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B-2017-0504CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0504 11430 CHARSAN LN CUPERTINO, CA 95014-4974 (362 10 061) FUTURE VISION REMODELING INC VAN NUYS, CA 91406 OWNER'S NAME: PARASURAM YEGNASHANKAR AND RAMYAY DATE ISSUED: 03/29/2017 OWNER'S PHONE: PHONE NO: (800) 485-4919 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #991840 Contractor FUTURE VISION REMODELING INC Date 04/30/2018 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: BATHROOM REMODEL (76 S.F.) - MASTER BEDROOM AND I hereby affirm under penalty of perjury one of the following two declarations: POWDER ROOM u. I have and will maintain a certificate of consent to self -insure for Worker's REVISION #1 - UPGRADE MAIN SERVICE PANEL (200 AMP); Compensation, as provided for by Section 3700 ofthe Labor Code, for the UPGRADE SUB -PANEL (125 AMPS) IN GARAGE - ISSUED 4/27/2017 r performance of the work for which this permit is issued: z. I have and will maintain Worker's Compensation Insurance, as provided for by 1 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $15000.00 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 362 10 061 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 u�Pderstands anTWffl omply with all non -point source regulations per W CupertinoMunicipal , ode, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Date 04/27/2017 Issued by: PAUL O'SULLIVAN OWNER -BUILD ER VBd&ATION Date: 03/29/2017 I hereby affir at I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is z. 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: 04/27/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. 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 Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use eq ent ouxrc` r dev►cerw ich emit hazardous air contaminants as defined by the B Area Air Quality Man ement District I will maintain compliance with the Cu rtino Municipal Code, ha ter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &Safety Code, Sectio - O5, 25533, 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is ,' END AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that theconstruction lending agency for the performance m relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Se03097, 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. 1 understand my plans shall be used as public records. Licensed Signature Date 04/27/2017 9 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0504 11430 CHARSAN IN CUPERTINO, CA 95014-4974 (362 10 061) FUTURE VISION REMODELING INC VAN NUYS, CA 91406 OWNER'S NAME: PARASURAM YEGNASHANKAR AND RAMYAY DATE ISSUED: 03/29/2017 OWNER'S PHONE: PHONE NO: (800) 485-4919 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class.B Lic. #991840 Contractor FUTURE VISION REMODELING INC Date 04/30/2018 X BLDG _ELECT —PLUMB COMMERCIAL MECH X RESIDENTIAL 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: BATHROOM REMODEL (76 S.F.) - MASTER BEDROOM AND I hereby affirm under penalty of perjury one of the following two declarations: POWDER ROOM 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. / /k,, APPLICANT CERTIFICATION ertify 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 362 10 061 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. 3/29/2017 Issued by: Abby A, eL Date: 03/29/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t. 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. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 3/29/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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. 1 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. 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 the any manner so as to become subject t 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 Cupe�� ' 1 Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Co , sections 255 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed Owner revoked. � or authorized agent:, '®ate: APPLICANT CERTIFICATION 3/29/2017 certify that I have read this application and state that the above information is NSTRUCTION LENDING AGENCY I hereby a that there is a construction 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 permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 3/29/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION '10300 TORRE AVENUE - CUPER T INO; CA 95014-3255 CUPERTIN (408) 777-3228 • FAX (408) 777-3333 buiIding(Nupertino.arg (j ❑ NEW CONSTRUCTIOAI �[_1 ADDITION ❑ ALTERATION I TI ❑ REVISION/DEFERRED - ORIGINAL PERMIT 4 BIdg.Ipp 2t711.dae revised 116,21111 -41 OWNERNAME- I}I l PHONE EhiSIL STREET ADD }}1y� jj CITY STATE, ZIP {� FAX r`y1Y1 a 11 CC4 l CONTACT NAME � PlI(I 'E SAIL I C7c� 1} t )C1 LISP JVI Q} ST_ RE T A(DDRESS �j _ CITY, TE, ZIP t FAX ❑ OA'NER ❑ OWNER-13UILDER ❑ OWTNERAGE,Nr CONTRACTOR ❑ COATfR_ACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT •� CONTRACT, AME � l� n LICENSE NUMBEPqq) 6 �j�c^� LICENSE TYPE 1717 BUS. LIC COMPANY NAME \ f Ul V { S) o Yi AIAIt FAX LIRE ST?tET CM t tsSi i za�1"7 STAT ZIP ARCHITECTIERGINEERINANP2 LICENSE NUNVa .2 .BUS.L�IC4 C0,4IPANY NAME E-MAILT� FA( X i STREET ADDRESS v CITY; STATE, zIP PHONE DEC ;TONOF„"'"kap ,fit ���%�/' p 4yti cI 1STINGUSE. PROPGSEDUSE`CON�7R. TiPL:=ST_ORtE,S - USE TYPE OCC. I SQ.FT.- VALUATION (J MsTG r NEWFLOOR _ DEMO TOTAL ( AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER - - - - REMODELAREA RalODELAREA REMODELAREA t PORCH AREA DECK AREA 1 TOTAL DECRtPORCH AREA GARAGE AREA: DETACH GATTACH ,DWELLING UNITS: - ISASECONDUNIT []NES SECONDSTORY ❑YES - BEING ADDED? El NO. ADDITION? - ❑NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF ❑ ISTHEBLDGAN YES ❑ ._._ ,-,-,--: Itl;t� IVED'BY:- � IL TOTAL"A'.UATION: PLA\'NTINGAPPL-- ❑NO PLANNINGAPPROVALLETTER EICHLERHOME? []NO By my signature below, I certify to each cfthe followin,,: 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 providediscorrec ave Feo the Description of tVork and verify it is accurate, i agree to comply with all applicable local - ordinances and state laws relating to building constncu6 . nze representatives of Cupertino to enter the above -identified property for inspection purposes. T Signature Applicant/Agent: Bate: of .�', SUPPLEMENTAL 1(MATION REQUIRED Q , 'FLAN CHECK TYPE ROUTING SLIP e,.. �R Drly ©sun G PLAN IiEF7l tv _ New SPD or Multifamily dwellings: Apply for demolition permit forniirCau� existing building(s). Demolition permit is required prior to issuance of building - =. permit for new building. ©.. xRESB__Pi4IV'VI1YG PI:.Ah REV1E:41 - - _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fl STA-ND'.kRD fl-PLIBLIC WORhs To—nn if any Hazardous_ Materials are being used as part of this project. fl xaRGr `. ❑ FIi2EDEPT _ _ Copy of Planning Approval Letter or Meeting with Planning prior to Q SIA ION ❑ sAiVITARY sENEUDIsrItICT Subtnittal. of Building Permit application. El ENVIR6IkhIEtiTALHE4LTS- BIdg.Ipp 2t711.dae revised 116,21111 -41