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14060197CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7648 NEWCASTLE DR CONTRACTOR: MOKKAPATI ANUPAM I PERMIT NO: 14060197 OWNER'S NAME: MOKKAPATI SUBRAHMANYAM V AND ANUPAM 7648 NEWCASTLE DR I DATE ISSUED: 06/3012014 I OWNER'S PHONE: 4089967721 1 CUPERTINO, CA 95014 1 PHONE NO: I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date 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. 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. Signature JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMODEL KITCHEN 22 SQ FT, BATHROOM 84 SQ, FAMILY ROOM 8 SQ FT, PANEL UPGRADE 200 AMP REVISION #1- RELOCATION OF SHEAR WALLS AND PARTITIONS WALLS- ISSD OTC 8/28/2014 Sq. Ft Floor Area: I Valuation: $55000 APN Number: 36617083.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN F PERMIT ISSUANCE OR 180 DAYS M LAST CALLED INSP CT �ON. Issued by: Date: e - l / RE- ROOFS: 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 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 ofthe property, am exclusively contracting with licensed contractors to pio sect the project (See.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 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 p i is issued. 1 ti that m 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 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 -po t source regulations per the Cupertino Municipal Code, Section 9.18. � (\ Signature Date tV IVAl 4 Signature of Applicant: Date: 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 he Bay Area Air Quality Management District I will maintain compliance with a A25 ti no Municipal Code, Chapter 9.12 and the Health &Safety Code, Sec ' n 25533 d 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess 9 1W,0 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7648 NEWCASTLE DR DATE: 08/28/2014 REVIEWED BY: MENDEZ APN: BP #: 'VALUATION: Iso PERMIT TYPE: Building Permit Only? ® Yes) No PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: A WORK REVISION #1- RELOCATION OF SHEAR WALLS AND PAR-I -II -IONS WALLS SCOPE PME Plan Check: 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 preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Fes' '.1 X13) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes) No $0.00 hours Plan Check, Hourly $286.00 1STPLNCK Suppl. PC Fee: ) Reg. 0 OT 0.0 h rs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 F-1 ) ) Work Without Permit? © Yes ) No $0.00 Advanced Planning, Fee: $0.00 Select a Non - Residential Building or Structure ) Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: $286.00 Revised: 08/20/2014 CUPERTINO CONSTRUCTION PERMIT- APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingocupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION/ DEFERRED ORIGINAL PERMIT # I Lf 0 1014- PROJECT ADDRESS OVI, V-e, APN # OWNER NAME ' _ a ,. i PHONE �{,'q� �j _-772 E tv], Ll_ � �� l /VW STREET ADDRESS? ' V CITY, STATE, ZIP I17-r FAX CONTACT NAME AI_ e' PHONE /\ �QI �j}� 7 ern ` E -MAIL /4IFAX - `J STREET ��D�R,ES n ` —' b❑ 1/YL CITY, STATE, ZIP, / ' ^ n OWNER OWNER-BUILDER C3 OWNER AGENT El CONTRACTOR 1:1 CONTRACTOR AGENT El ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL, FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTTNGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTI N OF WORY �1 e EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OTC. SQ.FT VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITC14EN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA LJDETACH ❑ ATTACH # DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY E] YES BEING ADDED? ❑NO ADDITION? E] NO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VAL A ]ON: 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 property owner's behalf. 1 haver ad this application and the information I have pr vided 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 bui ng constr ion. I au representatives of Cupertino to enter the abo i entified pr perty for inspection purposes. Signature of Applicant /Agent Date: SUPPLEMENTAL INFORM TION RF,QUIRED P HECK TYPE A OUTINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER-THE -COUNTER BUIL DING PLAN REVIEW 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 ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting With Planning prior t0 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121111 �F w� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7648 NEWCASTLE DR CONTRACTOR: MOKKAPATI PERMIT NO: 14060197 SUBRAHMANYAM V AND ANUPAM OWNER'S NAME: MOKKAPATI SUBRAHMANYAM V AND ANUPAM 7648 NEWCASTLE DR DATE ISSUED: 06/30i2014 OWNER'S PHONE: 4089967721 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL REMODEL KITCHEN 22 SQ FT, BATHROOM 84 SQ, License Class Lic. # FAMILY ROOM 8 SQ FT, PANEL UPGRADE 200 AMP Contractor Date 1 hereby affirm that 1 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 Sq. Ft Floor Area: Valuation: 555000 performance of the work for which this permit is issued. 