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B-2016-2276
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2276 1077 MILKY WAY CUPERTINO,CA 95014-5008(362 18 042) KUBRO CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: GUNTURU VAMSIDHAR RAVULA SUNAYANA DATE ISSUED:09/16/2016 ' OWNER'S PHONE:858-692-7296 PHONE NO:(408)839-5800 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#960307 Contractor KUBRO CONSTRUCTION Date 04/30/2017 X BLDG _ELECT _PLUMB X MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: REMOVE FIREPLACE AND RELOCATE LAUNDRY FROM FIRST TO I hereby affirm under penalty of perjury one of the following two declarations: SECOND FLOOR(1 11 SQ FT);REMODEL FIRST FLOOR BATHROOM 1. I have and will maintain a certificate of consent to self-insure for Worker's (53 SQ FT);REMODEL/CREATE BATHROOM ON SECOND FLOOR Compensation,as provided for by Section 3700 of the Labor Code,for the (45 SQ FT);REMODEL MASTER BEDROOM AND CLOSETS(355 SQ performance of the work for which this permit is issued. FT). ,., I have and will maintain Worker's Compensation Insurance,as provided for by REV#1-INSTALL(N)A/C;RELOCATE LAUNDRY ROOM;REMOVE -e '`� ' Section 3700 of the Labor Code,for the performance of the work for which this UPPER CLOSET FROM SCOPE OF WORK-ISSUED 9/29/2017 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 Sq.Ft Floor Area: Valuation:$50000.00 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 APN Number: Occupancy Type: City of'Cupertino against liabilities,judgments,costs,and expenses which 362 18 042 Deferred Submittal(R-3),Deferred Submittal(R- may'accrue against said City in consequence of the granting of this permit. 3),Deferred Submittal(R-3),Deferred Submittal(R- Additionally,theapplicant understands and will comply with all non-point 3),Deferred Submittal(R-3),Deferred Submittal(R- . source regulations per the Cupertino Municipal Code,Section 9.18. 3),Deferred Submittal(R-3),Deferred Submittal(R- 3),Deferred Submittal(R-3),Deferred Submittal(R- z,. 3),Deferred Submittal(R-3) r�•r.nature Date 1 OWNER-BUILDER DECLARATION PERMIT EXPIRES IF WORKIS NOT STARTED I hereby affirm that I ant exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 180 DAYS FROM LAST CALLED INSPECTION. 't. I;as dwner 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) Issued by:ABBYAYENDE z. I,as owner of the property,am exclusively contracting with licensed Date:09/16/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: RE-ROOFS: t. I'.have'and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any roofing material being installed.If a roof is Compensation,as provided for by Section 3700 of the Labor Code,for the installed without first obtaining an inspection,I agree to remove all new materials for inspection. I performance of the work for which this permit is issued. 12.: Ilhavel and will maintain Worker's Compensation Insurance,as provided for by Sectioti 3700 of the Labor Code,for the performance of the work for which this Date: Signature of Applicant: perm'rtitis issued. 3.' licertify 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t Worker's Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE Labor'Code,I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the be'deemed revoked. California Health&Safety Code,Sections 25505,25533,and 25534. I will I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the APPLICANT CERTIFICATION Health&Safety Code,Section 25532(a)should I store or handle hazardous I certify that l have,read this application and state that the above information is i material. Additionally,should I use equipment or devices which emit hazardous correct.I agree ito comply with all city and county ordinances and state laws air contaminants as defined by the Bay Area Air Quality Management District I relating to building construction,and hereby authorize representatives of this city will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and to enter upon the above mentioned property for inspection purposes. (We)agree the ety Code,S tio Health&Safety ns 25505,25533,and 25534. to save indemnify and keep harmless the City of Cupertino against liabilities, ` ' C , judgments!costs,and expenses which may accrue against said City in consequence of,'the granting of this permit. Additionally,the applicant understands, O or authorized agent: and will comply with all non-point source regulations per the Cupertino Municipal erate: Code,Section 9':18. CONSTRUCTION LENDING AGENCY i 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.) Signature Date ' Lender's Name 4 ' Lender's Address . CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION v 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • lit'w ., r. (408) 777-3228 • building@cupertino.org PEMIT#B- 20/G - 22 - CUPERTINO • REVF 1 DEFE ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS6 . - 7 ^n .1 I? �/A y 3APN t / 2 _ /g 09 2 OWNER NAME P4 r*i s /9 "'�L/`J 7`c,2 U PHONE 8 Sg3 a g?z— zz MAIL STREET ADDRESS CITY, STATE,ZIP b/ /0 �►.74Yw4y [�/Jr3-27`x'/+/e ❑CONTRACTOR NAME MOWN COMPANY NAME LICENSE NUMBER LICENSE TYPE ISTREET ADDRESS CITY,STATE, ZIP I E-MAIL PHONE BUS.LIC It 0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL To56 r#W-A/Pn,"Z2 er 2 (I /,44.rs g e' ,V,� '1 STREET ADDRESS qq CITY,STATE,ZIP/� PHON ✓ p Y00/ en,I irC//FS'77/t— �✓d i g J C /�/7,8r2a rag.SI 2..g.9LS O DECRIPTON �, .1 NsT4 G G /941"4--- 4C. f goLc)( ,9 7`.E ,/fie pol o , Zn/.