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B-2016-2500CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2500 911 S STELLING RD CUPERTINO, CA 950144203 (359 06 017) BILGA CONSTRUCTION FREMONT, CA 94538 OWNER'S NAME: SUNDARESAN CHANDRASEKAR AND SWAMINATHAN SAN OWNER'S PHONE: 408-718-1672 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #890348 Contractor BILGA CONSTRUCTION Date 01/31/2019 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: 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. z:' 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 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature r/ Date 4/14/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. 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 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 which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 4/14/2017 DATE ISSUED: 01/18/2017 NO: (510) 755-0048 PERNUT INFO: BLDG —ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT & REAR ADDITION/GARAGE COVERSION TO CREATE (1) LIVING RM, OFFICE & LAUNDRY RM & MASTER BATH (743 S.F.); REMODEL (E) KITCHEN (300 S.E); REMODEL (E) HALL & (E) MASTER BATHS (250 S.F.); RECONFIGURE/REMODEL (E) BEDROOMS (400 S.F.); ENCLOSE PATIO AREA TO CREATE (N) 2 CAR GARAGE (425 S.F.) REV#1 - REDESIGN OF A FOUNDATION BEAM - ISSUED 02/14/2017 #2 - RAISE CEILING HEIGHT - ISSUED 4/14/2017 Sq. Ft Floor Area: 1168 1 Valuation: $250000.00 "N Number: Occupancy Type: 359 06 017 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE 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., Signature of Applicant: Date: 4 4 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 4/14/2017 CONSTRTICTION LENDING AGENCY 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 Professional ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPL1CEVIVI �� j��COMMUNITY DEVELOPMENT DEPARTMENT • BUILD'ITSIO V 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 . (408) 777-3228 •FAX (408) 777-3333 • buildinae-cupertino.or ,J —2 �0 ❑ ADDITION ❑ ALTERATION / TI M REVISION / DEFERRED ORIGINAL PERMIT 4+ PROJECT ADDRESSn i (�� ` APN# Cor CA 1 ®r ! ® ' OWNE/RjNAMEe p d PHONE _ L i5vS .%��^j^ri JLrII � ^.iF1 ��� _t� b-� 12- E-MAIL f i �1'�iiG(i S _f fA Ci Ltiv✓s L ' A, STREET ADDRESSI CITY, STATE, ZIP it S, -q-rp LL i d j. C Ja" `� T rv� t„ E17 ITU c S -b t FAX CONTACT NAME ` (�> 1 1 S 3 v 'A,-r`�F�.%� nl PRONE i � 4a 0 g- - `% ! Z& _b EV111r;1b) STREET ADDRESS CITY, STATE, ZIP FAX © OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT AENGiNEER ❑ DEVELOPER ❑ TENANT CONT OR N�An ME LICENSE NUMBER (� LICENSE TYPE BUS. LIC # 1 _[ - ' , ! COMPANY NAME 1 MAH FAX STREET ADDRESS Ll (c4 VCAfO CITY, STATE, ZIP a r — PHONE ARCHITECT/ENGWEER NAME I LICENSE NUMBER BUS. LIC # COMPANY NAME; � E-MAIL FAX STREET ADDRESSCITY, STATE, ZIP / L _ EXISTING USE PROPOSED USE � CONST TYPE # STORIES USE TYPE OCC. SQ FT. VALUATION ($; EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NE'rAREA 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? ONO ADDITION? ❑NO PRE -APPLICATION ❑ YEs IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: - TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO CUM s 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. 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 buildi..I thoriz. e representatives of Cupertino to enter the above -identified property for inspection purposes. �J Signature ofApphcanVAgent: ..- i Date: SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP 13 ovER-TllcornvTER ❑ Buu DING PLAN xEVI} w _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS - - © PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ HRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to [� MAJOR [] sANI'TARY SEWERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2500 911 S STELLING RD CUPERTINO,CA 95014-4203(359 06 017) BILGA CONSTRUCTION FREMONT,CA 94538 OWNER'S NAME: SUNDARESAN CHANDRASEKAR AND SWAMINATHAN SAN DATE ISSUED:01/18/2017 OWNER'S PHONE:408-718-1612 PHONE NO:(510)755-0048 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.