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 APN Number: 36617083.00 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 S 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 DA S FROM AST 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 by: 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 [ am exempt from the Contractor's License Law for one of 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, B iness & Professions Code) , 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 I 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 1 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. permit is issued. Owner or authorized agent: ertify 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, Date Signature • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building Qcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 7(/ I g ^,fe I - (&6- //a PY 111 // APNR i / J- t 7 _�� S I (7Z PHONE - OVVNERNP.ME �V �) 1 E-MAIL sVmt) k �<o, pC y� j�vv STREET ADDRESS 7 I Q New 6 Ae D)( I CITY, STATE, ZIP car , e���� `7/ /A qSo4 FAX CONTACT NAVE SiJ b 1'CT' lI ftlo yl m m Moo k-6 /// PHONE %`_G(g- cf' - 7Z I E -MAIL �'�Ofi�IO( J / <'t-C, (Gl(ilVO� STREET .ADDRESS -76 / p (q 11 /e L. # r„ HC D �� `B-FLMDDER, IJ CITY, STATE, ZIP CA 1- �0 l FAX x OIANER ❑ OWNER- 13 OWNER AGENT ❑ CONTRACTOR ❑ CONTR.ACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER LICENSETYPE BUS. LIC R COMPANY NAME E -MAIL FAX STREETADDRESS CITY, STATE, ZIP PHONE ARCHTIECT/ENGINEER NAME CG��1 rl' ( 0c C LICENSE NUMBER < i\ lJ (L l� J BUS. LIC k' COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK n--} c A44 P e m c, eb "'1 'e),l %y YC Gig ;0 AttP' EXISTING USE PROPOSED USE CONSTR TYPE R STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM �y D. REMODEL AREA 7ti 1 J KITCHEN OTHER REMODEL Alj�p _ p P �- REMODEL AREO PORCH AREA DECK AREA TOTAL- DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH R DR'ELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE - APPLICATION -- ❑YES -- - -IF -YES, PROVIDE COPY OF. .. 1. IS THE BLDG AN_ _ El YES RECEII ED BY -r - TOTAL VALUATION: PLANNINGAPPLP ❑NO PLANNING APPROVAL LETTER EICHLERHONIE? ❑NO - -- - - - - - - -- - - - - -- � 4 SS o v0 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 building 0 struct(on. I auth(orrizze repres ntatives of Cupertino to enter the a bove- identified property for inspection purposes. Signature of Applicant/Agent: Date: 6 30 �! SUPPLEMENTAL INTFORMA ON REQUIRED PI AI\ c%rECi T1PE . iiouTLVC:sLIP, New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER TF[)rCOi1\7ER is G- BUILDI\GPL4I� RE��EW permit for new building. EI.PRESS FLANI�INGPLAnREVIE�V Bldgs: Provide a completed Hazardous Materials Disclosure [❑ sT.nAxD } Cl ruBLic ;voRls _Commercial form if any Hazardous Materials are being used as part of this project. ' t Copy of Planning Approval Letter or Meeting with Planning prior to URGE M 3 Q FIRE DEPT z Far+ _ submittal of Building Permit application. yrTOxy C�A�I�R'sEV�RnlsTixrcr - _�� � si; -- �.<E:V�'IRO7�'ASENTALFIEALTFi '_' sF •r BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FM-No FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 7648 newcastle dr FEE DATE: 06/30/2014 REVIEWED BY: Mendez APN: BP #: `VALUATION: 1$55,000 `,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Suppl. PC Fee: Q Reg. 0 OT 0.0 PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK remodel kitchen 22 sq ft bathroom 84 sq, family room 8 sq ft panel upgrade 200 am SCOPE $0.00 = s. f. $626.00 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS Fee Resolution II -053 E.'7i1-13) FEE QTY /FEE Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 hrs $47.00 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS Fee Resolution II -053 E.'7i1-13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 22 s.f. $626.00 Remodel, Kitchen (< =300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 = s. f. $626.00 Remodel, Bath (< =300 sf) IREMRESBAT Permit Fee: $0.00 Suppl. Insp. Fee: (j) Reg. 0 OT 0,0 hrs $0.00 ® S.f. Remodel, Other $418.