•9Te ic,01 Foy 4%c,.v,Q 2 y 4-ti A gra k/.s l_1/° 6(1.- .' -'z-- /c). fe t f,2 Sc ' of e,--o -/ ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISFIRE ISPRINKLERS❑ NO EICHLER ,--,E)LI YES SECOND STORY ADDITION OYES NO DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER UNITSa UNITADDITON: ❑NO SF POOLSI ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED El YES 0 NO I TOTAL-SF REC VED BY: TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swinuuiug Pools requires Department of Environmental Heath approval "i J RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF E ASPHALT SHINGLES E WOOD SHAKES❑WOOD SHINGL S E TILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD D'1„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS AYES F OF LAYERS THICKNESS❑5/8" OTHER 1=1 OSB ❑CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF Oaf SQUARES 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 s,--- la.:. - : Ing to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspecti..-r..-es. I acknowledge and authorize all information contained on this application form to be made available for public record. 9 /D Signature of Applicant/Agent: . - Date: - SUPPLEMENTAL INFORMATION REQUIRED • *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. • *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association BldgApp_2017.doc revised 08/01/17 CITY O. •: �� • REQUEST FOR PERMIT EXTENSION Please e-mail the completed form to $•:, building@cupertino.org CUPERTINO. 0 Under Plan Review Process 0 Issued Permit Building Address: /d 7 ,7 714,Yky wly Permit Number: 6 zoi 6- 2 Z?-‘ Owner Name: '/"AM 5 ; ' C' (Mit ci/2 ti Owner Address: /c 7 /14th' y w y Phone: 6F? 6 '2 F 296 Contact Name: 7225 5- (5-'2 z E-mail Address: v f/li�17S dyi i/.&'"'Phone: 4/ 75•.57 2,_ 3 y C7c7 Reason(s) (please be specific): /tfl'." Tv , i v2 l'v Ase9- 64-/- l AL NS J04C td Signature: — Date: 9/20//. (CITY OF CUPERTINO USE ONLY) Yes No. / 0 �,�/ � i16-/M Approval: Expired Date: I Fee: $ Revised 7/25/2017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1077 MILKY WAY CUPERTINO, CA 95014-5008 (362 18 042) CONTRACTOR: KUBRO PERMIT NO: B-2016-2276 CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: ROSS SUSAN TRUSTEE DATE ISSUED: 09/16/2016 OWNER'S PHONE: 858-692-7296 PHONE NO: (408) 839-5800 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT ]NFO: License Class B Lic. #930307 Contractor KUBRO CONSTRUCTION Date 04/30/2017 X_ BLDG _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 in full force and effect. JOB DESCRIPTION: REMOVE FIREPLACE AND RELOCATE LAUNDRY FROM FIRST TO I hereby affirm under penalty of perjury one of the fopowing two declarations: SECOND FLOOR (111 SQ FT); REMODEL FIRST FLOOR BATHROOM 1. 1 have and will maintain a certificate of consent to self-insure for Worker's (53 SQ FT); REMODEL/CREATE BATHROOM ON SECOND FLOOR Compensation, as provided for by Section 3700 of the Labor Code, for the (45 SQ FT); REMODEL MASTER BEDROOM AND CLOSETS (355 SQ performance of the work for which this permit is issued. FT). 2. 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. Sq. Ft Floor Area; Valuation: $50000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 18 042 Deferred Submittal (R-3),Deferred Submittal (R- representatives of this city to enter upon the above mentioned property for 3),Deferred Submittal (R-3),Deferred Submittal (R- inspection purposes. (We) agree to save indemnify and keep harmless the 3),Deferred Submittal (R-3),Deferred Submittal (R- City of Cupertino against liabilities, judgments, costs, and expenses which 3),Deferred Submittal (R-3),Deferred Submittal (R- may accrue against said City in consequence of the granting of this permit. 3),Deferred Submittal (R-3),Deferrcd Submittal (R- Additionally, the applicant understands and will comply with all non-point 3),Deferred Submittal (R-3) source regulations per the Cupertino Municipal Code, Section 9.18. (1 " PERMIT EXPIRES IF WORK IS NOT STARTED sgnatu.