12090140CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22388 SANTA PAULA AVE
OWNER'S NAME: GUPTA RAJAT AND PUJA
OWNER'S PHONE: 9259171046
LICENSED CONTRACTOR'S DECLARATION
License Class f y #
r 'bl% �.. µ
Contractor ate 1 1 — l
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
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 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 tt Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
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
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.
I certify that in the performance of the work for which this permit is issued, l 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, 1
become subject to the Worker's Compensation provisions of the Labor Code, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 certify that 1 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.
CONTRACTOR: NEW WORLD BUILDER PERMIT NO: 12090140
1196 BRANDYBOOD WAY DATE ISSUED: 11/30/2012
SAN JOSE, CA 95121 PHONE NO: (408) 472-3692
BUILDING PERMIT INFO: BLDG I— ELECT F PLUMB r—
MECH RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: REBUILD EXISTING SFD (1842 SQ FT) AND REMOVE
EXISTING 507 SQ FT ATTACHED GARAGE. CONSTRUCT A
1264 SQ FT ADDITION, 424 SQ FT ATTACHED GARAGE,
Sq. Ft Floor Area: I Valuation: $425000
APN Number: 35705034.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 8 DAYS OF PERMIT ISSUANCE OR
180 DA F OM LAST CALLED INSPECTION.
Issued by: J"", Date:
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:
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) 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 orized agent:
Date:_
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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22388 SANTA PAULA AVE
CONTRACTOR: NEW WORLD BUILDER
PERMIT NO: 12090140
OWNER'S NAME: GUPTA RAJAT AND PUJA
1196 BRANDYBOOD WAY
DATE ISSUED: 11/30/2012
OWNER'S PHONE: 9259171046
SAN JOSE, CA 95121
PHONE NO: (408) 472-3692
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[]
License Class Lic. # %
REBUILD EXISTING SFD (1842 SQ FT) AND REMOVE
1 �
Contractor �� h rid VL< Date t' 3
EXISTING 507 SQ FT ATTACHED GARAGE. CONSTRUCT
A 1264 SQ FT ADDITION; 424 SQ FT ATTACHED GARAGE;
I hereby affirm that I am licensed under the provisions of Chapter 9
REVISION #2 GARAGE DOOR, LANDSCAPE & VENEER &
(commencing with Section 7000) of Division 3 of the Business & Professions
STUCCO CHANGES - ISSUED 6/11/2013
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: $425000
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: 35705034.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 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 DAYS OF 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 FRO, LL.AST CALLED INSPECTION.
City Pagainstls, judgments,
indemnify P harmlessmay
costs, ad expenses whichayacrue against said Citycone9uence of the
3
granting of this permit. Additionally, the applicant understands and will comply
Date:
with all non -point source regulations per the Cupertino Municipal Code, Sectio W
9.18.
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. [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.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 25505, 533, and 25534.
Owner or authorized agent: Date:
40
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
I 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
#40
CONSTRUCTION PERMIT APPLICATION 00
COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISI N
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 B
(408) 777-3228 -FAX (408) 777-3333 - buildinqCa)
e_"o,to-rtk1^ cupertino.org
F-1
NEW CONSTR I T(-.TTON rA Ar)r)TTI`0M 1Z AT TT7V A TTnXT / TY M DVWTCTnw i--
PROJECT' ADDRESS
22,2>1�6 A, #\()LA NG
APN #
OWNER NAME MYA 6�V PIA
PHON"(0 25) el 1 -4 0. 4L
E-MAIL •etl
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PUJA Cft F�T
PHONE2k
Lrk as) Ltu,,
STREET ADDRESS
CITY, STATE, ZIP &4j 4
FAX
KOWNFR 1:3 OwNlik-BUILDER. 0 OWN�R AGENT 13 CONTRACTOR 11 CONTRACTOR AGENT 11 ARCHITECT 13 ENGINEER 13 DEVELOPER 11 TENANT
CONTRACTOR NAME
I'M614 "
LICENSE NUMBER 6,733 or
LICENSE TYPE
,BUS. LIC # 3 1 g 3 -7
I
COMPANYNAME NGV4 fVVM 1
E-MAIL
AJF1W'yq
FAX &� q,7,2 —2,01
STREET ADDRESS
CITY, STATE, ZIP Sk,
PHON(P 00 Z
ARCHITECT ENGINEER NAMEA
ri,49"
LICENSE NUMBER
BU
TVVIY-13( 2—) D
COMPANY NAME(
E-MAIL
STREET)kDDRESS
CITY, STATE, ZIP
PHO H0
DESCRIPTION OF WORK
EXITING
PROPOSED USE
CONSTR.
