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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10561 STOKES AVE
CONTRACTOR: TBD - TO BE
PERMIT NO: 09070168
DETERMINED
OWNER'S NAME: AMIT & ANITA PATEL
DATE ISSUED: 07/24/2009
OWNER'S PHONE: 4083067005
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION��
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
fl"-- r--' r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REMODEL 143 SQ TO TO BATHROOM, 350
(commencing with Section 7000) of Division 3 of the Business & Professions
TO OTHER,
Code and that my license is in full force and effect.
STRUCTURAL NO RE -ROOF. 2 NEW DOOR OPENING,
REMODEL LIVING, DINING, BATHROOM, BEDROOM.
1 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: $30000
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: 32649025.00
Occupancy Type*
permit is issued.
i
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 DAYS 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
granting of this permit. Additionally, the applicant understands and will comply
Issued b _ �-- 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. 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,
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. 1 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, Sections 25505, 25533, and 25534.
01
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: r Dater
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, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
ADDITION/REMODEL
PERMIT APPLICATION FORM
APN #
Date:
Is a 2". unit being added? Yes [:]No ® If yes, please fill out the permit application for 2" unit.
Building Address:
Mailing Address (if different from building address):
Owner's Name:
e #
Contractor:
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone #: LW-) S Ze1 Z-ZfS60
c--_ y\anat , Gt
Fax #: 2-612,- 7900
Building -Permit Info:
Bldg. gj Elect. Plumb. Mech. Hillside ❑
Job Description: e
3�
Addition -What is being added.7 (Be Specific): \ ,�d ups
What is being remodeled (not including addition)?
NZ.uJ 'b O,_n p�ie'`� rvSS �v�hev�O.r Q. Wxxa 1 n� \ ,4J: c)
N . �1Ly k\CJUA ps.--�" . N - " r, 1.
q2c S% uc c v T. tlUuSt Qc �lzt1c ��� �� �� owS - �r VOrcan COv - lis t:�
Remodel Includes Re -Roof: Yes ❑ No ® If yes list number of squares
Remodel Includes Structural: Yes YJ No ❑
Do you have the pre -application planning approval? Yes ❑ No
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: 4�_ q- Garage: Detached Attached
_(g�_
Remodel: Kitchen BathjL Other � _ 5 c 45 C
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/IIIN-A ❑ II/III B, IV -HT, V -B
Valuation: Z�W�-'C =-
Please check this box if the project is a
second -story addition ElProject
Size: Express Standard 11Large ❑ Ma -or El
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over -the -Counter ❑
Revised 07/06/09
Community Development -
10300 Torre Avenue
a Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPERTINO
Building Department
00 .416 - # z-361 S
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
�' /v
Date
JOB ADDRESS:
s rVlz�E5 ��
PERMIT #
09 o 70/eT
BUSINESS NAME
BUSINESS LICENSE #
OWNER'S NAME: Ant ► r -V-4`
PHONE # 4o e £T y 3 - 7
GENERAL CONTRACTOR:
FAX #
00 .416 - # z-361 S
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
�' /v
Date
Owner/ Contractor Signature
A-�/-/°
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
(� laz GHQ!
Z ZS'y
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
A-�/-/°
Date