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B-2016-1884CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21491 COLUMBUS AVE CUPERTINO, CA 95014-4972 (362 04 012) OWNER'S NAME: PRATIVADI SRIDHAR AND KALPANA TRUSTEE OWNER'S PHONE: 408-891-6503 LICENSED CONTRACTOR'S DECLARATION License Class Q Lic. #694247 Contractor VICTORY CONSTR COMPANY Date 08/31/2016 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. 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. 2.•. 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. APPLICANT CERTIFICATION 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, 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 Code, Section 9.18. Date 9/29/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 2. 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. a.. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I haveread 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, 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 Code, Section 9.18. Signature_ as - - - Date 9/29/2016 CONTRACTOR. PERMIT NO: B-2016-18.84 VICTORY CONSTR COMPANY SAN JOSE, CA 95116 DATE ISSUED: 07/13/2016 PHONE NO: (408) 256-8098 BUILDING PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: tract addition to detached workshop (201 sq ft). #1 - RELOCATE (E) SUBPANEL TO OUTSIDE - WORKSHOP ED 9/29/2016 Sq. Ft Floor Area: 201 I Valuation:: $20000.00 APN Number: Occupancy Type: 362 04 012 1 U (Private Gar /Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by; Abbyegg Date: 07/13/2016 RE ROOFS: 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. Signature of Applicant: Date: /9 29/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & SEvreW Code, Sections 255 15, 25533, and 25534. Owner or authorized agen Date: 9/2912016 CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed CONSTRUCTION PERMiT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (a� C U P S RTI ISI O cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI VISIOl /DEFERRED ORIGINAL PERMIT PROJECT ADDRESS 1 LA ( COLO M P)n ' k„ q e APN R OVdN'ERNAME RK f Q 1(w ay t PHONE Lq E-MAIL STREET ADDRESS me� CITY, STATE, ZIP FAX CONTACT NAME (� PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX El OPATER ❑ OWNER-BuiLDER ❑ o-„NERAGENT ❑ CONTRACTOR ❑ CONTTRACTORAGENT ❑ .ARCHITECT ❑ ENIGL17EER. ❑ DEVELOPER ❑. TFN?'T s CONTRACTOR NAME � jr/ � p� (4 /� � (R�• LICENISE NUMBERCA14 L LICENSE TYPE BUS. LIC # COMPANY NAME V I` TOV-! a, COPS-To E-MAIL W ! v FAX STREET ADDRESS til Is r (�Q e CITY; STATE, ZIP �y PHONE ARCHITECT/ENGLNEER NAME tJ �i q e I LICENSE \TUMBER , r'v BU'S. LIC COI\4PANYNA1,4Es E-A4AIL FAX STREET ADDRESS b sly WAY CITY, STATE, ZIP t�"ice' I PHONE S � DESCRIPTION OF WORK n C1 L) EXISTING USE - PROPOSED USE - CONSTR. TYPE :;' STORIES U UI I F SE TYPE OCC. SQ.FT. VALUATION' (5) FXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER I - REMODEL AREA REMODEL AREA REN40DELARFA PORCHAREA DECK AREA TOTAL DECKPORCHAREA G.ARAGEAREA: El DETACH - - - ❑ ATTACH DWELLING UNITS: - ISASECONDUNIT ❑YEs SECOND STORY ❑YES ' BEING.ADDED? ❑NO ADDITION? EINO PRE-.APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN E] YES RECEIVED BY ” TOTAL VALUATION: PLANWLNGAPPL= ❑NO PL.AN`NTNGAPPROVAL LETTER EICHLERHOAIE? E] NO --' "''++ ,� i^ By my signature below certify to each of the following: I am the property owner or authorized agent to act ontte property owner's behalf. I have read this application and the inf nation I have provided is corre . I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state law elating to building construcy . I authorize representatives of Cupertino to enter the above `denti e ci property for inspection purposes. Signature ofApplicant/AgeDate: 6 1 1l SUPPLEMENTAL INFORMATION RE UIRED �> '� r � Q PI A CHECK TIPS , ,v.....: ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for � O\ ER 7HE COL 4TER ❑ BUIML DIc PLS. RE\zEv, existing building(s). Demolition pen-nit is required prior to issuance of building a permit for new buildins. EiPlEss ' PLAn�r.cPLA `iiE\IE1\ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L7 sT�4DARD ❑. PLBLIC1joRls fora 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 submittal of Building Pena-lit application. ZAJOR x� s�4rrAxl sE\\ ExDISTRICi Ell. EN IROI TME �TAI'HEAL3Ii , y B7d,aApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMITP O: B-2016-1884 21491 COLUMBUS AVE CUPERTINO, CA 95014-4972 (362 04 012) VICTORY CONSTR COMPANY SAN JOSE, CA 95116 OWNER'S NAME: PRATIVADI SRIDHAR AND KALPANA TRUSTEE DATE ISS D: 07/13/2016 OWNER'S PHONE: 408-891-6503 PHONE No 1 (408) 256-8098 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #a24247X Contractor VICTORY CONSTR COMPANY Date 08/31/2016 —BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL _ — OMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: Construct addition to detached wo shop (201 sq ft). 