B-2016-1149 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1149
10701 S BLANEYAVE CUPERTINO,CA 95014-4543(369 34 044) EURO DESIGN&
REMODEL CO INC
DURLINGAME,CA
94010
OWNER'S NAME: Mr&Mrs NIRA)D AND NANDITA S DANGORIA DATE ISSUED;04/04/2016
OWNER'S PHONE:650-562-6674 PHONE NO:(650)759-3709
LICENSED,CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#801557
Contractor EURO DESIGN&REMODEL CO INCpate 11/3012017 X BLDG X ELECT_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 lot full force and effect. JOB DESCRIPTION:
Demolish(e)sunroom and patio(132 sq ft);Construct first floor addition
I hereby affirm under penalty of perjury one of the following two declarations: (408 sq ft)with covered patio(75 sq ft);interior remodel(391 sq ft);
1. I . e.and will maintain a certificate of consent to self-insure for Worker's upgrade electrical panel(200 amp),
ai pensation,as provided for by Section 3700 of the Labor Code,for the
i formance of the work for which this perinit is issued.
I have and will maintain Werker'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:966 Valuation:$100000.00
APPLICANT CERTIFICATION
I erFify 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 Dumber: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 34044 R-3(Custom)
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 CJ I onsequence of the granting of this permit. WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR
Additionally,the a ticant upders ridwill comply with all non-point
source reg,,,tloyi's p e Cup !no unicipal Code,Section 9.18. 1$0 DAYS VSPECTION.
Signature Date 04104LZOIB Issued by:MELISSA NAMES
Date:04/04/2016
OWNER-BTJTY. DECLARATJ N
I hereby atlitti that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following tw reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. as owner of tile property,or my employees withwages as their sole installed without fust 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec-7044,Business&a Professions Code). Date:04/04/2016
I hereby affirm under penalty of pejjury one of the following three declarations: ALL ROOF COVERINGS TO 13F 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 DISCLOSURE
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 25505,25533,and 25534. I will
permit is issued. maintain compliance With the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Henith&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
au contaminants as defined By lite Bay Area Alr_ 'ty Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain complianco with the npei Iiuo 1vlulsi ' 1 Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety Co e,Se 2550 5533,and 2553d.
Labor Code,I must forthwith comply with such provisions or this permit shall :
be deemed revoked. Owner or authorized agent:
APPLICANT CER'T'IFICATION Date:04104/2016
I certify that I have read this application and state that the above information is CON.TRTJCTfONJNDINC AGENCY'
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a ccnstru n lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is i ed(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 AI2CIT1'rFCI"S DECLARATION
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.
Signature 1°` Date 041041201 6 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPEttTINO (408)777-3228•FAX(408)777-3333•buildingkilcupertinG ora F-d'o r'k' • /f yq
®NSW CONSTRUI;TION W ADDrrm -EIALTERATioNITI ❑ REVISION I DEPBRRBD ORIGIKAL€'ERMIT II
PROB?CTADDRESS I l V` U $Uk4ey "CA. APN# -,-TIU 9
OWNERNAME `'�11tA`_{ D!°r CI C)p+ f1 �/
P
ta50 �a��. �p�o?�' Elap: Ce04�.�Ar4t�l •c. t�
STREET ADDRESS � r ^� ��. CITY,STATE.ZIP f) Y IOU 4 FAX
CONTACT NAME 1 J b 4(
p094 I0 y
! f'rf�vPfl�.g �p Ct t V A- "t rs�if�v• �11
STREET ADDRESS:19 I I CIT7C,STATE,ZIP - FAX
GWNER ®.OwNER-BUILDER Cl OWNER AGENT O CONTRACTOR CONTRACTOR AGENT 13 ARCiirmcr ®ENGINEER 13 DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSETYPE BUS.LIC#
COMPANY NAME - E-MAIL -
FAX
STRERI'ADDRESS - CITY,STATE,ZIP7. PHONE -
ARCHITECT/ENGINEFA NAME VVEt r[SY D �U ftr LICENSE NUMBER e_.19�'�O 5�4-4 7 BUS.LIC#
COMPANY NAME � 1 E-MAIL - FAX
'�
STREET ADDRESS rL x CiTY.STATE,21P L'.l,f _It)S CA q5 X51 PHONE D&
DESCRIPTIONOF WORK 0151 t4 t)(A Ir t o m ov It)tl S71 MG Fl It ST "OK%V-Ar— C(A N W0 4E4 VAJ?3 . Gb A:1'-1 F-U
cT144 Dr- 469 SF F1Uf FIM P, T109 10 Ofke- VWJS AAT &)> 7S5r- p*110
Sftwe t,4rGt 4 S rr A tX>"T k 0"kt— /�j' 4.,
BXISrB1G USE PROPOSED IISE CONSTR.TYPE d STORIES -
USE TYPE OCC. SQ.Fr, VALUATION($)
EXISTO NEW FLOOR DEMO TOTAL- -
-AREA AREA AREA N&TAREA
BATHROOM iTCHEN OTHER -
REMODELAREA REMODELAREA REMODELAREA
PORCHARRA DECK AREA TOTALDECKIPORCHAREA GARAGE ARRA: DETACH -
ATTACH
#DWELLING UNITS: ISA SECOND U NIT U YES SZCOND STORY DYES - - -
REINGADDEDT []NO ADDITION? ®NO
PRSAPPLICATION YES IF YES,PROVIDE COPY ON IS THE BLDG AN 113 YES RFP$ - -y TOTAL,VALUATION:
PLANNINGAPPL# �NG PLANNING APPROVALt£sTTHR EICHLERHOMB? 13 NO -:
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 provi ' 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 b ' astructio�nJ.IIaut_horize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLMIENTAL FOR TION REQUIRED
PLANCHEL7CTYP&;' Rt)LITiIVGSLIP °:
T New SFD Or Multifamily dwellings: Apply for demolition permit for pg ButLntvt:rLAta isvlEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDARn: CI rIIBLIC wow .
form if any iIazatdous Materials are being used as part of this project.
C} I,$RGIiU F[R)DEPT -
_Copy of Planning Approval better or Meeting with Planning prior to 11IAJOR SANrrARYfiEWERbtS7TttC3
Submittal of Building Permit application.
-. ..,: - °�❑ BNVSR€INMENTAiELEAL'TH:.- :--�:.
BldgApp_201].doe revised 06121111
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DANGORIA RESIDENCE
SHEET NO. SK1 OF 1
JOB NO. 15-144 .
EQ ENGINEERING
BY EPQ DATE , 5/13/16
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FOR SHEAR TRANSFER.
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SHEET NO. SK2 OF 2
EQ ENGINEERING JOB NO. 15-144
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