—ate os/�s/2o�s WITHIN 180 DAYS OF PERMIT ISSUANCE OR crERDECLARATIo1V 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by: PAUL O'SULLIVAN 1. I, as owner of the property, or my employees with wages as their sole Date: 09/16/2016 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 3. I, as owner of the property, am exclusively contracting with licensed RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 09/16/2016 2. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If, after making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed_ revoked. material Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I certify that 1 have read this application and state that the above information is the Health & SafetyCode, Sections 25505, 25533, and 255 . correct. I agree to comply with all city and county ordinances and state laws a - relating to building construction, and hereby authorize representatives of this city ` to enter upon the above mentioned roe for inspection purposes. e agree p property rtY P P p (We) 9 Owner or authorized agentr .. _ � to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 09/16/2016 _ judgments, costs, and expenses which may accrue against said City in CONSTRTICTION LENDING AGENCY consequence of the granting of thispermit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.) Code, Section 9.18. Lender's Name Lender's Address Signature Date 09/16/2016 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. . a CUPERTINO I NF.W CONCTRTIC'.TInM CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40�8)777-3228. FAX (408) 777-3333 buildiinng(akupertino.Ora I --y 1 dTlTliTitlAi Z AI IPLIIU ArinhT trot 17 nLcrtcrnWT t�Uenanc �re7Z2_71(p nntr_�+at n -rL PROJECT ADDRESS q 1 y'y�/' APN 0 2 OWNERNAME VW r PHONE as� (4,L —;n 101 E-MAIL STREETADDRESS vi CITY, STATE, 4pt - 7P•.7`i[ C i4"J FAX AX CONTACT NAMfi J Q PHONE A C } pg � 1 UU *' f [i i t Nun S vn� 1 EMAIL at t [ C STREET AD NESS + CITY, STATE, ZIP FAX ❑ OWNER ❑ :OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR '❑ CONTRACTORAGENT ❑ ARCHITECT VENGINNEER ❑ DEVELOPER ❑ TENANT CONTRACTORN 9 LICENSENUMBER LICENSE TYPE, 13US.LTC#�� COMPANY NAME � E-MAIL FAX STREETADDRFSS �^ CITY, STATE 2IP PHONE ARCHITECVFNGINEGRNAME J L1C�NSENUMBER BUS. LIC# COMPANYNAMEgll� Yl EMAIL j FAX STREET ADDRESS - • CITY, STATB, Z[P / lq PHONE rsI 2_ DESCRIPTION OF WORK { al4 11 ' EXISTING USE PROPOSED USE - CONSTR, TYPE - # STORIES USE TYPE OCC. SQ.FT: VALUATION ($) Exi.STG NEW FLOOR ': DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TYITALDECKIPORCHAREA GARAGEAREA: []DETACH ❑ ATTACH # DWELLING UNITS: - .ISASCCOND UNIT ❑YES SECONDSTORY []YES I3EllVGADD$D? ONO ADDITION? ❑NO PRE APPLICATION []YES IF YES, PROVIDE COPY OF IS THE DLDG AN ❑ YES _; RE$ D'SY: - . ; ,: r � ? = • TOTAL VALUATION; PLANNING APPL# NO PLANNING APPROVAL LETTER MCHLER ROME? NO 000 Pn . By my signature below, I certify to each of the following: I am the property owner or authorized agent toact on he property owner's behalf. I have read this application and the Information 1 I provided is correct. I have read the Description of Work and verify it is accurate. I agreeto coinply with all applicable local ordinances and state laws telatiD fo uilding construction. I authorize representatives of Cupertino to enter the above -ident'if'ied property for inspection purposes. Signature of Applicant(Agmt: A Date: Ito SUPPL INFORMATION REQUIRED 3- .. ... PLAN.CHECKTYPE_ , ..::. ..- .:._;-RD.LI'f1M1GSL1Ps . -... .:`. Q. pVERTHE-COUi�fABR ❑. BUWIE0% _ New SF} or Multifamilydwellings: Apply for dell0i1ttO1pe17ri1tfor existing building(s). DernOliton permit is required prior to issuance of building perinitfornewbuildutg. © SlFRESS D PIAN]\IM1GPLAI3RE)IEIi _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -ii ©srANDn zD D i TIBLic «oxxs Ton if any Hazardous Materials are being used as part of this project. ` LARGE Copy Planning pP al Lotter Or Meeting With Planning pIlOr t0 Q. AA OR © 3AM1ITAI2Y S> ii IsRDI$TRICT - suan tial of Building1eririlt application. ...... . ..:[ ENVIRONA4�11TALi�ALTIT BIdgApp_2011.doe revised 06121111 A, fit s SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building A_cu pertino.org Address I I-II ( L" PURPOSE Permit No.,; '— tZ--0(-6 "2�_7-b PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIVINED AND RETURNED NED TO THE BUILDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) Signature Lic.# Date: On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section 8314 and CBC Sections 907.2.11 4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below I have read and aaree to comely with the terms and conditions of this statement Owner (or Owner Agent's) Name: f'.ir\GL ROVV � a_ Signature. Date: .j.�...��.... Contractor Name: Signature Lic.# Date: y Smoke and COform.doc revised 03/18/14