The URL can be used to link to this page

B-2017-0104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0104 7668 NORMANDY WAY CUPERTINO,CA 95014-5253(366 17 054) BUILDCOM CONSTRUCTION SAN JOSE,.CA 95111 OWNER'S NAME: BHUVANAGIRI LAKSHMINATH AND NATARAJAN VINAY DATE ISSUED:01/19/2017 OWNER'S PHONE:408-708-6546 PHONE NO:(408)605-9382 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class¢ Lic.#9Ei6238 Contractor BUILDCOM CONSTRUCTION Date 09/30/2017 X BLDG X ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE WINDOW(5)-LIKE FOR LIKE TO MEET EGRESS; I hereby affirm under penalty of perjury one of the following two declarations: REPLACE(1)PATIO DOOR;RE-ROOF;TEAR OFF;INSTALL OSB; m. I have and will maintain a certificate of consent to self-insure for Worker's COMP SHINGLES-(22 SQ);UPGRADE PANEL(200 AMP)-SIDE Compensation,as provided for by Section 3700 of the Labor Code,for the YARD performance of the work for which this permit is issued. L2.^. 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. Sq.Ft Floor Area: Valuation:$20000.00 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 36617 054 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 understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 1/19/2017 Issued by:AbbyAyende Date:01/19/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law For one of the RF 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:1/19/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER m. 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 Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: - APPLICANT CERTIFICATION Date:1/19/2017 w 1 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 shall be used a DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 1/19/2017 professional } 60 1t - 0I CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 SUPE TiiNt3 (408)777-3228•FAX(408)777-3333•building0-cupertino.org ❑NEW CONST-7662 R�umoN ❑,C�ADDITION �� ❑ ALTERATION/TI ❑ REVISION/DEFERRED -^1 ORIGINAL PERMIT# PROJECT ADDRESS / 6�y 2 /�C1 AJ I a 1/v t J APN# 2 /_ Z � 6J �/ OwNERNAME Lfg—l<r�V ,Ili ATPN B� PHONE 409"709 6 6 E-MAIL � S '1 VU � STREET ADDRESS M A_,V 6 P An Vo A.U-6 CITY,STATE,ZIP CA FAX CONTACT NAME � � PHONE � �r-�� E-MAIL STREET ADDRESS PQ CITY,STATE,ZIP rM1" l C (l FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑`ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME J�J LICENSE NUMBER�6 ys ® LICENSE TYPE Q BUS.LIC# ® COMPANY NAME E-MAIL t� Cl fJ FAX it is d (/� f3 i44 STREET ADDRESS `( 1.� CITY,STATE,ZIPcv �' t 0� 07/�f ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ("�Jw x ,,av P,,o, ; Lin C,V-a)e- 2z d A5, Con Gmt `lk- EXISTING USE I 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 DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLINGUNITS: IS ASECOND UNIT []YES SECONDSTORY ❑YES BEINGADDED? E]NO 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 A MIA1 _ 2- -.0 ,ci0-0 By my signature below,I certify to each of the following: I am the property owner or authorized agent lo act on le 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 building co ti . I authorize representatives of Cupertino to enter the above-identified propellyfor inspec on purposes. Signature of Applicant/Agent: - - Date: SUPPLEMENTAL ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW 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 El STANDARD El PUBLIC WORKS form 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 SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111