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14080160I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 18760 NEWSOM AVE CONTRACTOR: ANNAPARAREDDI PERMIT NO: 14080160 PRASAD BABU AND ANNAP OWNER'S NAME: ANNAPARAREDDI PRASAD BABU AND ANNAP 18760 NEWSOM AVE DATE ISSUED: 10/09/2014 OWNER'S PHONE: 4083689412 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT REAR ADDITION (617 SQ FT); FRONT License Class Lic. # ADDITION (38 SQ FT); GARAGE ADDITION (15 SQ FT); Contractor Date FRONT COVERED PORCH (55 SQ FT); GARAGE SPACE I 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. 1 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 ofthis 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 t ' rmt . ally, the applicant understands and will comply with all non oint sour — tons per the Cupertino Municipal Code, Section 9.18. t Signature Date c ❑ OWNER- BUILDER DECLARATION 1 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 (See.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea.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 permit is issued. 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, l 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 wb. m accrue against said City in consequence of the granting of this p it. Additionally, the applicant understands and will comply with all non- in a regulations per the Cupertino Municipal Code, Section 9.18. Date revision #1- raise ceiling and relocate window- issd ote Sq. Ft Floor Area: Valuation: $150000 APN Number: 37530011.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1 PERMIT ISSUANCE OR 180 DAYS OM LA ALLED INSPECTION. Issued by: Date: ► r �2� r " RE- ROOFS: All roofs shall be inspected prior to any rooting material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should 1 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 Cuu�unicipal Code, Chapter 9.12 and the Health &Safety Code, Suns 25505 3, and 25534. Owner or authorized agent• Date: �' �1% 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18760 NEWSOM AVE CONTRACTOR: ANNAPARAREDDI PERMIT NO: 14080160 PRASAD BABU AND ANNAP OWNER'S NAME: ANNAPARAREDDI PRASAD BABU AND ANNAP 18760 NEWSOM AVE DATE ISSUED: 10/09/2014 OWNER'S PHONE: 4083689412 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ CONSTRUCT REAR ADDITION (617 SQ FT); FRONT License Class Lic. # ADDITION (38 SQ FT); GARAGE ADDITION (15 SQ FT); FRONT COVERED PORCH (55 SQ FT); GARAGE SPACE Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 deferred #1 truss cales- issd otc 1/14/2015 (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 decl "� 1 have and will maintain a certificate of consent to self - insure for Wor \ Compensation, as provided for by Section 3700 of the Labor Code, for the q. F't Floor Area: Valuation: $150000 performance of the work for which this permit is issued. ((�o 1 have and will maintain Worker's Compensation Insurance, as provided Dby Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 37530011.00 Occupancy "type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF FORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating VVIT IIIN 180 DAYS OF MIT 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 DAYS FROM 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 7LLED granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: I 11-4.1S 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 I 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, Business & Professions Code) 1, 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. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9A2 and the declarations: Health & Safety Code, Section 25532(a) should I 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 1 performance of the work for which this permit is issued. will maintain compliance uperh m no ipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by - er Sections the Health & Safety Co , 5 5 d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, l 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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-pomt lations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18760 NEWSOM AVE CONTRACTOR: ANNAPARAREDDI PERMIT NO: 14080160 PRASAD BABU AND ANNAP OWNER'S NAME: ANNAPARAREDDI PRASAD BABU AND ANNAP 18760 NEWSOM AVE DATE ISSUED: 10/09/2014 OWNER'S PHONE: 4083689412 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT REAR ADDITION (617 SQ FT); FRONT License Class Lic. N ADDITION (38 SQ FT); GARAGE ADDITION (15 SQ FT); FRONT COVERED PORCH (55 SQ FT); GARAGE SPACE 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 Sq. Ft Floor Area: Valuation: $150000 performance of the work for which this permit is issued. l 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: 3753001 L00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXP ORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 80 D F 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 O I)AY T 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 p0 �+ granting of this permit. Additionally, the applicant understands and will comply Date: with all non -point source regulations per the Cupertino Municipal Code, Section 4.18. 