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $47.00 200 amps $47.00 Electrical IBELEC200 Services Administrative Fee: IADMIN $44.00 0 0 Work Without Permit? 0 Yes) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $5.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $146.50 7.001 TOTAL FEE: 1 $1,863.50 Revised: 04/01/2014 I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 7648 NEWCASTLE DR I S ONTRA TOR:�MOKKAP ANUPAM I PERMIT NO: 14060197 OWNER'S NAME: MOKKAPATI SUBRAHMANYAM V AND ANUPAM OWNER'S PHONE: 4089967721 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor Date 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. 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 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 G 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 Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, qusiness & Professions Code) h/ 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: 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. 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 . ce ify that in the performance of the work for which this permit is issued, I shall o 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 1 have read this application and state that the above information is correct. 1 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 sour regulations per th upertino Municipal Code, Section 9.18. Signature Date 7648 NEWCASTLE DR j DATE ISSUED: 06/30/2014 CUPERTINO, CA 95014 I PHONE NO: JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL REMODEL KITCHEN 22 SQ FT, BATHROOM 84 SQ, FAMILY ROOM 8 SQ FT, PANEL UPGRADE 200 AMP REV # 2 - RE -ROOF (E) 29 SQ'S, REPLACE & RELOCATE (E) FURNACE TO ATTIC & ADD (N) A/C UNIT IN SIDE YARD AREA - ISSUED 9/30/2014 Sq. Ft Floor Area: I Valuation: $55000 APN Number: 36617083.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D T ISSUANCE OR 180 OM LL ALLIED INSPECTION. b Date: TD RE- ROOFS: All roofs shall be inspecte rior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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 Cupertin Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections .25505„#t533, and 25534. Owner or authorized agent: DatfltP, /' I CONSTRUCTION LENDING AGENCY I 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a )cupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI )� REVISION /DEFERRED B ORIGINAL PERMIT # ! 17-f D v 0 ` PROJECT ADDRESS-7,4 f ; rE Lv C>✓'�:54 _J6 (�S. APN # �V -'�) OWNER NAME L' 1 I`fi�- L,\ �,.yiQLYI �f/I YI'� ♦/�I D�� PHONE/ L �j ]� E -MAIL (I YI %1'I 1 �! Cf? yd's �I rv' STREET ADDRESS �"�✓ J CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS//S CITY, STATE, ZIP FAX El OWNER LT OWNER- BUILDER R AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME LICENSE NUMBER 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 PHONE DESCRIPTION OF WORK �a tvG a � l To ,de- EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA. DETACH [:]ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: - " - TOTAL VALUATION. PLANL7NG APPL # (:]NO PLANNING APPROVAL LETTER EICHLER HOME? []NO (2 0 0 0 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 building construction. I authorize representatives of Cupertino to enter the identified property for inspection purposes. �aybove- ApplicanUAgent: v�pY / v � C' Date: 1 p } C7 Signature of SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ -OVER- THE - COUNTER ❑ BUILDING PLAN REVIEW _ New SFD Or Multifamily dwellings: Apply for demolition permit for 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 ❑ .F]REAEPT -' _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ SANITARY SEWERDISTRICf submittal of Building Permit application. ❑' ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 L /Y F. M-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7648 NEWCASTLE DR DATE: 09/30/2014 REVIEWED BY: MELISSA APN: 366 17 083 BP #: 14060197 "VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: I PENTAMATION 1 SFDWLROOF PERMIT TYPE: WORK REV # 2 - RE -ROOF E 29 SQ'S REPLACE & RELOCATE E FURNACE TO ATTIC & ADD N A/C SCOPE UNIT IN SIDE YARD AREA 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -0.53 E': ?!/ %13) Mech. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 hrs $48.00 QTY /FEE MISC ITEMS 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -0.53 E': ?!