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14010140aR N CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 821 BETLIN AVE CONTRACTOR: ANAND BAGGA PERMIT NO: 14010140 OWNER'S NAME: ANAND BAGGA 821 BETLIN AVE DATE ISSUED: 04/01/2014 OWNER'S PHONE: 4083986360 CUPERTINO CA, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F_ i BUILDING PERMIT INFO: BLDG ELECT Pl.t >nt License Class Lic. # r' (u MF.CH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION: CONS,rRUCT ONE STORY ADDITION TO EXISTING DWELLING I hereby affirm that I am licensed under the provisions of Chapter 9 (605 SQ FT TOTAL): FRONT COVERED PORCH (36 SQ FT); (commencing with Section 7000) of Division 3 of the Business & Professions INTERIOR REMODEL (400 SQ FT); PANEL UPGRADE TO 200 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: $130000 performance of the work for which this permit is issued. 1 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: 36927019.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 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 DAY T 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 Z granting of this permit. Additionally, the applicant understands and will comply Date: ! 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. It' a roof is installed without first obtaining an inspection, I agree to remove all new materials I'm inspection. 10 OWNER -BUILDER DECLARATION Signature of Applicant: Date: - I hereby affirm that 1 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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 1 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 t e Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t Cup rti o Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the health & Safety Code, Sectio s 25_ SS33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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, 1 CONSTRUCTION !.ENDING AGENCY become subject to the Worker's Compensation provisions of the 1. bor Code, 1 must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deelted revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 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 tf is city to enter upon the above mentioned property for inspection purposes. (We) igree 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 conseq ence of the 1 understand my plans shall be used as public records. granting of thi permit. Additionally, the applicant understands and will comply with all non -p 'nt s rc regulations per the Cupertino Municipal Code. Section Licensed Professional 9.18. Signature Date Lwz14 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 821 BETLIN AVE CONTRACTOR: MANA GENERAL PERMIT NO: 14010140 CONTRACTOR OWNER'S NAME: ANAND BAGGA 1839 TAMPA WAY DATE ISSUED: 04/01/2014 OWNER'S PHONE: 4083986360 SAN JOSE, CA 95122 PHONE NO: (408)3754288 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITION TO EXISTING G License Class Lic. # (0 1 DWELLING r1G� �Jt��V++l �• : Z (605 SQ FT TOTAL); FRONT COVERED PORCH (36 SQ FT); Contractor hr1C�t Date INTERIOR REMODEL (400 SQ FT); PANEL UPGRADE TO I hereby affirm that I am licensed under the provisions of Chapter 9 200 (commencing with Section 7000) of Division 3 of the Business & Professions REV01 INCREASE ROOF & WALL HEIGHTS; REMODEL ADDITONAL 250 Code and that my license is in full force and effect. SQFT - ISSUED 7/2/14 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: $130000 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: 36927019.00 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 0EARMIT 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 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 thel Iss b granting of this permit. Additionally, the applicant understands and will comply with all non -points urce regulations per the Cupertino Municipal Code, Section 9.18. Z HaWy FSignature Date All roofs shall be inspecte or to ng 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: 1 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) 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 1 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, S s 2550h, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agentDate: 7 Z• 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 Ap CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 62 �c���� ��11erl�ce��l _ 4,��p �'�DOWNER APN BP# OWNER NAME NH A"C) R � ADDRESSF�a 1 DESCRIPTION OF WORK: f��rl 6�% �` ' S �- lO 'E-�»+In ►IOuSL We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) N6. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. k.b 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. A-3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. lb -5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. �_b6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. M7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. b 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 _L6. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. p h � 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. A � 11.1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. ! C12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: - Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification ac eptable t the city may be required to be presented when the permit is issued to verifythe property owner's si natur . Property Owner's Signature: Date:_212.A--- ------------------------------------------------------------- --------- ---------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(CDcupertino.org ❑ ON / TI n REVISION DEFERRED ORIGINAL PERMIT # '4U 00 ❑ NEW CONSTRUCTION L�-J ADDITION ALTE�RATI PROJECT ADDRESS 2-1 I (>-✓2v� Ue , 1� n0 CH CISDI AIN 1A� OWNERNAME A PHONEAolR-7Jci$ _G�EaO + E-MAILG�InC�Y�C1bo (J A M STREET ADDRESS B�1 -I; *� ��^te�nu e . CITY, STATE, ZIP ` no, C" a SOI FAX CONTACT NAME �Sa rips PHONE 4�0 J �� 20 q `ZIP O O 0 E-MAIL STREET ADDRESS CITY, STATI FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT -� CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �B�UC�f t 4 LICENSE NUMBER LICENSE TYPE Mamma BUS. LIC # �bS COMPANY NAME �J� (� E-MAIL h q � � � ` `►CX.t A1S FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE r DESCRIPTION OF WORKWCL— �,��.-� yiU �Zk CI.AA_ t \ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EJ DETACH ❑ ATTACH # DWELLING UNITS: Is A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF Is THE BLDG AN ❑ YES RECEIVED BY: TOTAL V.ALUATI N: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOQpC By my signature below, I certify to ea h of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have rea this and the information I have rovided 's correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local application ordinances and state laws relating to b ding c truction. I authoriz esentatives of Cupertino to enter the above -i enti ed property for inspection purposes. Date: to I G 1 Signature of Applicant/Agent SUPPLEME TAL ORMATIONREQUIRED PLAN CIIECKTYPE " ROUTING SLIP ❑ o�°ER-TIT> coLNTi R fl BUILDING PLAN REVIEW 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. D FXPRESS PLANNING PLAIN RLNIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SF«VER DISTRICT submittal of Building Pen -nit application. ❑ ENV7ROSDIEN"FALHEALTH BldgApp_2 011. do c revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 821 BETLIN AVE CONTRACTOR: MANA GENERAL PERMIT NO: 14010140 CONTRACTOR OWNER'S NAME: ANAND BAGGA 1839 TAMPA WAY DATE ISSUED: 04/01/2014 OWNER'S PHONE: 4083986360 SAN JOSE, CA 95122 PHONE NO: (408)375-4288 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] ❑ LICENSED CONTRACTOR'S DECLARATION 1(605 CONSTRUCT ONE STORY ADDITION TO EXISTING p License Class_ Lie. # O ( DWELLING SQ FT TOTAL); FRONT COVERED PORCH (36 SQ FT); Contractor 1/ Arw ;?!1"M( Date < l y INTERIOR REMODEL (400 SQ FT); PANEL UPGRADE TO I hereby affirm that I am licensed under the provisions of Chapter 9 200 (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: I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36927019.00 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 + PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DA FROM LAS CALLED INSPECTION. 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 may accrue against said City in consequence of the by: Date: comply Issued granting of this permit. Additionally, the applicant understands and will with all no t source regulations per the Cupertino Municipal Code, Section 9.18. `1 RE -ROOFS: 4� � Signatur 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: 1 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) 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 (lie 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 of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S s Section 3700 of the Labor Code, for the performance of the work for which this &5,25533,,and25134, Owner or authorized agent Date 1 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 Code, I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor must 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 r1---- _____ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingOcupertino.om rl M -Ti" rl va1FTC rnXrir-IU17Vn0Frl n01rTWAi.PPRMTT9 IBJ 11r.W LJ . -- -- ---- ----- PROJECTADDRESS U2 I �1`TLIT1 �W�jj R� I NOS C'R �i501.4 APN# / Gj 2,1 I OWNERNAME pr Ni t 1 Ct }X ' `2 PHONES c 6a'99 MQl CO1M STREET ADDRESS ' `L JI -A v CITY, STATE, ZIP CUPS�TIND ^�A 9r014 FAX CONTACT NAME S E kF- E ?110 P=,s - C - 012.