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 I 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, Business & Professions Code) 1, 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 I 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 rtino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the health & Safety Cod ections 25505, 6533, and 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. ertify that in the performance of the work for which this permit is issued, 1 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, l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 • ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 ^ buil cu ertino.or ❑ ADDITION ❑ ALTERATION /T40JtVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS /i�� 7 �/G�,j APN 4 � � ( -all J OWNER NAME PHONE E -MAIL STREET ADD SS J CITY, STATE, ZIP FAX CONTACT NAME PHO E- t`4AIL n rA STREETADD�2ESS i CITY, STATE, ZIP /� FAX (i ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / i ENSE NUMBER T�7SETYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT /ENGINEER NAME � r -' LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA 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 [I YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED "� TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO '; +.,:r'. /►,L't7 � ®0 — o By my signature below, I certify to each o I am the property owner or authorized agent to ac on rty owner's behalf. I have read this application and the information e provided is corr I. 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 const tion. I auth resentatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: e/ 7 SUPPLE INFORMATION RE PLAN CHECK TYPE. xy n .:ROUTING SLIP " x OVER TA"E- COIJNTEA - �s ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for Demolition is to issuance building existing building(s). permit required prior of permit for new building. I `EXPRESS 7:�a °; 0 � PLANNIAGPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D STANDARD ❑ PuBl ICwoRxs _ form if any Hazardous Materials are being used as part of this project. ` } D LARGE � kIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to El r rt 1 N ❑ _ submittal of Building Permit application. AWJOR , r r x SAAITARX_SEW ER DISTRICT ENVIRONI.IENTAI, AEALTA' -' BldgApp_201 1. doc revised 06121111 • CONSTRUCTION PERMIT APPLICATION (,U COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 V (408) 777 -3228 ^ FAX (408) 777 -3333 ^ buildina�cuDertino.org ❑ NEW CONSTRUCTION X ADDITION ❑ ALTERATION /TI ❑ REVISION / DEFERRED ORIGINI.AL PER1,41T PROJECT ADDRESS APN OWN' 'AME I PHONEf _ � � E -MAIL e STREET ADDRESS '+ I CITY, STATE, ZIP I FAX ! I ` CONTACT NAME + ?MNF E -MP.IL STREET D CITY, STAM ZIP V, FAX ❑ O1A%TR ❑ O' TWM- BUDAER VJ oWAiER AGEN7 ❑ CONF ACTOR ❑ CO1diR 4Ci0R AG'cNlr ❑ ARC_HrrECT ❑ ENGLN*EER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME I LICENSENUh1BER LICENSETITE BUS.LICR COMPANY NAME I E -MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGR.rEER NAME 00 LICENSE NUMBER la 'C 0u 62 b0 BUS. LIC COMPANY N.Ah1E 71 M V1 E -h1AIL �i4 FAX �j STREET ADDRESS -U CITY, STATE, Z /j /2 (L C/ !+J PHONE °Y y O ✓ DESCRIPTION OF WORK a EX STAG USE PROPOSED USE CONSTRTI'PE RSTORIES yD � i si ®� L7 USE TYPE OCC. SQ.FT. VALUATION (S) EXIS7G AREA/ 'EW iZ00R AREA D So p� AREAI�K�/f TOTAL NET AREA ?79 2 BATiIR00h1 CHEN WRE OD AREAA'� o RII 10DEL A Q /H� REMODEL P C' A DE AREA TOTAL DEC RC AREA ` GARAGE AREA: U DETACH 7,3 , 1116- 2o;CTIACH *'DR TLLM UNITS: IS A SECOND UNIT Q311S SECOND STORY BEING ADDED' �NO ADDrr10N? (.'0 — PRE- rFPPL- IC- .4TIO;J—- 1= ES1i- a'�S.- P.XOh +17i E.LOPL' OF PLANNING 9 NO ?LkWIG APPROVALLETTER _1S THE BLDG AN -1 1 rSRE�FI1r EICHLERHOME? D EY - - �. 4 °'al; ;+><.� :.:.'' R,,• -. +' T UATION: APPL ❑NO kb.� By my signature below, I certify to each of the following: I am the property owner or authorized agent 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 ng const�t . authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: / ..