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B-2016-2811 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2811 21391 MILFORD DR CUPERTINO,CA 95014-1327(326 41 104) S&A CONSTRUCTION INC DALY CITY,CA 94015 OWNER'S NAME: MADAN ANIL AND MALHOTRA SHALINI TRUSTEE DATE ISSUED:09/27/2016 OWNER'S PHONE:408-893-7805 PHONE NO:(415)810-6005 LICENSED ONTR A TOR' DECLARATION BUILDING PERMIT INFO: License Class.Q Lic.#982464 Contractor S&A CONSTRUCTION INCDate 04/30/2017 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencingMECH 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: I hereby affirm under penalty of perjury one of the following two declarations: ADD COVERED PORCH(103 S.F.) 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 i '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. Sq.Ft Floor Area: Valuation:$5000.00 APPLICANT CERTIFICATION I certify that l have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 41 104 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 City in consequence of the granting of this permit. WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regu►af per t e upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. G f g Date 9127/2016Issued by:Abby Aygnde Date:09/27/2016 OWNER-B ILDER.DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first 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. I,as owner of the propertn am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I 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 3. I certify that in the performance of the work for which this permit is issued,I Health&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 air contaminants as defined by the Bay Area Air Quality Management DistrictI Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co^Sections 25505,25533,and 25534.x° Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked /-Owner or authorized agent: LAL APPLICANT CERTIFICATION G Date:9/27/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending-agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(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 and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 9/27/2016 Licensed Professional .R/Y+��s •'t<.\I.a/ v vrP v-= a rr R,rvfr+ r • R! 1 viv�/E 1+ avMs>'�-,�N�ICI(- COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DiViz JN 10300 TORRE AVENUE R C,UPERTINO,CA 95014-3255 (408)777-3228•FAX X408)777-3333 b buil6ng cupertino.or- ❑NEW CONSTRUCTION El ADDITION < ALT O TI ® REVISION/DEFERRED ORIGINAL P RJRmrr#� PROJECT ADDRESS APN# 21391 MILFORD DRIVE 326-41-104 OWNERNAME PHONE E-MAII, ANIL MADAN (408)893 7805 1 madananil@hotmail.com STREETADDREss 21391 MILFORD DRIVE Orly sTATE,zIP CUPERTINO,CA95014 FAX CONTACT NAME PHONE E-MAIL SAME STREET ADDRESS CITY,STATE,ZIP FAx 10 OWNER ❑ OwNERBUTLDER ❑OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT 13 ENGINEER ❑'DEVELOPER ❑TENANT CONTRACTORNAME ARTHUR ABEZGAUZ LICENSE NUMBER 982464 LICENSE TYPE B BUS.LIC# COMPANYNAME S&A CONSTRUCTION INC E-MAa amz537(§hotmai1.com FAX 415)523 9421 STREET ADDRESS CITY,STATE,ZIP PHONE 55 CASTLEMONT AVE DALY CITY CA,94015 (415)810 6005 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# JAVIER RODRIGUEZ COMPANY NAME E-MAIL FAX JAVIARCH 'aviarch@ ahoo.com STREET ADDRESS CITY,STATE,ZIP PHONE 7025 CALIFORNIA ST,APT 204 SAN FRANCISCO,CA 415)6719231 DESCRIPTION OF WORK PORCH ADDITION AT FRONT ELEVATION ONLY(NO OTHER WORK TO BE DONE IN THE HOUSE) EMSTINGUSE PROPOSED USE CONSTR TYPE 1 #STORIES RESIDENTAL i RESIDENTAL V-B 2 USE TYPE OCC. SQYT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL - - - AREA 2,965 - AREA 103 AREA 99 NET AREA 3,068 BATHROOM MCHEN OTHER REMODEL AREA 0 REMODEL AREA Q REMODEL AREA 103 PORCHAREA DECKAREATOTALDECK/PORCHAREA GARAGE AREA DETACH 103 0 0 404 ATTACH #DWELLINGUNITS: ISA SECOND uNrr ❑YES SECOND STORY ❑YEs 1 BEING ADDED? ®NO ADDITION? ®NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF- IS THE BLDG AN O YES I3'Y ,- TOTAL VALUATION: PLANNINGAPPL.# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? [a NO 1 By my signature below,I certify to each of the following: I am the property owner or authorized agent tb act oA 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 above-identified property for inspection purposes. SignatureofApplicant/Agent: _ ,\& be Date: SUPPLEMENTAL INFORMATION REQUIRED I=raicI. I 4.., z ,_ RfIIIrIfiISIIF, _New SFD or Multifamily dwellings: Apply for demolition permit for ott rllcbuisIlflulNI��Art existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ RxP =rI A� rIArI Iz>vvlw 777 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I ST m-AItD I� PI7BL C�4 CICS form if any Hazardous Materials are being used as part of this project. ; R _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. SAISIrARTtSI wE$nISTItIC �o�n�I�rAI� Tri ,