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B-2016-2735 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2735 21506 MONROVIA ST CUPERTINO,CA 95014-4804(356 23 022) DONE RIGHT HOME REMODELING INC SANTA CLARA,CA 95131 OWNER'S NAME: GUNNIGUNTLA SAGAR AND NARAYANASWAMY DATE ISSUED:09/15/2016 ARCHANA OWNER'S PHONE:408-613-5849 PHONE NO:(800)816-0000 LICENSED CONTRACTOR'S DECLARATION' BUILDING PERMIT INFO: License Class B. Lic.#1002689 Contractor DONE RIGHT HOME REMODELING INC Date 04/30/2017 X BLDG_ELECT _PLUMB 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: 1ST FLOOR(N)WINDOW BEDROOM I hereby affirm under penalty of perjury one of the following two declarations: REV#1-CHANGE WINDOW TO BAY WINDOW-ISSUED 10/31/2016 1. I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2:'' I have and will maintain Worker's Compensation Insurance,as provided for by ;jam Section 3700 of the Labor Code,for the performance of the work for which this i-o- permit is issued. Sq.Ft Floor Area: Valuation:$12000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 23 022 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 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant uerstands and will comply with all non-point source regulations per da€C . . 'k 'cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. C Signature s92- .> Date 10/31/2016 Issued by:ABBYAYENDE Date:09/15/2016 OWNER-BUILDER 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 property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/31/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of'the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 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 ality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino i pattode,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec+o 2 :1 ,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICA IT CERTIFICATION 'Date:10/31/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby correct.I agree to comply with all city and county ordinances and state laws 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 tender'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. I understand my plans shall be used as public records. Licensed Signature Date 10/31/2016 Professional N, . CONSTRUCTION PERMIT APPLICATION . : COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION f1111,17 10300'T ORRE AVENUE• CUPERTINO,CA 95014-3255 -=,- (408)777-3228•FAX(404777-3333 buildino(a�cuDertino.ora CUPERTINO El NEW CONSTRUCTION ❑ ADDITION E ALTERATION i TI REVISION/DEFERRED ORIGINAL PERMIT i 7 z3- i PROJECT ADDRESS / hp,4 r 2/ 5-06 0r/7(1[0_V,`4 b' 3sZ 3 oe,,2 OWNER N A vIE I PF.Oh>; E-MAIL 2 U,V 1Y? ' TL 4 S,4 0 8 ,gif_�'Bqq STREET ADDRESS CITY,STATE;ZIP S'0Mr FAX • PHONE - E-MAILi- `CONTACT NAME / 44°5 P /2"Mete � L, 0g. ., /0/a p a3Gee ,/e ms STREET ADDRESS CITY,STATE,ZIP FAX Jt)of eae�'1 oil C 7-A tf� �® OWNER 0 0W?, -BLT_DER 0 011,'?`'MAGEiT 0 CONTRACTOR 0NTRACTORAGENT ❑ ARCHITECT 0 E GD'e±c 0 DEVELOPER 0 TENANT , CONTRACTOR NAME _/ LICENSE NUMBER LICENSE TYPE BUS.LIC# F if COMPANY NAME ®... -' ' T E-MAIL FAX lfA�3 a j(� /� �9 f p STREET A:IDDRESS / fl Ion itY Co/� z Ad.2„,,,, CITY:STATE:ZIP c n"�4 (44 > (1''T PAO?�'E /80/367 .=.RC1IITECT/ENGBEER NAME � yam_ 1.LICENSE NUMBER BUS.LIC= /J r/F /��a7�}��! 36'S / j • COMPANY NAME )P G O�J� c/ ;,,„---. E-MAIL jovitslieevric,et, P e F STREET ADDRESS 0/ 6 -e4/VC M 61, CI Y,STATE,ZIP � � r, �ig ® 7 2 !_ / ! ! G'e t,9 PHON7: DESCRIPTION OF WORK j - 3 • EX1STLNG L'SE PROPOSED USE -- CONSTR.TYPE STORES I ErAs USTYPE OCC. SQ.FT. VALUATION (5) EXISTG _ NEW FLOOR DEMO TOTAL • - - I - - - . AREA ARTA AREA NET A.P.EA. I BATEROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH A2EA DECK AREA TOTAL DECIC?ORCH AREA GARAGE AREA: D DETACH 0 ATTACH DWELLING UNITS: ISA SECOND UNIT DYES SECOND STORY ❑YES BELN'G ADDED? JJ"NO ADDITION? DM0 PRE-APPLICATION DYES D YES PROVIDE COPY OF IS THE BLDG AN O YES R� Za ED BY - i �� - TOTAL VALU A 1O\ : -' PLANNING A??L ' �NO PLt.�L' G."3PROVALLETTER £ICHLERHO3E? � :O 1a". z \ - � By my signature below,I certify to each of the follow the property owner or authorized anent to act on .e property owner's behalf. I have read this • the and information I have provided is s-..ct. . e read the escription of Work and v my it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building .s' .icti -. I authorize representatives of Cupertino to enter the aboove tif�rop i i for inspection purposes. S i mature of Applicant/Agent: � - Date: > � SUPPLEMENTAL INFORMATION REQUIRED 1 - _..,:.::PLA_\CHECK TIPE .,....�' ,.,. ;ROUTNG CLIP .. "...•; E \e,� Si D or?ful iT milt'd«ellin�s Apply for demolition permit for F G } Ot ER TI-:COL-\TER ❑ B1,ILDI\G PLfi\RESTETT e`istinz b.iloing(s). Demolition permit r5 required prior to issuance of building .. permit for new buildinz. D r.1PRE Pc PL&N-\LNGPLAP FE\IEI1 cS Co. n cial BldES.: Provide a completed hazardous Materials Disclosure STAN-DaRD'.. r.. . .j p uiLTLIC\;ORICS form if any'Hazardous Materials are being used as parrt.of his project. - _ r .RGE - FINE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to fl MAJOR 'max - SANITfiRX SE\W'ERDISTRICT submittal of Building Permit application. 1 71-4-4'„-x.._ . ,.,. ._ . ,.. ,.. ::� ENNVIRO??SENTALHEALTii ,,.,. Bldggpp_2011.doc revised 06/21/11