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B-2016-2274 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2274 10812 BARRINGTON BRIDGE CT CUPERTINO,CA 95014-6401(375 22 096) S O D BUILDERS INC ENCINO,CA 91316 OWNER'S NAME: MANOMOHAN RANJIT AND SESHADRI ANUPAMA TRUST DATE ISSUED:07/08/2016 OWNER'S PHONE:408-835-2538 PHONE NO:(818)616-8377 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL'BUILDING CONTRACTOR Lic.# 4 0 Contractors O D BUILDERS INC Date 11/30/2017 X BLDG —ELECT X 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: I hereby affirm under penalty of perjury one of the following two declarations: REMOVE 3(E)WINDOWS;ADD GAS LINE-F1 ZE PLACE 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 i;%performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by v Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9500.00 APPLICANT CER IFI ATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 22 096 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,th plcan t understands-and will comply with all non-point source regul ions er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. f gnature e Date 7/812016 Issued by:Abby A ede Date:07/08/2016 - DER D LA T N I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material eing 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 rei nove 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/8/2016 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 DISCL )SURE z. 1 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 25505,25:533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Co e,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I stor or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devic es which emit hazardous air contaminants as defined by the Bay Area Air Quali 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 25505,25 33,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:7/8/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING NDIN Y 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 properly 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 ARCIEUTECTIS DE LARATI Code,Section 9.18. 1 understand my plans shall be used as public records Signature Date 7/8/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPS l<TI (408)777-3228-FAX(408)777-3333 building0cupertirlo.ora el ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION J TT ❑ REVISION/DEFERRED ORIGINAL PERMIT t. PROJECT ADDRESS / 10,912 7r, APN# � OWNER .; NAME �` t` j� EMAIL j �t STREET ADDRESS �0 k j- �� 2 r'�` CITY, STAG,ZIP 'No Cc+ 067'j FAX CONTACT NAME PHONE �S t f 110�/Yl P S(1- —&-too E-MAIL �tt na 5 rM •Com. STREET ADDRESS 3 l uu n�1. � ;-r -,RwJ, CITY,STATE, y��t eA �C5 cd FAx ❑OWNER ❑ OwNER BUILDER ❑ owNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT X ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEP LICENSE NUMBER Z� LICENSE TYPE BUS.LIC# `Z V LRAS COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP 6;n gw 713147 PxoNE - D J-3z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LTG# COMPANY NAME E-MAILFAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Wt ya' EXISTING USE- PROPOSED USE CONSTR.TYPE I #STORIES. USE TYPE OCC. SQ:FT_ VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA - TOTAL DECIUPORCB AREA I GARAGE AREA: ODETACH - ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES. SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REQ D „ TOTAL V UATION:. PLANNING APPL# ❑NO PLANNING APPROVAL LETTER. EICHLER HOME? ONO QlJ By my signature below,I certify to each of the following. I am the property owner or authorized agent to act on the property owner's behalf. I have read this. application and the information I 'c =d is correct. T have read the Description of Work and verify it is accurate. I agree to comply with all a plicable local ordinances and state laws relatin to bui Ing construc+tiioon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: 'I/ r Date: SUPPLEMENTAL INF ON REQUIRED _. PLAN Grli C SPE I2011TI G SLIP. _New SFD or M y dwellings: Apply for demolition permit for existing building(s). Demolition permit is required.prior to issuance of building ovF R'T�counrl�s BU�LDIxGP REVIEW �J p new g permit for building. xkBl S5 PLANNINCxP REVIEW: . _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0:-sTA1 nA D CD rUSLre wou form if any Hazardous Materials are being used as part of this project. ,LAR _Copy of Planning Approval Letter or Meeting with Planning prior to nrAaoR ❑ SANITARY sI . DISTRICT . submittal of Building Permit application. Q RNVIRON3LIEN AL.I7EALT1 BldgApp 2011.doc -evised 06121111 ,u. fttyAl - ow con � . vt 0 JO A Y g s .y x