#890348 Contractor BILGA CONSTRUCTION.Date 01/31/2019 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: FRONT&REAR ADDITION/GARAGE COVERSION TO CREATE(N) I hereby affirm under penalty of perjury one of the following two declarations: LIVING RM,OFFICE&LAUNDRY RM&MASTER BATH(743 S.F.); 1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL(E)KITCHEN(300 S.F.);REMODEL(E)HALL&(E) Compensation,as provided for by Section 3700 of the Labor Code,for the MASTER BATHS(250 S.F.);RECONFIGURE/REMODEL(E) performance of the work for which this permit is issued. BEDROOMS(400 S.F.);ENCLOSE PATIO AREA TO CREATE(N)2 I have and will maintain Worker's Compensation Insurance,as provided for by CAR GARAGE(425.S.F.) Section 3700 of the Labor Code,for the performance of the work for which this REV#1-REDESIGN OF A FOUNDATION BEAM-ISSUED 02/14/2017 permit is issued. Sq.Ft Floor Area:1168 Valuation:$250000.00 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 359 06 017 R-3(Custom) 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. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature 07 Date 02/14/2017 Issued by:Kim Dunbar Date:01/18/2017 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:02/14/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 a 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 Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534. be deemed revoked. Owner or authorized agent: , { APPLICANT CERTIFICATION Date:02/14/2017 • 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. I understand my plans shall be used as public records. Signature Date 02/14/2017 Licensed Professional B - it, -2_ CONSTRUCTION PERMIT APPLICATION "` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION j€j`�-. 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 REVISION (408)777-3228• FAX(408)777-3333• buildinocuDertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI 12J REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS 01 11 > _ST-LL l a )CKnp±�.) � 3 .9 r) OWNER NtME PHONE E-T,�iAIL >Liilt e,'1: s -S'vP i ' E-9 41"/ e-7 !6/' — STREET ADDRESS CITY; STATE;ZIP FAX . 'I1 5- S,-l-c_Lfr4 )., '_ tCitl PJ CA- `1-co/ti, CONTACT NAME PHONE E-MAIL STREET ADDRESS II CITY,STATE,ZIP FAX - !� OWNER 0 OWN -BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 0 ENGT'EER 0 DEVELOPER. 0 TENAA`T CONTRACTOR NAME LICENSE NUMBER LICENS- YPE BUS.L1410 3 I i .. 1 -f- f A` -�t n5 'N 8-1 0 3 '' s ` - COMPANY NAME E-MAIL FAX 1Lgii coro„STIL.VX106(.5 - STREET ADDRESS CITY,STATE;ZIP - 10 4 VE-tj . el_ r t'- 'a.,•• cAL ,_ f ARCHITECTIENGB'IEER NAME LICENSE NUMBER BUS.LIC f 11 e 1 COMPANY NAI, E-MAIL FAX STREET ADDRESS " - CITY,STATE,ZIP PHONE DESCRIPTION OF WORK PO triOPAT70) ISF- ISsiO4j EXISTING USE • PROPOSED USE CONSTR.TYPE a STORES USE TYPE OCC. SQ.FT. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL . AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: ❑DETACH ❑ATTACH 1 DV;ELLI G UNITS: ISA SECOND UNIT DYES SECOND STORY DYES BELNG ADDED? ❑NO ADDITION? ❑NO 4 I PRE-APPLICATION DYES LF YES,PROVIDE COPY OF IS THE BLDG AN DYES .:P tD - _ TOTAL\ N:, PLANKLGAPPL= 0 N PLANNING-PPROVALLETTER EICHLERHOME? ❑'O ' i, - 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. I have read this application and the information I have provided is correct. I have read the Description of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons ction. authorize representatives of Cupertino to enter the above-identified propertyfor inspection purposes. - • ail 0 Signature of Applicant/Agent: - Date: 2 J-I 1 if / 7 SUPPLEMENTAL-INFORMA IO?t REQUIRED - :.PLA\:CHCIeTIPE=: __, . .2Yi.R64Orn o:s1.,IP:° , _ :: :_. r: L '::: 4-....;-_ W • . New SFD or Multifamily l} dtP11_nas. App.} for demolition permit.or oKR-THf26.61.n:TER.11!Ni- : ] surL�c i3iA:RE\?t. ;.7-.'.:::'. . a <<,nQ Lild ,a s . Demoloi pennitnmtls,eeu required priort issuance of building: ..._ . .. ........ ....:.. . _:_: :. :.: = : .._ :-: ...: .:':- :: , . • PL.A Ic\L\G PL;A?�RIMES\'u: '=.I€`,.�i pernrt for new building ,�iPREssr- ,=:;_:. :� _:�:�:.>_,:>. _ - -- - Commercial Bldgs: Provide a completed Hazardous Materials Disclosure l0 STAND RD �� PUBLICwORKS a_ Materials _ g., P - t--project. <::................ .... _ ,... ..:_. �_..d.aspart of this ... :.a rie . :: ; form if any Hazardous are being. --..± L-.��E< EPL`:€'?'-£ _ - < 5. :..-:. _ _CoPv of Planning:Approval Letter or Meeting with PlanninQprior to t:'�1?'i40R = -< _:>-` s`__"'� ;?0';S*ItRYSEERDISTtTCT==, x submittal of Building Permit application. : ..�._,:: ..-::�:-: , =- .._ _ - :: w •,.. .. : ;e:.