^�'� /�/��"� Date: SUPPLEMENTAL P\TFOR4.4TI0N REQUIRED ca cKT E�= r NMI ' RO�tJ�u�cirp "c New SFD or Multifamily dvv+ellines: Apply for demolition permit for � � � � buildings }. Demolition permit is required prior to issuance of building OV :PrRy COUNTERS + LDf GPN Iexisting SIR-,Q e permit for ne v buildine. � fi WN` l 'G:JPLL Izz RE IESS Commercial Bidgs: Provide a completed Hazardous Materials Disclosure ��`� RE � Srs '$ -'{ �k�' r " t Y 1 4 �Iisil }ti o� s� QJ _ foim if Hazardous Materials being this any are used as part of project.F�? Dos x� Copy of Planning Approval Letter or Meeting with Planning prior to M _ submittal of Building Permit application. '��irolt ��tr5 ;RDISTRlcr . ,�.rx. „ ;�.„��.N°35�, ��!•:� r..:EN1'IRbTT4Er\IAI . iiEA ' i;Tli> :;rte,'. Bldg.4pp_201 Ldoc revised 06121111 CUPERTBNO C0) TN STF CTIO� PEF �, APP CA OO N COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 ^ FAX (408) 777 -3333 ^ building(a.cugertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/ DEFERRED ORIGINAL PERMIT # Is PROJECT ADDRESS K / APN # ®— OWNER NAME�p " +^ ` V i PHONE � yy�� /� ((11JJll E -MAIL $ �'I �� STREET ADDRESS �J + CITY, STATE, Zl f FAX C. CONTACT NAME i -� PHONE_ D 0 E -MAIL STREET ADDRESS v 5 i CITY, STATE, 7 FAX ❑ OWNER ❑ OWNER- BUILDER IYOWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP Law E _ ARCHITECT/ENGINEER NAME E NUMBER BUS. LIC # COMPA E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) ''. EXISTG NEW FLOOR DEMO TOTAL ''.... AREA AREA AREA NET AREA ''. BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETAH []ATTACH '.. #DWELLING UNITS: IS ASECONDUNIT ❑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 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 the property owner's behalf. 1 have read this application and the information I ha v t. 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 construc ' n. I authorize Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL FORMATIO QUIRED � PLANCHEC TYPE ROUTING SLIP OVER - THE - COUNTER ❑ BUH.DINC PLANREVIEw New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. 4❑,EXPRESS .; z ❑ rLANNINCPLANREVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ "i.ARCE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MAJOR� ❑ sANrrARY SEWER DISTRICT ❑" ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ]ES'T'IMATOR - WELDING DIVISION] ADDRESS: 18760 newsome ave DATE: 08114/2014 REVIEWED BY: Mendez APN: BP #: EVALUATION: $150,000 *PERMIT TYPE: Building Permit PLA CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex 2nd Unit? 0 Yes (D No PENTAMATOON 1 R3SFDREM USE: OTC. 0 Yes E) No PERMIT TYPE: WORK addition of 703 sq ft toe sfdwl remodel through out 1325 sq ft panel upgrade to 200 am SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP ]FEES BP ]FEE ID R -3 (Custom) II- B,111- B,IV,V -B 703 $2,654.00 IR3PLNCK $1,666.00 IR3INSP I lilac hip Fee- $0.00 200 amps $48.00 Electrical IBELEC200 Services Permit Fee: $1,666.00 Suppl, Insp. Fee:Q Reg. Q 21_h rs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 TOTALS: 703 $2,654.00 $1,666.00 MECII, HOURLY 0 Yes (D No PI.>(JM1B, HOURLY Q Yes Q No E1LEC, HOURLY Q Yes 0 No 1h 1�hln t he:-k Plr,mh. Plain Elec. Plan Check 0.0 hrs $0.00 !11--!,. pern,il Fol.- Plwnh 1 "orm Fee: Elec. Permit Fee: IEPERMIT Ll�)nc� ti1� h. tnsi. Other P/wrin Insp Other Elea Insp. 0.0 hrs $48.00 ;91<z h, h?'P. F,:e• Ghrr„ h. lush. FLY. I lilac hip Fee- NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.)- These fees ara ha.sed on the nreliminary information availah /e and are only an estimate_ Contact the Dent far addn'/ infix ]FEE ITEMS (Fee Resolution 11-053 Eff 7/1113) FEE QTY/FEE MISC 11T EMS Plan Check Fee: $2,654.00 1,325 s.f. $4,888.00 Remodel, Other IREMRES2 Suppl. PC Fee: (D Reg. Q OT NKI hrs $0.00 PME Plan Check: $0.00 200 amps $48.00 Electrical IBELEC200 Services Permit Fee: $1,666.00 Suppl, Insp. Fee:Q Reg. Q 21_h rs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 i oF1.1'lriwiioni IcIA. 'I dtniniStratira h *ee: 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $98.42 Select a Non - Residential Building or Structure G 0 4 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $19.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS- $4,539.92 $4,936.00 TOTAL FEE: j $9,475.92 Revised: 07/10/2014 CITY OF CUP E]1 TINO FEE ]ESTIMATOR - BUILDING DIVISION Y ADDRESS: 18760 new►som ave DATE: 11/21/2014 REVIEWED BY: Mendez Llac�! ?. Pernil Fee' APN: BP #: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: P/111111'. Fee. PENTAMATION 1GENRES I PERMIT TYPE: WORK revision #1- raise ceiling and relocate window SCOPE Suppl. Insp. Fee:Q Reg. Q OT 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 -053 Eff.� 7i11Q Ilech. Plan Check Pho+nb. Purr ChCC'k 1.Ir� . Plon Cheek Llac�! ?. Pernil Fee' 1'lurnb. Perinil Fee. �I,,( PerwiT l�c' 0;ncr b/cch. InsP Or/ter Plumb Irop Oo._" i:i, c. l+tsj'. il'<h Insp P/111111'. Fee. 1.1,. 'j?5P.1- „i-” 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 -053 Eff.