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
"ISTO
"s
AREA i34q
w FLOOR
EA
D 0
A I-
'rA
TOTAL
NET AREA
md.
-2,
4:
4
IL, 04
BATHROOM
REMODELMAR-EA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA SC)
PORCH AREA
,J
DECKAREA
TOTAL DECK/PORCH AREA
.k
L$� 2
GARAGE AREA: ADETACH
ATTACH
1
# DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES
BEING ADDED? JkNO ADDITION? 70
PRt-APPLICATION ❑YES IF YES, PROVIDEOF IS THE BLDG AN 0 YES TOTA�VALUATION:
PUNNING PLANNINGAPPR LLTTER EICHLER 119ME-1
01 WO
C]N COC4 E
IAPPL#
oll I am the property owner or au on the property owner's behalf. I have read this
By,my signature below I certify to each of thol f , 0
ct. I have read the Description of I s accurate. I agree to comply with all applicable local
application and the information I have provided is11 1
ordinances and State laws relating to building const ion. I authorize representatives of Cupertino to enterthe aboveldentified property for inspection purposes.
Date:
Signa lure of Applicant/Agent:
SUPPLEMENTAL mokMAPO)MQUIRED
�,q gg",
New SFD or Multifamily dwellings:' Apply for demolition permit for
existing building(s).,, Demolition permit S required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Cw0w
Form if any Hazardo s Materials are bel used as part of this project.
C y of Planning Approval Letter or", Meeting with Planning prior to
o�Ubmittal
'P
SltWER-
of Building Permit application.t
I
BidgApp_2011.doc revised 06121111
7 1"
)- ctrw
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building okupettino.orcl
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti VISION / DEFERRED ORIGINAL PERMIT tl 1 Z-0 / O I f D
PROJECT ADDRESS l�ACC
APN M P?
OWNER NAME """
PHONE C/1� �1�r /f
E-MAIL
(
STREET ADDRESS '" ,CITY, STATE, ZIP Z TVV . AX`
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
/❑
CONTRACTOR NAME /�jl /
LICENSE NUMBER
LICENSE TYPE
BUS. LIC M
COMPANY NAME /J/%„/1 �lv�l /J/l1 y7� y
l'
E-MAIL
FAX
STREET ADDRESS(
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC H
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
N 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
I GARAGE AREA: DETACH
❑ ATTACH
M DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? 1:] NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
INLETTER
#NO PLANNING
IS THE BLDG AN ❑ YES
EICHLER HOME? NO
CEIV /� r
�"' '
/j r ,//U �i��%
�//`
y� TOTAL VALUTION:
INAPPROVAL
PLANNING APPL ❑
❑
%��
�//
By my signature below, I certify to each of the followin I am the property owner or authorized agent;to�ct 6"n the property owner's behalf. I have iead this
application and the information I have provided is corre t,', 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 constructs I authori representatives of Cupertino to enter the above -i entifi d property for inspection purposes. .
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION UIRED
ew SFD or Multifamily dwellings: Apply for demolition permit for
New
— N
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
/
iGcaiirryai///affil/i/;/,
,f;/7,,fs rfir e/f i
— Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
'�%!i�i� %�//i/ii✓c/hiss /y��i/�/lif/�/
�� i � i � . ,f � i , ��,!l/f �(,,.
Copy of Planning Approval Letter or Meeting with Planning prior to/���p�r���i�/
l�i,/�/l,
��/1 �11�yb�r¢ �!
submittal of Building Permit application.