>:; . tR\IRON IENTAD 3EALTH__ <r BJdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2500 911 S STELLING RD CUPERTINO, CA 95014-4203 (359 06 017) BILGA CONSTRUCTION FREMONT, CA 94538 OWNER'S NAME: SUNDARESAN CHANDRASEKARAND SWAMINATHAN SAN DATE ISSUED: 01/18/2017 OWNER'S PHONE: 408-718-1612 I I PHONE NO: (510) 755-0048 1 1911% 3011.1 K1 111 1'k4m 101 WO AA 9 11.e License Class B Lic. #890348 Contractor BILGA CONSTRUCTION Date 01/31/2019 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: 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 Section 3700 of the Labor Code, for the performance of the work for which this G 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 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. `�-- Date 01/18/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. 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 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 which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 01/18/2017 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FRONT & REAR ADDITION/GARAGE COVERSION TO CREATE (I) LIVING RM, OFFICE & LAUNDRY RM & MASTER BATH (743 S.F.); REMODEL (E) KITCHEN (300 S.F.); REMODEL (E) HALL & (E) MASTER BATHS (250 S.F.); RECONFIGURE/REMODEL (E) BEDROOMS (400 S.F.); ENCLOSE PATIO AREA TO CREATE (1) 2 CAR GARAGE (425 S.F.) Sq. Ft Floor Area: 1168 1 Valuation: $250000.00 APN Number: Occupancy Type: 359 06 017 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF'PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 01/18/2017 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. Signature of Applicant: Date: 01/18/2017 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: C "`� --'—�. I Date: 01/18/2017 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 ARC'HITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 0 CtJ Pt R I N O F1 1 VPW fVlTTCT`kr Ir" CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVF.:t`"P-: CUPERTINO, CA 95014-3255 (408)7,--7-3226 • F-4'9 j408) 777-3333 • building0cu2ertino.ora rrfNJ PROJECT ADDRESS /�1y t. _(}� �y { , C. ` APN# r7s - r� / 9 OWNERNAME �""� 1�1�V �'/r VJt� ✓v PHONE rt'-��ri_fl�fJ)'7.7� E-MAIL - STREET ADDRESS p �/� fj¢ r{v 1 CTTY, STATE`, ZIPi �j�` �+ 11i FAX CONTACTNAME PI4ONE ry p 1 STREET ADDRESS j lam, CTTY, STATE, ZIP SCILAI Q . ,1/} ,} „ ` ❑ OWNER ❑ OWNER-BULDER ❑ OWNERACENT © CONTRACTOR © CONTRACTOR AGENT ❑ ARCHITECT "dENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME r ®.�`/-,1y>(�^ S(+ '�e,y� -r-r_sT/r,�I-+C�U-�h^� Ncry' i LICENSENUMBER QQ�- °� .Q V C o LICENSE TYPE VZ- Y' COMPANY NAME (l�, j L 0� A C Imo' t � -s- `R u C �. I o o P "I I E-MAIL Si �SZ�L C� � 4 i°�' C � FAX STREET ADDRESS � ( ©(' V o ('i J us PL- CITY, STATE, ZIP ��� jp'� ��--�ii� eA j,4, "HON& q0 ARCHTPF.C'rM4GINHER NAME Cel _ �1 (_ LICENSE NUMIiER ,� BUS. LIC #J COMPANYNAML, j f i YI L' �r%f E-MAIL c ' + { . GaGLart[�✓''�`C? . Lt,�•w F FAX STREET ADDRESS '!� ry( j� j CITY, STATE, ZIP�,�l d�t.0 65 ' " 7 L W CRS PHONE q ', � I_2L3 DESCRWTIOW-Or-Wordy_-_*7.0_y1__- � LCi"YUi.. EXISTINGUM PROPOSEDUSE CONSTR. TYPE #STORIES Dyke— - USE TYPE OCC. SQ.FT, VALUATION ($) EXISTG AREA �j �i11 MW FLOOR ^`iM0 AREA .1, 7 fEA TOTAL NETAREA BATHROOMKIT_CI-1EEN REMODEL AREA a� 5` RHMODELAREA $C� OTHER RRMODELARHA PORCHAREA DECKAREA 'PDTALDECYJPORCH AREA DETACEI t, 7 .1 'ATTACH # DWHLLINGUNITS: © � ISA SECOND UNIT ❑ YES BEMGADDED? NO SECOND STORY I] yEs ADDITION? 0 PR&APPLICATTON ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NG PLANNWG APPROVAL LETTER IS THE BLDG AN E]YES EICHLERHOME? ❑ NO TOTAL VALUATION: By my signature below, i certify to each of the following: I am the property owner or autborized agent to act on the owner's behalf. I lave zeal this application and the information I have provided is correct. I have read the Description ofWork and verify it ire ate. I agree to comply with allapplicable local ordinances and state laws relating to buil ' g con ueti n Iutho ' e reps esenta4ves of Cupertino to e�the above identified. property for inspection purposes. SignattueofApplicant/Agent: Date: 2 ' SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP. ❑ OVER THE -COUNTER ❑ BUILDING PLAN REVIBW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s), Demolition permit is required prior to issuance of buildurg permit for new building. ❑ Ex-Pms ❑ PLANNINGPLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ -PUBLIC worMS . fonn if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT - Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR © SANITARY SEwERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTALRKALTH Bldgflpp 2011. doe revised 06/21111 477K N Phuong Devries 10/20/16 Phuong Devries 10/20/16 Phuong Devries 10/20/16 Phuong Devries 10/20/16 Phuong Devries 10/20/16