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15080165-DP CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20387 GILLICK WAY CONTRACTOR:PERFECT HOMES PERMIT NO: 15080165 CONSTRUCTION CORP OWNER'S NAME: AMBATKAR PARIKSHIT AND GADEPALLI PA 382 LASSENPARK CIR DATE ISSUED:08/26/2015 OWNER'S PHONE: 4086700580 SAN JOSE,CA 95136 PHONE NO:(408)600-8033 EP V LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 15�6� % '5 CONSTRUCT(N)COVERED PORCH(174 S.F.) License Class Lic.4 Contractor `ytw*4?Am Date Y S� 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 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:$20000 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:36936018.00 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 OF PERMIT ISSUANCE ®I8 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 LAS d D 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 — Date: with all non-point source regulations per the Cupertino Municipal Code,Section - 9.18. `422�'l any roofing Date All roofs shall be inspected prior to any roofing material being installed.If a roof is 77 installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I,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 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 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 5505,2 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 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 CONSTRUCTION PERMIT APDL MATIN ISM16. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE^CUPERTINO,CA 95014-3255 CQJPERTYFlO (408)777-3228 o FAX(408)777-3333^building a�cupertino.orp ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl ❑ REVISION/DEFERRED ORIGINAL PERMIT# d PROJECT ADDRESS APNt! _� –3 G— ` �"►��oc.1c ..4J OWNERNAME t PHONE --1 E-MAIL ^ d'�`•�, C ID's ©� STREET ADDRESS D `° ` CITY STATE,ZIP FAX �5'vI CONTACT NAI1E :� HONE ( EMAIL � -�1 &e_ } STRE DRESS �� CITY,STATE,ZIP FAX �-til ft.� o"° R•\ ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 11__,�CHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME` ��Q^ LICENSE NUMBER 3 LICENSE TYPE BUS.LIC# COMPANY NAMn� �V Y� E-MAIL FAX JCC STREET ADDRESS p CITY,STATE,ZIP Q / PHONE ARCMTEC-IENCLINEER NAME LICENSE NUMBER BUS.LIC# COMPA AMEE- AIL FAX STREB;PYDRESSCITY,STATE,ZIP S DESCRIPTION OF WORK L EXISTING USE PROPOSED USE CONSTR TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA POCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 601 E]ATTACH #DWELLING UNITS: ISA SECOND UNIT OYES SECONDSTORY ❑YES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES LVED BY" TOTAL VALUATION: PLANNING APPL H ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 0 T"� fi ®P V b° Lf�J{ Gt �f7 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 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 buil 'ng construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: —' -z���� SUPPLEMENTAL WFORMAT164LAEQUIREDPLAN,CHECK TYPE � ROUTINGSLIP _New SFD or Multifamily dwellings: Apply for demolition permit for oVER-THE-COUNTER El BUILDING PLAN REVIEW 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 El..,FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. [] 'MAIOR' 171 SANITARY sEWERDISTRIOT ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoc revised 06/21/11 CRTY OF CUPERTffN® 100165. FEE ESTIMATOR-BUILDING DAWSMN ADDRESS: 20387 Gillick Way DATE: 08/24/2015 REVIEWED BY: PAUL APN: 369 36 013 BP#: `YALUATI®N: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK Construct N Covered Porch 174 S.f. SCOPE 1 _J Ale ch.Ptah Check Phunh. Plan Clteck Dec. Plait Check A-tech. Pernait Fee: Phimb.Pernair Fee L'lec. Permit fee: Other_Llech. Insp. Other Plunih htsp. C Other Klee. 111sp. Alech, Lisp_ Fee: Phrmh. Insp. Fee: Flec Imp. Fee. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the ereliminar information available and are on! an estimate. Contact the PTY or addn'1 in o. FEE ITEMS (Fee Resolution I1-053 Eff. 7/l/13� FEE QTY/FEE M)ISC ITEMS Plan Check Fee: $0.00 = # Covered Porch Suppl. PC Fee: (F) Reg. 0 OT [�Q.Qj hrs $0.00 $1,003.00 ICOVPORCH PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT Q.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: L] Achninistrative Fee: Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential D Travel Documentation Fees: Building or Structure Strong Motion Fee: 1BSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3.60 F$1,003.00 TOTAL 1FEE: $1,006.60 Revised: 07/02/2015 BuBding Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E fR T V N O Fax:408-777-3333 CONTRACTOR SUBCONTRACTOR LM JOB ADDRESS: PERMIT# 1,5-68 01 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: USINESS LICENSE# ADDRESS: — CITY/ZIPCODE: *Our municipal code req uir s all businessies worlknng lh tlne u o have a City of Cupertino business &ensc. NO BUILDING (FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS ACTORS HAVE OBTAINED A CITY OF C>UP E][ TINO BUSINESS LICENSE. I aM2!!Laasing any subcontractors: Sig toe (Date Mease check appllicablle subcontractors and compllete the ffolii®wing infformoflone V SUBCONTRACTOR lE USffNIESS NAME BUSINESS N ESS ILff CIEl\NSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing w Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature (Date MOHMMAD U.SADIO,PE Project Title: GADIPALLI&AMBATKAR RESIDENCEE ' 1586 GRASS VALLEY DRIVE Engineer. MUS Project ID: WOODLAND,CA 95TT6 Project Descr. PORCH REMODEL PHONE:530-315-4907 E-MAIL:mohammad,.sadiq@sbqlobal.net P irtkd:16 AUG 2015,5:41 PM r Pio�,ect lnformatloln EIEEftCA-1i4A[ehV-4.06.R = adOCU�harm415,6dS15:7.30,Vu.-615131ENERCALC,INC.i98inI O •D D p Project Title :GADIPALLI&AMBATKAR RESIDENCEE Description :PORCH REMODEL I.D. Address :20387 GILLICK WAY, CUPERTINO, CA 95401 Project Leader :MUS Phone : 530-315-4907 Fax : eMail mohammad.sadiq@sbcg Project Notes This project proposes to remodel the existing porch to enhance the architechtural feature of the existing residence. CUPERTRO 5,e. �uiPdil D8P2 ,-- -<EVIEtA'ED�-Ok CQDE COMPLaAaCE DFRCE Copy L y/ AUG 2 ��p4 E55 rp'��l lY A 4C l