%ri//i
„EllIVI 0T AL14 , / 10,
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22388 SANTA PAULA AVE
CONTRACTOR: NEW WORLD BUILDER
PERMIT NO: 12090140
OWNER'S NAME: GUPTA RAJAT AND PUJA
1196 BRANDYBOOD WAY
DATE ISSUED: 11/30/2012
OWNER'S PHONE: 9259171046
SAN JOSE, CA 95121
PHONE NO: (408) 472-3692
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL
License Class " s Lic. q 7T3 3 0 -9 44
REBUILD EXISTING SFD (1842 SQ FT) AND REMOVE
/_
EXISTING 507 SQ FT ATTACHED GARAGE. CONSTRUCT
Contractor Tp n "-S m 6,1L Al Date
A
I hereby affirm that I am licensed under the provisions of Chapter 9
1264 SQ FT ADDITION; 424 SQ FT ATTACHED GARAGE;
(commencing with Section 7000) of Division 3 of the Business & Professions-
full
/C/,QGG l'! L��G ✓� ��
Code and that my.license is in force and effect.
-i3 S��
pF�i` q�oy - 5 _ a • a�
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: $425000
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: 35705034.00
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. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF 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 FROM LAST 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
granting of. this permit. Additionally, the applicant understands and will comply
Issued by: Date: 117
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
�7
` Z� 3
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I 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 byte ay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with th pertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the of the work for which this
the Health & Safety Code, Section 505, 15533, and 25534.
performance
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
q-7-1not
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
I 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 wh may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. ditionally, the applicant understands and will comply
with all non -point source r gulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
<
Signature Date
vt V
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org
CUPERTINO
❑ NEW CONSTRUCTION MPADDITION ❑ ALTERATION / TI Y— REVISION / DEFERRED
ORIGINAL PERMIT # 9l1 f elv Q
PROJECT ADDRESS +� � (, .�' �( ^ 'x /1'7 AV�
APN fl
OWNER NAME V 4G 4
PHONE G r�
EMAIL
-I _k °fa�^":�
� I � .r"
STREET ADDRESS , . ' O
CITY, STATE, ZIP 1 PL
CONTACT NAME d .,&C [i /rt�� G y )!�°
V ) , 1 l L
PHONE ry^ p / 1'� P�
I I
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
WNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK -
° i,, t,"
w"6., w
d� ( � ., c ,
EXISTING USE
PROPOSED USE CONSTR
TYPE
k STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO TOT
AREA AREA
'9
p,r
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA �°"'"'
REMODEL AREA
PORCH AREA
DECK AREA
TO DECK/PORCH ARE
GARAGE AREA: U DETACH
❑ ATTACH
I
k DWELLING UNITS: w°
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE-APPLIC ON DYES IF YES, PROVIDE COPY OF
IS THE BLDG AN YES
❑
RECEIVED
TOTAL VALUATION:
AL
PL ' APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ No
--
�-
By my signature below, I certify to each of th 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 provid is correct. I have read Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state Iaws relating to buildings I au ze representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORM ON RE UIRED
Q
PLAN CHECK TYPE
I ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s), Demolition permit is required prior to issuance of building
1( OVER-THE-COUNTER
((`�
UI'LDINGPLAN REVIEW
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
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldg,4pp2011.doc revised 06/21/11
CITY OF CUPERTINO
EE ESTIMATOR - BUILDING DIVISION
ADDRESS: 22388 Santa Paula DATE: 10/17/2012 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$425,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? Yes No PENTANLATION 1 R3SFDW
USE: PERMIT TYPE:
WORK REBUILD EXISTING SFD 1842 SQ FT AND REMOVE EXISTING 507 SQ FT ATTACHED GARAGE.
SCOPE CONSTRUCT A 1264 SQ FT ADDITION; 424 SQ FT ATTACHED GARAGE; AND 452 SQ FT OF r
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
3,982
$3,043.40
IR3PLNCK
$3,244.35
IR3/NSP
PME Plan Check:
$0.00
TOTALS:
I
Suppl. Insp. Fee:0 Reg. Q OTlirs
0:0:1
$0.00
3,982
$3,043.40
$3,244.35
PME Unit Fee:
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 nreliminary information available and are only an estinxate. Contact the Dent for addn'I into.
