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15120043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15120043 10263 JUDYAVE CUPERTINO,CA95014-3524(375 08 043) CRAIGAROGERS CONSTRUCTION INC . SAN JOSE,CA 95136 OWNER'S NAME: BA1NS KULVINDER SINGH AND SUKHVANT KTRUSTE DATE ISSUED:07/15/2016 OWNER'S PHONE:408-891-9637 PHONE NO:(408)978-5484 I ICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie.#978553 Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11/30/20.16 —BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL COMMERCL4LL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT(N)ATTACHED IN-LAW UNIT(415 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: REV#1 INCREASE HEIGHT OF CEILING 9 FT TO 10 FT.;INCREASE 1. I have and will maintain a certificate of consent to self-insure for Worker's HEIGHT OF ROOF LINE',;ADD COFFERED CEILING 2ND FLOOR - Compensation,as provided for by Section 3700 of the Labor Code,for the ISSUED 9/27/2016 ,gip ormance of the work for which this permit is issued. l/r 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. Sq.Ft Floor Area: Valuation:$61000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 08 043 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,the applicant underst ds and will comply with all non-point source regulati s per tka Cupe i o and Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature lwc / Date 9/27/2016 Issued by:ABBY AYENDE Date:07/15/2016 ON VNE ER DECLARA& 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 being 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 remove 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. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Scc.7044,Business&Professions Code). Date:9/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER.'; 1. 1 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 2. I 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 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store 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 devices which emit hazardous air contaminants as defined by the Bay Area Air Quality 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,Se 'ons 25505,25533,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:9/27/2016 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 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 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 L ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 9/27/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING.DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPER`T'I[NO (408)777-3228• FAX(408)777-3333 o building(a)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI IeREVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS�� APN# V OWNERNAME hA I V I a . C � � �� PHONF e Q&)�qt—\��' E-MAIL f/•s) STREET ADDRESS q Q CITY,STATE,ZIIP m 2—to 57 FAX CONTACT NAME ` E MAIL "7`-1 �� '�l�%c�•—�--C7fl� STREET A]=,... CITY,STATE P n ' (2 %31�� FAX 13OWNER ❑ OwNER-BUH,DER ElOWNER AGENT ElCONTRACTOR ElCONTRA'C"T'O�R'AGENT ElAR+C�HITECT. ❑wENGINEER ❑ DEVELOPER ❑ TENANT —CONTRACTOR NAME LICE LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP T-;;01,'E DESCRIPTION OF WORK l EXISTING USE PROPOSED USE - CONSTR_TYPE #STORIES -USE TYRE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK.AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH []ATTACH f DWELLING UNITS: IS A SECOND UNIT ❑YES. SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES gYES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECENEDB.'""•;� a ., TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO' - ,: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on theproperly owner's behalf I have read this application and the information I have provided is correct. I have read the Description of)Vork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorizer esentativyes of Cupertino to enter the above-identified property for inspection purposes. ,Signature of Applicant/Agent: v f` Y Date: SUPPLEMENTAL INFORMATION REQUIRED PLA)\;CHECKTIPE ROUTING SL3P ' New SFD or Multifamily dwellings: Apply for demolition permit for E ovER THE CfluNTER ❑ sun DNG PLAT\S2E�IE�i existing building s). Demolition permit is required prior to issuance of building permit for new building. ❑ EaPRss ❑PLAItiNIlVGPLANREVIEYI k _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAND�RD ❑ I,UBLIC��©RKs form if any Hazardous Materials are being used as part of this project-. LQ LARGE. ❑,,,SIRE SEPT= _Copy of Planning Approval Letter or Meeting with Planning prior to �,: ❑ sA1STTARY SRF'ER DisTRICT submittal of Building Permit application. -.,.,� � ❑=�NvzaonnWWALgEALTa. BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:15120043 10263 JUDYAVE CUPERTINO,CA 95014-3524(375 08 043) CRAIG A ROGERS CONSTRUCTION INC SAN JOSE,CA 95136 OWNER'S NAME: BAINS KULVINDER SINGH AND SUKHVANT KTRUSTE DATE ISSUED:07/15/2016 OWNER'S PHONE:4088919637 PHONE NO:(408)978-5484 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lia#97$553 Contractor CRAIG A ROGERS CONSTRUCTION INC Date 11/30/2016 —BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH 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: CONSTRUCT(N)ATTACHED IN-LAW UNIT(415 S.F.) I hereby affirm under penalty of perjury one of the following two 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. V I have and will maintain Worker's Compensation Insurance,as provided for by R-1 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$61000.00 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: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 08 043 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 ti, Additionally,t n applicant underst s and will comply with all non-point source regul ns per the Cupert Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. �, Signature Date 07/15/2016 Issued by:PAUL O'SULLIMAN Date:07/15/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the. FRCS following two reasons: All roofs shall be inspected prior to any roofing material being 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 remove 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. 