� 7i11Q ]FEE QTY /FEE M11SC ITEMS Plan Check Fee: Hourly Only? C) Yes Q No $0.00 0 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 10 No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('nlz,tivlct ?:�n 7us: A(/m ill istrativee I'ee. E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non- Residential Building or Structure O d Tr,r,el Docuinunlalinw Fees. Strong Motion Fee: $0.00 0.0 hrs Inspections $0.00 Inspection, Hourly Bldg Stds Commission Fee: $0.0011 SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Revised: 10101/2014 CETY OF SCUP ERTTNO FEE IESTEMATOR - BUIDLDRNG MVISEON 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolulion 11 -053 Eff' 7,/1/13) ADDRESS: 98760 nevvsome ave DATE: 01/14/2015 REVUEWED BY: Mendez ,t9ech. PeJVrrit Fee' APN: BP #: *VALUATION: Iso 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: phewl), 111,x1. f.c": PENTAMATION PERMIT TYPE: 1GENRES WORK deferred #1 truss calcs SCOPE hrs 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolulion 11 -053 Eff' 7,/1/13) Afech. Plan Check Plan ;h. Plan ('Im -4 I'/e, Non Check 7E ,t9ech. PeJVrrit Fee' Plurr,h. Pcraur Pee: glee Prim :, l.",.. Orher A-1crh. IrtsP Li Other Plumb Inch U v r. r• l c. fps"). Lj I _ti'le"A IniS=1). i'et': phewl), 111,x1. f.c": i.!,v '"! ;n. 11"' 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolulion 11 -053 Eff' 7,/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: (E) Reg. OT 0.0 hrs PME Plan Check: $0.00 $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:) Reg. C OT Q.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 construction 7'd.�: Achnini.str-ulive Fee: Select a Non - Residential Building or Structure E) d Work Without Permit? 0 Yes E) No Advanced PlanninL Fee: $0.00 $0.00 Traivl Docurnenfufion Fees„ 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: 01/06/2015 Jul 10 15 12:38p CU'PE(l TIRl The Ups Store 2048 4153800345 CONTRACTOR / SUB COIF( RAC7I OR LIST p.1 (Building Department City Of Cupertino 10300 Tone Avenue Cupertino. CA 9SO14 -3255 Teleph -3228 Fax: 408 -777 -333 JOB ADDRESS. l Y7 j D Ax-ve PERMIT # : L t ? < C ONVNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ' .ADDRESS: CITY /ZIPCODE: 'Our municipal code requires all businesses working in the city to have a City of Cupertino business license. YO BUILIDtNG FINAL OR FINAL OCCUPANCY INSPECTION(S) WELL BE SCHEDULED UIdTT#L THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CRTY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Da to Please check applicable subcontractors and complete the ffollowing information: d .,v U owner ok�ntractor Signature c2- Date 5 i SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork K old Cement Finishing — 0tj,,4— r Electrical ` gtld Excavation Fencing Flooring /Carpeting Linoleum / Wood Glass / Glazing .e Heating &ri . r- Insulation Landscaping Lathing Masonry Painting / Wallpaper' yl,� Paving Plastering Plumbing Roofing /-� L,4 Septic Tank Sheet Metal Sheet Rock Tile .,v U owner ok�ntractor Signature c2- Date 5 i CUPERTINO 54011 UZI F-42MA1111,101 "11 Ad 016�31 (01,30 WE, AMOCO' COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • build ing(a)cupertino.org 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 ADDR s APN BP# OWNER NAME fj /a atiyktLArtsh PRR3PrD NNit A fn0 N>✓vrGA ED AWNER ADDRESS �� 7�p� �/ /j'prr/ e �W -1/0 q 5,67/ A DESCRIPTION OF WORK: / Q 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 INFORMA'rlON (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) J,fdki. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - 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. i3. 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. 4 —fle-4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5r1-understand if I_ employ or otherwise enoage 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. -6. 1 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. 1W7. I 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. ,14V-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. OwnerBuilderForm 2010.doc revised 04114110 ,L9. 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. ,,OL-10. 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. 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. ✓6_12. 1 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 signature. Property Owner's Signature: Date: L ZG -------------------------------------------------------------------------------------------------------------------------------------------- (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. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: �1 /ia I �j Tel No ?2,: - 'T- 'W e -1 - 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. I t 1 Property Owner's Signature: i Date: Z 20� OwnerBuilderForm 2010,doc revised 04114110