FEE ITEMS (Fee Resolution 11-053 Eff.' 711112)
FEE
QTY/FEE
NVIISC ITEMS
Plan Check Fee:
$3,043.40
$0,00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
Q,Q
hrs
PME Plan Check:
$0.00
Permit Fee:
$3,244.35
Suppl. Insp. Fee:0 Reg. Q OTlirs
0:0:1
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
b new
units
$629.29
_
—
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee: IPLLONGR
$517.66
Select a Non -Residential
Building or Structure
A
Strong Motion Fee: IBSEISMICR
$42.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$17.00
SUBTOTALS:
$7,494.20
$0.00
TOTAL FEE:
$7,494.20
Revised: 10/0112012
CITY OF CLTPERTINO
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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolulion 11-053 Efr 7/1112)
ADDRESS: 22388 Santa Paula Ave
DATE: 02/21/2013
REVIEWED BY: Sean
111/w�h. 1 "Im't ('frc' /.
APN:
BP#: 12090140
"VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
oliveC Ic r 1)rV).
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
Revision #1: Revise master bathroom layout shower and water closet); Revise detail 9/DS-5.
SCOPE
Suppl. Insp. Fee -0 Reg. Q OT
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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolulion 11-053 Efr 7/1112)
FEE
QTY/FEE
1e<:h. °1crrt (la, r.6t
111/w�h. 1 "Im't ('frc' /.
LMc'. P/o/I 01cu'k
1 hours Plan Check, Hourly
$133.00 1sTPLNcx
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
1 hlryd; hd v)
oliveC Ic r 1)rV).
Hech. frnp. 1"c(I:
phoib. b)xp. Pvc,
00(' Ms/) t 'w.
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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolulion 11-053 Efr 7/1112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? O Yes O No
$0.00
1 hours Plan Check, Hourly
$133.00 1sTPLNcx
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cr>ns1r action Tax:
f r)sr2ir;t.y a`+ rrtr� :t .f^`c>(, •
0
E)
Work Without Permit? 0 Yes O No
$0.00
Advanced PlanninL Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
A
",I)E;>(,rrrrncr ttrrtifrrr Frc5:
Strong Motion Fee:
$0.00
Select an Administrative Item
BldgStds Commission Fee:
$0.00
i , / STBTCITAI,�
$ 0.00
$ '
133.00 i ;;' ,,TUA`,.'
$133.00
Revised: 01/01/2013
CITY OF CUPERTINO
F91 FEE ESTIMATOR -BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 22388 Santa Paula
DATE: 10/17/2012
REVIEWED BY: Sean
PC FEE ID
APN:
BP#:
*VALUATION: 1$425,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
REBUILD EXISTING SFD 1842 SQ FT AND REMOVE EXISTING 507 SQ FT ATTACHED GARAGE.
SCOPE
CONSTRUCT A 1264 SQ FT ADDITION; 424 SQ FT ATTACHED GARAGE; AND 452 SQ FT OF o
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
3,982
$3,043.40
IR3PLNCK
$3,244.35
IR3INSP
Permit Fee:
$3,244.35
Suppl. Insp. Feer Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXU
1
# new
units
$629.29
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
3,982
$3,043.40
$3,244.351
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn 7 into.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12,)
I
QTY/FEE
MISC ITEMS
E17-
LJ
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (!) Reg. 0 OT
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn 7 into.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,043.40
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (!) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,244.35
Suppl. Insp. Feer Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXU
1
# new
units
$629.29
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning_Fee: I PLLONGR
$517.66
Select a Non -Residential G
Building or Structure 0
Strong Motion Fee: IBSEISMICR
$42.50
Select an Administrative Item
1 1
Bldg Stds Commission Fee: IBCBSC
$17.00
SUBTOTALS:
$7,494.20
$0.00 TOTAL FEE:
$7,494.20
Revised: 10/01/2012
CITY OF CUPERTINO
FEW FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 22388 SANTA PAULA
DATE: 09/18/2012
REVIEWED BY: MENDEZ/SW
PC FEE ID
APN:
BP#: 12090140
*VALUATION: 1$425,OOQ
*PERMIT TYPE: Building Permit
Pf AN CHECK TYPE: Addition
PRIMARY SFD or Du
USE: Duplex
2nd Unit? • Yes No
OTC? C Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
ADDITION OF 1604 SQ FT TO REAR OF SFDWL PORCH/PATIO 452 SQ FT TOTAL 2,056 SQ FT
SCOPE
REMODEL 1,122 SQ FT
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
2,056
$2,678.98
IR3PLNCK
$2,305.03
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,305.03
Suppl. Insp. Fee -0 Reg.