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:07/15/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. I haveandwill 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 2. I 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 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material.Additionally,should I u shall not employ any person in any manner so as to become subject to the s equipment or devices which emit hazardous air contaminants as defined by th B y Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with t C ertino Municipal�g ,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C de, ections 255 5,25 33, nd 25534. Labor Code,I must forthwith comply with such provisions or this permit shall /� be deemed revoked.. Owner or authorized agent: a V APPLICANT CERTIFICATION Date:07/15/2016 I certify that I,havd read this application and state that the above information is N TR N A ENu correct.1 agree to comply with all city and county ordinances and state Jaws I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(See.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city, 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 ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 07/15/2016 professional CONSTRUCTION PERMIT APPLICATION COMMiiUNITY DEVELOPI0EN T DEPARTMENT•BUILDING DIVISION 10300 T ORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 buildino(a=oertino.org ��/ � (,f CUP;_RTINO ❑NEW CONSTRUCTIAON ❑ ADDITIO(N� . [I ALTERATION/TI ❑ REVISION/D-yEFER RBD ORRMIT ORIGINAL PET PROJECT hDDP ESS _\" F�°� � ;fig� � APE.'n f >C 0�C�� OA'NERNAN Kj�� � Lc I Nsck =1✓tIL STREET ADDRESS t� c CITY, _TATE,ZIP � �, ^ � tp® I 'FAXA CONTACT NME �9 t VI..i� `"� t SIRE% DR_S ®, ® y CITY,STATE,ZIP ,,g �� �bM� •� C , j.+�t®i Q�-�esaE\O >QkCx�! r'AX OANTEP ❑: OWNM-BUILDER ❑ O'A ERACEINT ❑ CON.iitACTOR ❑CONTP.ACTORAGMrT ❑ A-RC=- ,r.CT ❑ENGN cR ❑ D tirLOn ❑ icNAN-r CONTRACiORNAl `.� LICENSENUI,4BER I LICENSETYPE ( BUS.LIC R l �✓ e C01✓PATvYNAJuE I E-1J AIL I FAX STREET ADDRESS CITY,STATE,n,ZIP PHONE ARCIMFCTIENGI�---ER NA]JE I LICEINSE N'Uh3ER I SUS.LIC m COMPANY NAh STREET ADDP.ESS CITY,STATE,ZIP PHO DESCRY T ION OF WOP.K �C 11 6� � —iL�wV.� �1a� 1�'� �' ( °.1� ®�Ot lei 6�\ •� Ek1STLnG USE PROPOSED USE CONSTR TYPE Y STORIES USE I TYPE I OCC. SQ.FT. I VALUATION(S) EKLTG ( NiW FLOOR I DEMO I TOTAL AREA AREA AREA N'ET•AREA `- BATIMOOaI K,—CI—N. - OTI-ER I - REMODEL AREA P.EMODEL AREA REMODEL AREA PORCH.AREA. DECKAREA TOTAL DECKTOR CH T7 GARAGE AREA: Ll DETACH ❑ATTACH _DWELLINGUNTrS: ISASEC'ONDUNIT ❑YES I SECOND STORY []YES ( ( - BEInG ADDED? ❑N ❑ 0 ADDITION? NO PRE-.,L nP TC.A,T10N ❑TES IF=,PRO VIDE COPY OF IS THE BLDG AN ❑2 = -- — TOTAL V?.LUATION:. A'.'1 PLT'GAPPLR ANO PLAN'N'T�'GAPPROVf7 L.TR EICHLERHOME? _ _ ®p By my signature below,I certify to each of the following: I am the property oviner o aut went on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ' - verify it is accurate. I agree to-comply-vdth all applicable local ordinances and state laws relating to building c nstruction. I ar ize representatives-of Cupertino to enter the above-identi=�ed�propery for insp-tion puposes. Signature of Applicant/Agent: Date: --� { SUPPLE2��I�NTAL INFORMATION REQIJIRr.D s.�-���c>�cx �_ - 2\rew SFD or Multifamily d-,ehings. Apply for demolition pe nit for ❑ OFER THE COL tTEFt� BUIIDL\GPL3�Rr VSE4Y existing building(s). Dernolition perinit Is required prior to Issuance Of building AN permit for new building ErEss - �L PLs t1>hG>Len xssiEv � z v _Commercial Bldgs: Provide a completed Hazardous Materials Disclosurei cTri�e� i � L pTJBI Ic�oRTcs�� �{ form if any Hazardous Materials are being used as part ofthis project. = - t� S.�RG� - — � k•IIDFPT - _ � Copy of Planp-ing Approval Leer or Meeting with Planning prior to - - - submittal of Buildir+g Per it application. L�aoR Y �RvisrRrcr B1dg-,4.pp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 102 JUDY AVE DATE: 12107/2015 REVIEWED BY; MELISSA APN: 375 08 043BP#. VALUATION: j$61,0Q0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD Or Duplex 2nd Unit? ')Yes % No PENTAMATION USE: PERMIT TYPE; 1 R3SFD2Ng WORK CONSTRUCT N ATTACHED IN-LAW UNIT 415 S.F. SCOPE OCCUPANCY TYPE:. TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. R-3(Custom) II-B,111-B,IV,V-B 415 $2,654.00 IR3PLNCK $1,666.00 IR3INSP TOTALS: 415 $2;654.00 $1,666.00 tt?.,. •Zt L,?, r ��t.. 'l.tr Jlz..isr s:,tdr !.r.`; 1 t'<t.tll `i'£?: Oiller Nurr1b knsp, 7-- NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District, etc.). These,fees are based on the preliminar in ormation'avalable and are only an estimate. Contact the De t for addn'l in o. FEE ITEMS (Fee Resolution 11-053&L' 7,/1/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure Suppl, PC Fee: Reg. Q OT0.0 hrs $0,00 or Element of a Building PME Plan Check: $0.00 Permit Fee; $1,666.00 Suppl. Insp.Fee:E Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 # Construction.Tax: IBCONSTAXR 1 new $687.10 amts Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: 1PLLONGR $58.10 Select a Non-Residential Building or Structure Strong Motion Fee: IBSEISMICR $7.93 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SLTBTTALS:; $5,076 13 $0.00 TOTAI��EE $5,076.13 Revised: 10/01/2015