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 pensation, as provided for by Section 3700 of the Labor Code, for the rmance of the work for which this permit is issued. e and will maintain Worker's Compensation Insurance, as provided for by V on3700 oftheLaborCode, for the performance of the work for which this Sq. Ft Floor Area: 201 Valuation:20000:00 it is issued. APPLICANT CERTIFICATION 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: Occupant Type; and state laws relating to building construction, and hereby authorize 362 04 012 U (Private : ar /Ag Bldg) 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 O PERMIT ISSUANCE OR Additionally, the app icant understands and will comply with all non -point source regulationsper the Cupertino icipal Code Sect! n9.18. 180 DAYS FROM LA T CALLED INSPECTION. y, Signature to 7/1 72 ay Issued by: Abby AyendeU64 Date: 07/13/2016 � 1L,`�rt7",`- I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to & : Ly roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or: my employees with wages as their sole installed without first obtaining an insj iection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for spection. sale (Sec.7044, Business & Professions Code) i. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 7/13/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" R 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 Is requirements under 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materi 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 Cupe rtino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25 material. Additionally, should I use 32(a) should I store o or devices handle hazardous emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the ay Area Air Quality y Area A nag Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the C uperdno Municipal C ' e, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cod S ons 25505, 15533 4pud 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION I certify that. I have read this application and state that the above information is Date: 7/13/2016 CONSTRUCTI N LENDING AG N Y uction lending a e correct. i agree to comply with all city and county ordinances and state laws I hereby affirm that there is a const for t e performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is is ued (Sec. 3097, 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 ARITE DECLARATION ' and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be us as public records. Code, Section 9.18. Licensed Signature Date 7/13/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE , CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-•3333 • building cupertino.ormc IF 9014 ❑ NEW CONSTRUCTION DITION ❑ ALTERATION /TI [I REVISION /DEFERRED OR] PROJECT ADDRESS �l L�1 T4I4`v6-.'� Cl Lfl"`1" ML� )M X (5 . APN # OWNERNAME L/E-iM{rAI_ CAIVT N6q-6t - S'I'REETADDRESS �Yi11��v AA£ �'jr�ae.Y�. CITY, STATE, ZIP 4 CONTACT NAME HON. %Vee. �j EMAIL CITY, STATE,STREETA➢DRESS ❑ OWNER OWNER -BUILDER D OWNERAGPNT l7 CONTRACTOR ❑CONTRACTORAGENT Ca ARCHrTECT i©.{E CONTRACT tNAME� Y LICENSENUMBER TLJCFNSFTYPE COMPANYNAME E-MAIL STREET ADDRESS CITY, STATE; ZIP ARCHITECUENGINECR NAME LICENSE NUMBER COMPANY NAME il,,i!\�r ,/ C�/}(?, E-MAIL STREET ADDRESS 4 .LirIL1 I i .4 it t CITY, STATE, ZIP'- DESCRIPTION OF WORK NF�j <bi, e -1 P. ivNyWQ 16 '1VAtI C F`V��UV9 �3 T¢t C'i{ f3 E lstiU .k C � J�A -T� P—�—A , EXISTING. USE I PROPOSED USE I: CONSTR,TYPB I #STORIES NAL PERMIT # FAX FAX 21 4 ., BUS. LIC FAX PRONE, BUS. LTC # FA ti. n't PhONE ❑ TENANT EXI TG NEWPLODR DEMO TOTAI '-3..:...::i:...�..•.:::.�...^...2...`._.G..s.: ..:.�.:.:.:.;..:r.-:a..-.:.:.::,<::::;:--.....,..�...:�..,......, ,........._.... .__.___._._. ::::::.....:.: ------- - AREA ARBA AREA A__- NET ARE .. '... _ _ ...................... BATHROOM KTTCHEN OTHER �::::'• :`' -' :_.� ': - - REMODELAREA REM.._:,:::. ODEL ARBA REMODEL AREA PORCH AREA DECK AREA TpTAL DECK/PflRCH AREA OARAGRARFAe❑ DETACH ','_•-, -• _ _ _ ""' _ © ATTACH :_ - - -_ _ p➢�VE].I.iNGUMFs: ISASECON➢UNIT ❑YES SECOA'D STORY El YES BEING ADDED? NO ADDITION? NG ............. ..._,.. .._....: .... ..: .. _:.:_.:.::s_.:.::::.:c::.:.:.:.-:::.::::::_:............._____..._...._....... _. .. PRE -APPLICATION ElYEs IPYBS,PROVIOECOPYGP .P[.AA'NER'SNAMU; 'RECEIVED LD VALUA, jI PLANNINGAPPLU © No PLANNING APPROVAL LETTER By my signature below, 1 certify to each of the following: I am the pjnpeity owner or authorized agent to act on the property owr is behalf. I have read his application and the information I lave provided is correct. T have read the Description of Work and verify itis accurate. I agree comply with all appli bre local ordinances and state laws relating o build ng construction I authorize representatives of Cupertino to enter the above -identified nperty for inspection p Illoses, Signature of Applicant/Agent: ^_ Date: — 40 —.—New SFD or Multifarnily dwellings: Apply for demolition permit for. existingbuilding(s). Demolition permit is required prior to issuance of building permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy. of Planning Approval Letter or Meeting with Planning prior to submittal of Building Pennit application, _ 2011,doe 03/16111