® OT
Fowl
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
2,056
$2,678.98
$2,305.03
h104 "HOURLY Yes,",, , ; 1�0 EL�C,;I�IOV .Y � Yes Q No
W
Pi`wlih lay
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt Ptr_ )_ Thow fPPc are hnQPd nn the nrPliminary inTnr►natian availahle and are anly an estimate_ Cnntart the Dent for nddn't in fn.
FEE ITEMS (Fee Resolution II -053 Eff. 7/I/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,678.98
= s.f.
$4,281.00
Remodel, Other
1REMRES2
Suppl. PC Fee: E) Reg. 0=0
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,305.03
Suppl. Insp. Fee -0 Reg.
® OT
Fowl
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannin Fee:
IPLLONGR
$267.28
Select a Non -Residential
Building or Structure
0
�r.��e! ll?,tr�rr r,lrr�ie�r rrr ,.
Strone Motion Fee:
IBSEISMICR
$42.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$17.00
CTtL
$5,310.79
$4,281.00
; TQTAL FEE:'
$9,591.79
Revised: 07/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 22388 SANTA PAULA
DATE: 09/17/2012
REVIEWED BY: MENDEZ
PC FE SID
APN:
BP#:
`VALUATION: 1$425,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes . No
OTC. 0 Yes GNo
PENTAMATIOIj.�' 1R3SFDADD
PERMIT TYPE:
WORK
ADDITION OF 1,604 SQ FT TO REAR OF SFDWL REMODEL 1,1220 SQ FT S` .
SCOPE
1,604
OCCUPANCY TYPE:
TYPE OF
FLR AREA
PC FEES
PC FE SID
BP FEES
BP FEE ID
shT'errrti/ hie
Pla_/11
CONSTR.
s.f.
�/r.
Plrr r i�crrdr, /rtv=Fl-
0(hcr- Phwy !)
R-3 (Custom)
II-B,111-B,IV,V-B
1,604
$2,602.26
IRJ�LNCK
$2,030.11
IR3INSP
Suppl. Insp. Fee -0 Reg. 0/bT
0,0 Thrs
m.�
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without ermit? 0 Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$208.52
TOTALS:�L
Q
0
f 1"avc1
Strong Motion Fee: IBSEISMICR
$42.50
1YiGE Hy k616'
FEE
QTY/FEE
WP."h. ;'Ion C
N(wr b. N arr G `hertz
! (r. PI(do I<<.re1c
lc(;h' Perwo Vc,
shT'errrti/ hie
Pla_/11
/11"( I'errrrir l°c",
�/r.
Plrr r i�crrdr, /rtv=Fl-
0(hcr- Phwy !)
CJal rrr l:Irc lns r.
A'C"t2, l elr, kco:
f J.,¢✓f,4�J
P' wW). h/.
J'cc-
NOTE: This estimate does not include fees due toot er Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Thesefees are based on the relimi information available and are only an estimate. Contact the Dept or addn'1 info.
FEE ITEMS Fee Resolution 11-053 a. 711 11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,602.26
pa22 s. f.
$4,281.00
Remodel, Other
IREMRES2
Suppl. PC Fee: 0 Reg. 0 OT
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:`
$2,030.11
Suppl. Insp. Fee -0 Reg. 0/bT
0,0 Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without ermit? 0 Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$208.52
Select a Non -Residential
Building or Structure
Q
0
f 1"avc1
Strong Motion Fee: IBSEISMICR
$42.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$17.00
>Bt7'AL
$4,900.39
$4 281.00 TOTAL; FEE.
