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15030108I CITY OF CUPERTINO BUILDING PERMIT 13UILDING ADDRESS: 866 SEPTEMBER DR CONTRACTOR: PERFECT HOMES PERMIT NO: 15030108 CONSTRUCTION CORP OWNER'S NAME: DUTT HITENDRA K AND GAURI 382 LASSENPARK CIR DATE ISSUED: 03/17/2015 OWN 'S PHONE: 4088269757 SAN JOSE, CA 95136 PHONE NO: (408) 600 -8033 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATI0 REMODEL (E) HALL & MASTER BATHS, 160 S.F. REPLACE # 3 (E) WINDOWS (BEDROOMS & HALL BATH) & 1 (E) License Class c. SLIDING GLASS DOOR (NO STRUCTURAL CHANGES) Contractor Date I hereby affir 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 ompensation, as provided for by Section 3700 of the Labor Code, for the rformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $15000 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36214016.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAY F PECTION. 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 is ate: granting of this permit. Additional , the applic understands and will comply with all n -point r egulati er the Cupe ino Municipal Code, Section 9.18. Signature Datc:03_17�:_tr RE- ROOFS: 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 I, 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 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 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. the Bay Area Air Quality Management District I of the work for which this permit is issued. will maintain compliance w' h th ertino Municipal Code, Chapter 9.12 and performance 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,, s 2 05, 25 3, a 534. Owner or authorized agent Date: 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 CONSTRUCTION LENDING AGENCY 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 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 1 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. Signature Date 4 � �CUPERTINO 1 11Te'RTr nn2r[•TDTIn TT I'11.T CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - building Gecupertino.org F7 AT%nrrTn1J I I AT TCD ATT/11.T /TT I I R LXITC MV I T)FFT=R R FT1 nuvnreT AFRMTTii PROJECT ADDRESS ��/ V/ r J AIN # OWNERNAME rI , PHONE ' E -MAII STREET ADDRESS � / CITY STATE, ZIP. ^ O F i CONTACT NAME '_ D E -MAIL STREET ADDRESS CITY, ZIP FAX E] owNER - El OWNER- BumDER - ' ❑ OWNERAGENf ❑ICOA°TRACTOR OmmACTORAGENT ❑ ARCHITECT ❑ ENGINEER- : -.❑ DEVELOPER ❑ .11mu'-I CGNTRACrOR HA I LICENSE TYPE 71BUS.LIC# 0 /'J COA4PANY N E -MAIL STREET ADDRESS, / �aQ CITY, STATE PHONE o7 , ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK —T —� pSp- /., a' _F 1 d — Af / EXISTING USE PROPOSED USE CONSTR TYPE 1 k STORIES USE TYPE OCC. I SQ.FT. VALUATION (5) EXISTG NEEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER' ,T REMODEL AREA %,c, d / aDECK REMODEL AREA REMODEL AREA PORCH AREA AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # 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 CEIV ED ' T VALUATION: PLA.N-ZNGAPPL# ❑NO PLANNWG APPROVAL LETTER I EICHLERHOME? ❑N "w M. -IN By my signature below, I certify to ea of tdisco I am e property owmei r author' anent to the property o��rer's behalf.' I have r ad this application and the information I hav provi. I hav read the Descript' n of Work and v ' it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ildinn. I re res I es of Cupertino to enter the above-id en 'feed pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL 1NFORA4ATION REQUIRED r�C)31iC1iTYP a Oi3TiIGS7siP.`, ar;_ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building �< T T3�TER4 BUILD]?�GPI'RE«W mv <r png- permit for new building.E3tPRESS Bldgs: Provide a completed Hazardous Materials Disclosure 4�1 IrGP RE LEtIt JCAVDI UC x _Commercial form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to ©T7AJOR a -. SAI�u �y EFi ER]SIST CT 3: submittal of Building Permit application._ � �� _ BldgApp_201 1. doc rei,ised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. rlanning, ruouc rrurA3, r-tre, JunLLuly JGrvG sos, s.- , _ � __ _. _ .i o .dln6ly —d aro nnty an aClimate_ Contact the Dent for addn'l info. tnslrley elc . inese eea ure uuneu vs use P, FEE ITEMS Lee Resolution 11 -053 E . 7iJ 1/13) DDRESS: 866 SEPTEMBER DR DATE: 03/17 /2015 REVIEWED BY: MELISSA Afech. 1, PN: 362 14 016 r BP #: "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p 11iuru<, t PENTAMATION 1R3SFDREM PERMIT TYPE: USE: PME Plan Check: $0.00 WORK REMODEL E HALL & MASTER BATHS 160 S.F. REPLACE 3 E WINDOWS BEDROOMS & HALL SCOPE I BATH) & 1 (E) SLIDING GLASS DOOR (NO STRUCTURAL CHANGES) NOTE: This estimate does not include fees due to other Departments (i.e. rlanning, ruouc rrurA3, r-tre, JunLLuly JGrvG sos, s.- , _ � __ _. _ .i o .dln6ly —d aro nnty an aClimate_ Contact the Dent for addn'l info. tnslrley elc . inese eea ure uuneu vs use P, FEE ITEMS Lee Resolution 11 -053 E . 7iJ 1/13) FEE QTY /FEE Elec. Plan C'heck Afech. 1, Plan Check Fee: $0.00 Other Mech. Insp. Ether Phimb Imp, Other Elec, Insp. A1ech. Insp. Fee: 11iuru<, t hrs $0.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. rlanning, ruouc rrurA3, r-tre, JunLLuly JGrvG sos, s.- , _ � __ _. _ .i o .dln6ly —d aro nnty an aClimate_ Contact the Dent for addn'l info. tnslrley elc . inese eea ure uuneu vs use P, FEE ITEMS Lee Resolution 11 -053 E . 7iJ 1/13) FEE QTY /FEE -_ -- MISC ITEMS Plan Check Fee: $0.00 160 s.f. $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 4 1# $431.00 Window / Sliding Glass Door IWINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. o OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 fh , f t . 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 Travel Documentation Fees- Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bld& Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.951$1,076.001 TOTAL FEE: 1 $1,078.95 Revised: 02/14/2015