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15090124CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15090124 10529 JOHNSON AVE CUPERTINO CA 95014 (375 27 004) (J S C ENTERPRISES & GENERAL SERVICES) UNION CITY, CA 94587 OWNER'S NAME: PENCHALADUVVURUAND KATAMREDDY DATE ISSUED: 01/29/2016 OWNER'S PHONE: 770-295-8112 PHONE NO: 510-305-1538 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #976385 Contractor (J S C ENTERPRISES & GENERAL SERVICES ) Date 01/29/2016 — BLDG _ELECT —PLUMB MECH 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: CREATE (1) ADDITION (582 S.F.) WITH ('I) ATTACHED I hereby affirm under penalty of perjury one of the following two declarations: GARAGE (404 S.F.); Remodel (620 S.F.), Demo Carport (200 S.F.) ; 1. I have and will maintain a certificate of consent to self -insure for Worker's UPGRADE (E) PANEL TO (I) 200 Compensation, as provided for by Section 3700 of the Labor Code, for the AMP PANEL & DEMO (E) CARPORT 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 Sq. Ft Floor Area: Valuation: $144400.00 this permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct. I agree to comply with all city and county APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 375 27 004 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point rce regulations per the Cupertino Municipal 180 DAYS FROM LAST C LED INSPECTION. Code, Section 9.18. --. – - Issued by: EL AM Signature "'�� Date 01/29/2016 Date: 01/29/ 16 BUILDT RE -ROOFS: I hereby affirm at am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two rea s: installed without fust obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 01/29/2016 contractors to construct the project (Sec.7044, Business & Professions Code). 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the i. 1 have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Quality Management District I will maintain compliance with the Cup unicipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health &Safety Cod esti s 5505, 25533, and 25534. 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 Owner or authorized agent: be deemed revoked. Date: 01/29/2016 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is I hereby affirm that there is a c nstr ction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permits is ued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 01/29/2016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15090124 10529 JOHNSON AVE CUPERTINO CA 95014 (375 27 004) J S C ENTERPRISES & GENERAL SERVICES UNION CITY, CA 94587 I OWNER'S NAME- PENCHALA DUVVURU AND KATAMREDDY I I DATE ISSUED: 01/29/2016 OWNER'S PHONE: 770-295-8712 1 1 PHONE NO: (5 10) 305-1538 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #976385 Contractor J S C ENTERPRISES & GENERAL SERVICES Date 09/30/2016 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. 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 5�iertino consequence of the granting of this permit. Additionally, the apprstands and will comply with all non -point source regulations p Municipal Code, Section 9.18. Date 4/5/2016 I hereby affirm that I/am exempt from the Contractor's License Law for one of the following two yeas s: 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. Date 4/5/2016 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CREATE (N) ADDITION (582 S.F.) WITH (N) ATTACHED GARAGE (404 S.F.); Remodel (620 S.F.), Demo Carport (200 S.F.) ; UPGRADE (E) PANEL TO (N) 200 AMP PANEL & DEMO (E) CARPORT DEF #1 - TRUSS CALC'S - ISSUED 4/5/2016 Sq. Ft Floor Area: I Valuation: $144400.00 APN Number: Occupancy Type: 375 27 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLEDINSP CTION. Issued by: ALEX VALLELUNGA Date: 01/29/2016 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: 4/5/2016 ALL ROOF COVERINGS TO BE CLASS "A" 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 Cupe t ipal Code, Chapter 9.12 and the Health & Safety Code, S tons 25 0 , 25533, and 25534. Owner or authorized agent: Date: 4/5/2016 I hereby affirm that there is a constr4toroending agency for the performance of work's for which this permit is issLVec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION 1 aau- COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(dcuDertino.org ❑ NL -W CONSTRUCTION F1 ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS l/92 ` ' ok� r � . I APN 4 13 � r y lav4- fC•�GF6 OWNERNAME *EV � IA I-1 �'(1�I1� e�_•L�� E-MAIL (P�__��L"ems, STREET ADDRESS f�^'�V �O�,4\�! ) � CITY, STATE,ZI ! _ r fTN�IV ' u(J eA ei'Q? FAX PH01�CI CONTACT NAME E-MAIL V a�1 c� C'JbJt�.'Zi .510 3&C - LC -3& �► csn' IDy a�aoo . u� STREET ADDRESS CITY, , STATEZIP �, 9�8'j FAX 13 OWNER ❑. OWNER -BUILDER O\iNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSE TYPE BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-M/JL FAX STREETADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK CO i11 ►RR00M AVP1110A) MAVTM 040 0.M 19 -*-J W KTe44#-AJ iVCu1 2 "0- C3h>t eft'• 91h, LA 9C. RAV PANtL ME&" joeA Tb zoti 4JL4 r - ExISTNG USE PROPOSED USE CONSTR TYPE I STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DET40 TOTAL - AREA I it) 4Y AREA AREA NET AREA LA O s 4 ., BATHROOM KITCHEN OTHER REMODEL AREA REMODEL .AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH +0+ ;•ATTACH T DWELLING UNTrS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? NO I )4 w0 A i PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLA-NNTNGAPPL. []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME? []N0- VED - - -TOTAL. VALU T N: 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 btlialf. I have read this application and the information I have provided is c I have read the Description of Work and verify it is accurate. I ee t comply with all applicable local , ordinances and state laws relating to building c structi I authorize representatives of Cupertino to enter the above -i6 e ified rrA-perty for inspection purposes. Signature of Applicant/Agent: Date: 0 REQUIRED SUPPLEMENTAL INFORV'quired PLAT`C'EZECKrIPE;-= _ �'ROUrII3GSLIP _ - �\> New SFD or Multifamily dwellings: for demolition permit for = o\ER r>�coul.rER BUIIDL�GPL4NREVIER: existing building(s). Demolition permit is prior to issuance of building __7- Lik permit for new building.ExPxEss .' s PLAI,I�LNG PLANREVIEwr, _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosuresrArDARD2 �� _ r�uBicvoRxs form if any Hazardous Materials are being used as part of this project. ^� lARG1 r� s FIREDEPTfr _ M�..- Copy oPlanninb Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. ..,-YQ 3vIAOR '^� � � -- � - �SAI�'TT3IAYSER'ERDISTCT". -�� RI�� � t� ���, L�� s,. _ _ d Eli-VIROIa'MENTr1l FIEAY;TA , 3. " BIdgApp_2011.doc revised 06/21/11 S CUPERTINO F-1 T -FW rr)NlCTRT T('TTC1N CONSTRUCTION PERMIT APPLICATION A�A COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ` FAX (408) 777-3333 • buildingCc1cupertino.org n ATITITTTOV n AT TFR ATTON / TT 99V RFVTSTON DF.FA ERREn ORIGINAL PERMIT #6 S0 �7o 1 2- PROJECT ADDRESS .aPNr ✓ `11 ONMNERNAME PHONE 770 - 2AS -871'�' E-MAIL STREET .ADDRESS ?� + a } V cT Yv CITY, STATE, ZIP, A1 ^• � ( I FAX 'Vv ('j� CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OR'NER ❑ OWNER -BUILDER ❑ u9n\ER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGNTEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � � �.�1 LICENSE NU,, J, JI LICENSE WE yI/� V U BUS. LIC COMPANY NAME`yLl ` E-MAIL 7 b AX F� STREET ADDRESS CI STATE, ZIP Cir y Cotq gpr7 PHONE�I e -3� W3 L" _4�// - / .ARCHITECT,'ENGINEER NAME LICENSE :LUMBER ^ � � _ „� � BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF \\'OItK I I" -U SS C-41-0- /47 IhEXISTING EXISTINGUSE PROPOSED USE CONSTR. TPPE STORIES USE i TYPE OCC. SQ.FT. VALUATIO24 (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REN40DEL.AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECIVPORCH AREA GARAGE AREA: L.JDET.ALCH ❑ ATTACH 4 DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? 0 N PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ 17ES p B � RBMW TOTAL V.4L ' ION: PLANTING APPL R []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �e' By my signature below, I certify to each of th owing: 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 pr ed ' orrect. I have read the Description of work and verify it is accurate. e o coly \vit11 all applicable local ordinances and state laws relating to b -a c ruction. uthorize representatives of Cupertino to enter the above-i�raS,,dtPr0p-m-_1Pty for inspection purposes. Signature of Applicant!Azent: Date: SUPPLE\?ENTALATION REQUIRED ,'ILv cxT,cr 1�rE �.I;�c SLIP pply for demolition permit for N�Tew SFD or Multifamily diver iTitis�i4equired ' ❑• � building(s). Demolition p prior to issuance of buildin« 0A�EP T?:£ -COLLIER � .t _ � ,PLAN FEV JEWexisting permit for new building.�rr�ss Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ! STkND_xD PUrI.Ic \\ craS _ form if any Hazardous Materials are being used as part of this project. — L -J LARGE J FIRE DPT- _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. s_4NITA _R1 SES\ ER DIS. RIC T £N\'IRONMENT.AL H£Ar.TI1 Bldo 4pp_?011.doc revised 06121/11 CITY OF CUPERTINO 010 I FEE ESTIMATOR - BUILDING DIVISION 161 ADDRESS: 10529 Johnson Ave DATE: 09/18/2015 REVIEWED BY: PAUL PC FEE ID APN: 375 27 004 BP#: VALUATION: $144,400 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes • No OTC? ® Yes (j) No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK Create N addition 582 S.f. with N Attached Gara a 404 S.f. ; Upgrade Epanel to N 200 Am SCOPE Panel OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 986 $2,654.00 IR3PLNCK $1,666.00 IR3INSP L:iec. Irish. Pee $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:O Reg. Q OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 TOTALS: 986 $2,654.00 $1,666.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No ch. Plan Check 'Iremb. Plan Ckec% Elec. Plan Check 0.0 hrs $0.00 Al� ii-, _ Elec. Permit Fee: IEPERMIT (AhurIle& lnsp �r%reit'/urnb.lrw�l:>. Other Elec. Insp. 0.0 hrs $48.00 bfech. Insp. Fe.,laimb. Insp. Fc, L:iec. Irish. Pee 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 preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolulion 11-053 E . L 131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 =amps Electrical $48.00 IBELEC200 Services Suppl. PC Fee: O Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:O Reg. Q OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 G. =uclion 1 a: administrative Fee: E) Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $138.04 Select a Non -Residential Building or Structure 0 A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $18.77 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $4,578.81 $48.00 TOTAL FEE: $4,626.81 Revised: 07/02/2015