$9,181.39
Revised: 07/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
SUBCONTRACTOR
PERMIT# 01
BUSINESS LICENSE #
cv�r CA
('AA4
PHONE #Ow
GENERAL CONTRACT
V
R:
BUSINESS LICENSE#
ADDRESS: H e"' 6' tz"�
11111"IN11 , , r ,1
le"'L i C
CITY/ZIPCODE: � > NLI 17
*Our municipal code requires all businesses working in4he city to have a City of Cupertino" business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
�Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR LIST
JOB ADDRESS: 2-2,Us '(�WJ-A
r&UCAjkVC-,
PERMIT# i 20C�j Q Of Q
OWNER'S NAME: rQ JA Cn.)
P -CA
PHONE# _qZS;- -- Cf
GENERAL CONTRACTOR:
-Q)?'j vo)
BUSINESS LICENSE #
ADDRESS: (IL V<hb4 jr_k
W" Atj'
C(XITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
✓
Glass/Glazing
G-C)f �T-
515 Z -
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Contractor Signature
4:fl)i 161 t "�
bate
e4).
San Jose
OrWater
Company
110 W. Taylor Street
San Jose, CA 95110-2131
May 2, 2013
Puj a Gupta
22388 Santa Paula Avenue
Cupertino, CA 95014
Reference: 22388 Santa Paula Avenue, Cupertino
Dear Ms. Gupta: �Yv & ��)
San Jose Water Company
Water Services Administration
1265 S. Bascom Ave., San Jose, CA 95128
Facsimile: 1 408 279-7889
Writer's Direct Dial: 1 408 279-7800, ext. 5805
. i-,Cf�,VVD
MAY 0, 6 203
The purpose of this letter is to inform you of the procedures you need to follow to finalize
the installation of a new water service for this project. Basically, you will need to hire a
contractor to perform the work to our standards and under our inspection. It is suggested, but not
required, that you contact one of our general contractors to have this work performed. They are
West Valley Construction at (408) 371-5510, and Lewis & Tibbitts at (408) 925-0220. In any
case, your contractor must possess a valid license to perform this type of work, and must obtain a
permit from the City of Cupertino to do the job.
Based on the data that was provided on our water service questionnaire, our Engineering
Department has determined that a 1 %2" copper service with a check valve needs to be installed for
this house. The piping from the check valve/meter to the house should be 2" in size. By copy of
this letter, we are informing the City of Cupertino of our determination, and I have enclosed our
standard service drawing that details an approved installation. The meter/check valve (service
connection) defines the point at which you receive service, and the point where the owner's piping
begins. The owner of the property is responsible for all piping and equipment past the check
valve.
Please note that in addition to the check valve in the meter box, you must also install a
rubber seated single check valve (property of the owner) on the internal plumbing of the house.
The location of the check valve must be where the fire sprinkler piping tees off from the domestic
piping. Also, the water pressure in this area is over 80 PSI (approximate range at the meter will
be 88 - 97 PSI). San Jose Water Company recommends that a pressure regulator be installed on
private service lines that will prevent pressure in excess of 80 PSI from entering the structure.
Please contact your plumber regarding this matter.
Puja Gupta
May 2, 2013
Page Two
If you would like to proceed with the service work, please sign, date, and return this letter
with a construction deposit as discussed below. Also include the address where the monthly
billings should be sent. Monthly billings start when the meter is installed, and a copy of our rate
schedule is enclosed for your information. You must also submit a deposit in the amount of $779
to cover the cost of our reviews and inspection, and the purchase and installation of the new meter
and check valve. Please make your check payable to San Jose Water Company.
At the appropriate time, you will need to provide our Construction Department at least one
week notice for inspection services. Your contact is Nick Bernhardt, who can be reached at (408)
279-7830. A San Jose Water Company inspector must witness the actual tap of the water main.
Once the service lateral and meter box have been installed and approved, we can install the meter
and check valve at your request.
If you have any questions, or require further information, please contact me at (408) 279-
7800, extension 5805.
Sincerely,
ORIGINAL SIGNED BY
Jay Coito
Water Services Representative
JC:dmk
Enclosures
FIP#13-075
I
cc:ilding Department, City of Cupertino
ACKNOWLEDGED AND AGREED MONTHLY BILLINGS TO:
Responsible Party
Signature
Print Name
Date
Name
Address
City
Phone Number