -insure for Worker's installed without first obtaining an inspection, I agree to remove all new materials for Compensation, as provided for by Section 3700 of the Labor Code, for the inspection. performance of the work for which this permit is issued. i. 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 Signature of Applicant: permit is issued. Date: 5/9/2017 3. 1 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE Labor Code, I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the be deemed revoked, California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the APPLICANT CERTIFICATION Health & Safety Code, Section 25532(a) should I store or handle hazardous I certify that I have read this application and state that the above information is material. Additionally, should I use equipment or devices which emit hazardous correct. I agree to comply with all city and county ordinances and state laws air contaminants as defined by the Bay Area Air Quality Management District I relating to building construction, and hereby authorize representatives of this city wM maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and to enter upon the above mentioned property for inspection purposes. (We) agree the Health & Safety Code, Sections 25505, 25533, and 25534. to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in of the granting of this permit. Additionally, the applicant understands --,Owner or authorized agent: consequence and will comply with all non -point source regulations per the Cupertino Municipal L Date: 5/9(201Z Code, Section 9.18. CONSTRUCTION LENDING AGENCY 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.) Signature Date 5/9/2017 Lender's Name CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13080122 22635 SAN JUAN RD CUPERTINO CA 95014 (342 17 019) RED ROAD CONSTRUCTION PO BOX 82 OWNER'S NAME: SUMINA VERMA DATE ISSUED: 06/20/2014 OWNER'S PHONE: PHONE NO: 8314310614 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie. #428842 Contractor RED ROAD CONSTRUCTION Date 2/23/2016 —BLDG —ELECT _PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL-1ST FLOOR 1589 SQFT; 2ND I hereby affirm under penalty of perjury one of the following two declarations: FLR 1668 SQFT; BASEMENT 2110 SQFT; DETACHED GARAGE 1. I have and will maintain a certificate of consent to self -insure for Worker's 427 SQFT, OPEN COURTYARD 300 SQFT. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV #1'.;RELOCATE BATH 1; REVISE MASTER BATH AND 2. I have and will maintain Worker's Compensation Insurance, as provided for WALK-IN CLOSET CONFIGURATION; REVISE STRUCTURAL - by Section 3700 of the Labor Code, for the performance of the work for which FRAMING - ISSUED 2/23/2016 this permit is issued. APPLICANT CERTIFICATION PERMIT EXT'D TO 11/20/15 1 certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $1000000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby APN Number: Occupancy Type: authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep 342 17 019 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 with all non -point source regulations per the Cupertino Municipal PERMIT EXPIRES IF WORK IS NOT STARTED Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR _ , 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 2/23/2016 DECLARATION Issued by: PAUL O'SULLIVAN l rel I I� OWNER -BUILDER Date: 2/23/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered installed without first obtaining an inspection, I agree to remove all new materials for for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 2/23/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for HAZARDOUS MATERIALS DISCLOSURE by Section 3700 of the Labor Code, for the performance of the work for which I have read the hazardous materials requirements under Chapter 6.95 of the this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will 3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor- Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, _$ecti0ns 25505, 25533, and 25534. be deemed revolted. APPLICANT CERTIFICATION Owner authorized I certifythat I have read this application and state that the above information is P 2 Date: 2/23/2016 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant Lender's Address understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 2/23/2016 Licensed CITY OF CUPERTINO FEMN FEE ESTIMATOR - BUILDING DIVISION ikADDRESS: 22635 San Juan Rd DATE: 12/21/2015 REVIEWED BY: Phuong -b APN: 342 17 019 BP#: VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex $0.00 PENTAMATION PERMIT TYPE: 1 GENRES WORK Rev #1: Relocate Bath 1; revise master bath and walk-in closet configuration; revise structural framing SCOPE $0.00 n NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dk,trirt etc) These fees are based on the nretiminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) . .., QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 1 4 1 hours Plan Check, Hourly $572.00 ISTPLNCK E:r EJ L_ $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dk,trirt etc) These fees are based on the nretiminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 1 4 1 hours Plan Check, Hourly $572.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OThrs 0.0 $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT Q,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 wy 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item 1 Bldg Stds Commission Fee: $0.001 SUBTOTALS: $0,001 $572.001 TOTAL FEE: $572.00 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22635 SAN JUAN RD C NTRACTOR: KED f IX -0 m5( (W PERMIT NO: 13080122 OWNER'S NAME: SUMINA VERMA ` ISSUED: 06/20/2014 OWNER'S PHONE: 4083862713 jDATE Js i PHONE NO: J LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL (__ CONSTRUCT 2 STORY SFDWL-1ST FLOOR 1589 SQFT; 2ND License Class L1C. # ZggrL� FLR 1668 SQFT; BASEMENT 2110 SQFT; DETACHED ---- - n- - - - — - k --- - '- l GARAGE Contractors h01 NS at, _� _ 427 SQFT, OPEN COURTYARD 300 SQFT. 