15030151CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1089 MILKY WAY
CONTRACTOR: SOK HOME SOLUTIONS,
PERMIT NO: 15030151
INC.
OWNER'S NAME: SAMPATH GOMATAM
3801 CHARTER PARK CT STE B
DATE ISSUED: 03/24/2015
OWNER'S PHONE: 4082037532
SAN JOSE, CA 95136
PHONE NO: (408) 264-6964
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL E]
RECONFIGURE AND REMODEL (E) KITCHEN (88 S.F.) & 2
License Class N. r M vil Lic. # 41ZO Z S S
UPSTAIRS BATHS (MASTER & HALL, TOTAL OF 124 S.F.)
Contractor X� Date 11 - Z+' 1fr
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: $10000
performance of the work for which this permit is issued.
1 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: 36219004.00
Occupancy Type:
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 DAY 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
180 DAYS -MO 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 the
I
granting of this permit. Additionally, the applicant understands and will complyue
Date:
with all non -point source regul ns per Cupertino Municipal Code, Section
>
9.18.
/the
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).
1 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 by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
al Code, Chapter 9.12 and
will maintain compliance with thta-Datel.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: ,T.W'
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, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I 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
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
Z-4
CUPERTING
r
I NEW CONSTRUC'
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
.(408) 777-3228 • FAX ((408))777-3333 • buildino(cDcupertino.orq
ALTE
PION n ADDITION O RATION / TI n REVISION / DEFERRED
ORIGIIvTAL PERMIT R
PROJECT ADDRESS , ATN 4 Z n O Q
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❑ OWNER ❑l O=WNER-BBU-tDFRRmf 11 OWNER AGENT a CONTRACTOR --�❑�CONTRACTORAGTT ❑l ARCHJTECT ❑ ENGINTER. ❑ DEVELOPER ❑ TcNANT
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EXISTLNG USE
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PROPOSED USE CON'STR TYPE 44STORIES
-sp i� V - ��
USE TYPE
OCC.
SQ.FT.
VALUATION (S)
EJIISTG
AREA Cg6
NEW FLOOR
AREA 0-
DEMO TOTAL
AREA NET AREA - i
BATHROOM
REMODEL AREA
KITCHEN
RFMODEL AREA I. 8
OTHER
REMODEL AREA
PORCHAREA
DECK AREA
TOTALDECKRORCH AREA
GARAGE AREA: DETACH
❑ATTACH
t.' DWE].Ln. GrS:
IS A SECOND UNIT El
SECOND STORY ❑ YES
BEING ADDED? ®NO
ADDITION' ®NO
PRE.AIPLICATION r-1YES IF YES, PROVIDE COPY OF
PLAN'!.7NG ADPL -� $1NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLERHOME? 4ZNO
mN a ° w r : TOTAL VALUATION:
property o\'Ter or authorized agent to act on the property owner's behalf. have read this
By my signature below, I certify to each of the folio vin': I amPe,,d
application and the information I hav is o ect. I the Desciption of Work andverify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t ui o t tion. ze representatives of Cupertino to enter the abo�-i entif p opelty inspection purposes.
Signature of Applicant/Aeent: Date:
SUPPLEMENTAL INF NATION REQUIREDWN. aP?S)TinO SLIP
New SFD or Multifamil d�xellin s:. Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. 'Cr�ix�sArrr Y$�rxYc
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B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
IM -7, FEE ESTIMATOR - BUILDING DIVISION
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 Dreliminary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
ADDRESS: 1089 MILKY WAY
DATE: 03/24/2015
REVIEWED BY: MELISSA
APN: 36219 004
BP#: 1,56,3 0
"VALUATION: j$10,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: 0 Reg. Q OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
RECONFIGURE AND REMODEL E KITCHEN 88 S.F. & 2 UPSTAIRS BATHS MASTER & HALL
SCOPE
TOTAL OF 124 S.F.)
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 Dreliminary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
88 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1 124 1 s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Coftvi dtr,'Cioi7 d, tx
1Y7d7fr 5 (XF"(lh' �° r'F':
1
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:$0.00
Select a Non -Residential
Building or Structure
0
0
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r
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Y I"Cf�';'I f Al:�`l.f/YO('f77Lt(tflYF ,ti`
Strong Motion Fee: IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.301$1,290-001
TOTAL FEE:
1 $1,292.30
Revised: 02/14/2015
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