-1 'SeweC`I U e.Q r'rY.- % GC IYI STREET ADDRESS 432 + � CITY, STATE, ZIP ka n U + CJL L„p1 _1'r- Iq �2Adatr 11 OWNER OWNER -BUILDER 13 OWNERAGENT 1-1 CONTRACTOR 11 CONTRACTOR AGENT i ARCHr=❑ENGINEER ❑DEVELOPER El TENANT CONTRACTOR NAME77 // // LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME SEy V LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL s e k pe 4# Q VA a 1 (, con FAX 40 q '7t 13 9 2 6 De TQh . J STREET ADDRESS 632_ I Ja \ Y F. �_} (/�� CITY, STATE, ZIP 1 1 l I ` Y PHO & DESCRIPTION OF WORK _ Sfp r 1' IA . I J J t h e >N L t V 1 M t'4 �� 2 - CfAAV e fhe cif' L v- .6 A r90 AA EXISTINGU/SE Pie S U1 eh C F P OPOSED USE CO`N� zes' j Ce TR TYPE l � Q # STORIES USE TYPEOCC. SQ.FT. VALUATION ($) EXISTGIq 3 I AREA NEW Oq 0s AREA AREA V _ TOTALDEMO NET AREA 2x2-6 BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA 30c) PORCH AREA DECK AREA , TOTAL DECK/PORCH AREA 36 GARAGE AREA: DErACH 4S -q WATTACH 36 # DWELLING UNTiS: IS A SECOND UNIT[YES ADDED? O SECOND STORY ❑,YES ADDITION? O BEING IS THE BLDG AN ,1'�(.FTI -.. .f _ ,.,,.� .__.. ._;_ _ TOTAL VALUATION: PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING ADPL # U1•IO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: I am the property owner or authorized agent to a 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 to b 4 din construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: I/ 201 t Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CIIECK TYPE ROUTING SLIP ❑ OVER-THE-COhvTER ❑ BUILDING PLAN REVIEW 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. _ ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 I����ft7�� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 821 BETLIN AVE DATE: 01/24/2014 REVIEWED BY: MELISSA PC FEE ID APN: 369 27 019 11 BP#:��ial 'VALUATION: $125,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes No OTC? 0Yes �No PENTAMATION PERMIT TYPE: 1R3SFDADD WORK ADD 595 S.F TO RELOCATE LIVING RM ADD BEDROOM ADD 1 FULL & 1 HALF BATHS. SCOPE REMODEL & RECONFIGURE 300S.F OF (E) LIVING SPACE. UPGRADE (E) EL PANEL FOR p OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 595 $2,577.00 1R3PLNCK $1,617.00 1R3INSP ..... •• $0.00 1 200 1 amps $47.00 Electrical IRELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 TOTALS: 595 $2,577.00 $1,617.00 MECH, HOURLY © Yes O No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Wch. Plan Check Phimb. Plan Checb Elec. Plan Check 0.0 hrs $0.00 iLteck. Permit Fee: Plumb. Permit Frcr, Elec. Permit Fee: IEPERMIT Other Mech. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 �rs$47_00 hrs Phaiph. Fee: ..... •• NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Worirt air_ L Thpce fooc are haced on the nreliminarv, information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 =s.f. $418.00 Remodel, Other 1REMRESOTH Suppl. PC Fee: Q Reg. o OT p.0 hrs $0.00 PME Plan Check: $0.00 1 200 1 amps $47.00 Electrical IRELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tay: ,ldininisrrative Fee: O G Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $83.30 Select a Non -Residential Building or Structure 0 i Travel Documentation Fee: ITRA VDOC $47.00 Strom Motion Fee: IBSEISMICR $12.50 Select an Administrative Item B14, Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $4,388.80 $465.00 TOTAL FEE: 1 $4,853.80 Revised: 01/15/2014 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (ie. vianning, t uottc worxs, rtre, aanuary newer "iserncc, acauut Th— %es are paced on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef 71' /13) ADDRESS: 821 Betlin Ave DATE: 06/16/2014 REVIEWED BY: Sean APN: BP#: 140100140 'VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p 1 hrs PENTAMATION 1 R3SFDREM PERMIT TYPE: i WORK Revision #1: Increase roof and wall heights; remodel additional 250 sq ft. SCOPE NOTE: This estimate does not include fees due to other Departments (ie. vianning, t uottc worxs, rtre, aanuary newer "iserncc, acauut Th— %es are paced on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef 71' /13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes Q No $0.00 250 s.f. $418.00 Remodel, Other IREMRESOTH Suppl. PC Fee: (F) Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT O. p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 O 0 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 hours $139.00 Plan Check, Hourly ISTPLNCK e A A"I Ducuine nluiion F(T'5 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $557.00 TOTAL FEE: 7$558.50 Revised: 04/01/2014