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: $1000000 performance of the work for which this permit is issued. I,have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34217019.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 D YS 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 t �A .ry7/3 Issue/X d 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: being installed. If is Signature - --- - Date i� J'r All roofs shall be inspected prior to any roofing material a roof 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. 1 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 255 Owner or authorized agent: ` -- – _Date: G 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 D,iO Parnrr# IS0600% i)'Iy,J C� Ip�T�t4O,CAg5 41 PEmiT # 1��". qa635�3U �uPE�i�dJGA g5oi�- FILE �'A n- U -*-t t -p- co r actox o A t !s Co NS 7R UC r I aN /��' b e,",� 2!6 la c2 d /Oy GID �h D 1ge, ev ;'S 6g -t +'r��o�crna�r'o �h tt-j NQYr,t : q6D QDAD (ft)AISTCUC7+0N G;uwk , A.R-8 e4z3Eetz )4dd"Lw : l�� 0, gax gig , 'Plea -go n ko � f cf4 �p n to a N l G K K 1- 1 N CQnre-t Pka"(w): IVs- 3qg-E4d0 L'orr ct P1orQ <<� :gar -1,31- 0 6 l e7, Car•( �t Fax �j.2S - 3 9 8� g� 3 9 C.O►t �p CL` �r�/ I � h iC k aO,�PO�RpO`d COy'St - Cb !'✓r in/c. b s.�e '. W c,'V �"� R.Qr�hc� C bn S t• l 0 M 1�cA, YO(AA li-LA uRUCRA,\> rte w cpxAac 6.-( q4S� � Patricia Garcia From: Ashish Krishna [krishna.ashish@gmail.com] Sent: Monday, December 15, 2014 4:40 PM To: Sumina Verma; Patricia Garcia Subject: Re: PERMIT EXT RECEIPT Hi Patricia, We request an extension so that we can begin construction at 22635 San Juan Road, Cupertino, CA 95014 under Permit# 13080122. The main reason for delay has been due to unforeseen weather conditions and our budget timeline. We intend to start demolition as soon as the weather permits. Thanks, --Ashish & Sumina > From: Patricia Garcia <PatG(@cupertino.org> > Date: December 15, 2014 at 2:50:23 PM PST > To: "'sumina.verma@gmail.com "' <sumina.verma(@gmail.com> > Subject: PERMIT EXT RECEIPT > Per our discussion for ext request of permit #13080122. I will await > your email letter requesting the extension. > Kindly, > Patricia Garcia > Building Dept. > City of Cupertino > 408 777 3228 1 d CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22635 SAN JUAN RD CONTRACTOR: SUMINA VERMA PERMIT NO: 13080122 OWNER'S NAME: SUMINA VERMA 22635 SAN JUAN RD DATE ISSUED: 06/20/2014 OWNER'S PHONE: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFDWL- 1ST FLOOR 1589 SQ FT; License Class Lic.# 2ND FL 1668 SQ FT; BASEMENT 2110 SQ FT; DETACHED Contractor Date GARAGE 427 SQ FT, OPEN COURTYARD 300 SQ FT. 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: $1000000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34217019.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 PE ANCE 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 FRO ALL PECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Date: 6 Z(J 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 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, JBusiness & Professions Code) 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 I 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 CONSTRUION LENDING AGENCY CT 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 relatin-, 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 �� DateD ,��,�� CITY OF CUPERTINO I�'"� FEF, ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 22635 san juan rd DATE: 08/16/2013 REVIEWED BY: mendez PC FEE ID APN: BP#: c3 "VALUATION: 1$1,000,000 rPERMIT TYPE: Building Permit I PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3HILL PERMIT TYPE: A WORK I construct 2 story sfdwl- 1st floor 1589 sq ft; 2nd fl 1668 sq ft;basement 2110 sq ft; detached garage SCOPE 427 sq ft, open courtyard 300 sq OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,111-B,IV,V-B 6,094 $5,750.04 1R3HPLNCK $4,854.84 IR3HINSP $0.00 PME Plan Check: $0.00 Permit Fee: $4,854.84 Suppl. Insp. Fee -0 Reg. Q OT 0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 6,094 $5,750.04 Construction Tax: 1BCONSTAXR $4,854.84 # new units NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, Sanitary Newer District, Ncnool o,n r T1, c f- aro hacod nn tho nroliminary infnrmatinn available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff: 7%1.121 /Eich. Plan Check (truth. I'lc n Elec. Plan Check Xfech. 11, Plan Check Fee: Elec. Permit h,�- __10ofher ;llech. Insp. (Mier Plumb Insp. ;'her Elee. Insp. Mech. Insp. Fee: Phimb. lisp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, Sanitary Newer District, Ncnool o,n r T1, c f- aro hacod nn tho nroliminary infnrmatinn available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff: 7%1.121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,750.04 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,854.84 Suppl. Insp. Fee -0 Reg. Q OT 0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR F1 # new units $647.24 !rrfini�frurirrl ° C) 0 Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $853.16 Select a Non -Residential Building or Structure E) i Travel Documentation Fees: Strong Motion Fee: 1BSEISMICR $100.00 Select an Administrative Item BldgStds Commission Fee: 1BCBSC $40.00 SUBTOTALS: 12,245.28 $0.00 TOTAL FEE: 1 $12,245.28 Revised: 07/01/2013