/ %13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 2,900 s.f. $493.00 Re -roof 1REROOFREs Suppl. PC Fee: Q Reg. Q OT Q.0 hrs $0.00 PME Plan Check: $0.00 F 1-7 # $143.00 Mechanical 1MFR = <100 Furnace, Forced -Air Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT Q.Q hrs $0.00 0 # Mechanical $72.00 1BREMAIR A/C Units (< =10K cfm) PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: 1ADM1N $4 0 E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Building or Structure Select a Non - Residential G 0 Travel Documentation Fee: ITR.9VDOC $4 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $141.00 $708.00 TOTAL FEE: 1 $849.00 Revised: 08/20/2014 CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingocupertino.org 0J9z Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 7� /f � N� LL Cdr y �,� �1 (^Y Jfj APN ` 6 — (, f �— � /1°'91 3 V V BP# Yb 6Ol�j OWN_rNAME 0 b�c�hm�n ,gym )4rK_L_, o4 OWNER ADDRESS DESCRIPTION OF WORK: j2m ✓VICi- We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 0-""l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Y0144 Ore b �5� Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. [,�-2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner - Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 1�Y/5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. rte/ 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. -A-1 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. _�/8. I understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForin 2010.doc revised 04 114110 %W w k9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. &11110. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. AL"', 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b� ll by all applicable laws and requirements that govern Owner - Builders as well as employers. per' 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur . Property Owner's Signature: = �YV - �. , Dater^ r' ------------------------------------------------------------------------------------------------------------------- ----- - - - - -- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. ,y Scope of Construction Project (or Description of Work): 1 j C `�'r `n Project Location or Address: 7( 11s NE it!C013 4C C A (Ak C >�l Name of Authorized Agent: .Se� Q.� 17 0 Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 0 2.J ZL" f OwnerBuilderForm 2010.doc revised 04114110 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC -CFIR- ALT -03 -E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R- ALT -03 -E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R- ALT -HVAC) (Page 1 of 1) Site Address: 76,Y e/cL� 1 e D r Enforcement Agency: c�-P� Date repaired: a 7 ell - Permit #: j Yod olq Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil AFUE COP ❑ R -6 (CZ 1,3-7) Ducts Served by system Setback ❑ Split System ❑ Condensing Unit SEER ❑ R -8' (CZ 16) Ducts sq ft (If not already HSPF ❑ R -6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset EER ❑ R -5 or R7.5 Lineset be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this foll;m is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 1. HVAC Changeout /Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CFIR- ALT -02 -E Condenser Unit, Evaporator Coil, CF2R: MECH -01, MECH -20 -HERS Air Handler /Furnace CF3R: MECH -20 -HERS Installer Requirement: Duct leakage L15% or, < 10% to outside, or seal all accessible leaks) Exempted from dud leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts= CFIR- ALT -02 -E CF2R- MECH -01, MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS CF3R- MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS2 Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W /CFM), Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF111- ALT -02 -E Ducts= and one or more of the following: CF2R- MECH -01, MECH -20 -HERS, MECH -(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R- MECH -20 -HERS, MECH -(23 or 24) -HERS Installer Requirement: Duct leakage < 6 %, Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CFIR- ALT -02 -E space but less than All New Ducts2 CF2R: MECH -20 -HERS CF3R: MECH -20 -HERS Installer Required to: Duct leakage L15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. t All new ducting R -8 required when more than 40 ft installed and R -6 when less than 40 ft installed. This includes in walls, between floors etc. 2 A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material. D R -5 (1" thick insulation) for linesets 1" and less. R -7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5- 2T -2% ", 2.5- 3T -2 % ", 3.5 to 4T -2% ", 5T -4Y.." Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: Date Signed: License: Company : Address: City /State /Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1 -800- 772 -3300