12120049CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1091 MILKY WAY
CONTRACTOR: ALI'S CONSTRUCTION &
PERMIT NO: 12120049
REMODELING
OWNER'S NAME:. MURGAI VISHAL & SHALINI
681 E BROKAW RD
DATE ISSUED: 01/07/2013
OWNER'S PHONE: 4085335401
SAN JOSE, CA 95112
PHONE NO: (408) 898-6474
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL11
License Class_ Lic. 4 9 Oq
ADDITION OF 420 SQ FT TO REAR OF SFDWL; REMODEL
I
EXISTING KITCHEN INTO A DINING ROOM (140 SQ FT);
Contractor Date
REMODEL BATHROOM #2 (42 SQ FT)
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
Sq. Ft Floor Area:
Valuation: $60000
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: 36219005.00
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. 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
uponthe above.mentioned property for inspection purposes. (We) agree to save
180 DAY AST 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:
with all non -point sou ce regulations per the Cupertino Municipal Code, Sec 'on
9.18.
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
10,
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ O ER UILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm tha 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)
1, 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 defincd 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
the Health & Safety Code, Sections AV5,25533, and 25534•
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Pat
permit is issued.
-44/
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. Cal ifomia. If, after making this certificate of exemption, 1
CONSTRUCT ENDING AGENCY
6111
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 buildingconstruction, 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
3
CONSTRUCTM PERNT APPUCATON
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION �CP
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 \
,CUPERT[NO (408) 777-3228 o FAX (408) 777-3333 > building-cupertino.orq \�
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS -0 9 M,I(KY
w cA APN #at_pz o05—
OWNER
05—
OWNER NAME1 I , j 1 ]b 5)6 - 1 E-MAIL
SW ALk4�klo 1i
STREET ADDRESS D Q /�/� •� / 1 M CITY, STATE, ZIP /I (� p ,/ FAX
CONTACT NAME 1 / , W PHONE lJ \ E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER --BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME f L O � w LICENSE NUMBERq 0 3 LICENSE TYPE BUS. LIC #
COMPANY NAME �' E-MAIL C0A Sf t ( C®� / nl F n 110
STREET ADDRESS6xi 67, �� CITY, STATE, ZIP t PHO
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK Al( ! O yi o e'_,0 p� , D
_& !�:
64 1+ % W
EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES
USE TYPE OCC. SQ.FT. VALUATION ($)
EXISTG NEW FLO R DEMO TOTAL
AREA AREA C7 gra AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES
BEING ADDED? []NO ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY:TOTAL VALUATION:
IN
PLANNG APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 000
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 pro ded 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 b g construction. I authorize representatives of Cupertino to enter the above-identi d pro erty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF TION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_ New SFD or Multifamily dwell' V. Apply for demolition permit for ❑ OVER-THE-COUNTER E] 'BUILDING PLAN REVIEW
existing building(s). Demolition pe it is required prior to issuance of building-
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUB%ICwORKS
form if any Hazardous Materials are being used as part of this project.❑ � , 1 ° V ,.
AR
❑ LGE" FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. 0 MAJOR ❑ ` SANITARY SEWER III STRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
IM-0
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
LIN
ADDRESS: 1.091 Milky Way
DATE: 12/11/2012
REVIEWED BY: Mendez
ON
APN:
BP#:
WALUATION:
1$60,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
I Elec. Insp. Fee:
PENTAMATION
PERMIT TYPE: 1GEIVRESA
WORK
add 420 sci ft to rear of sfdwl for kitchen and extend m.suite
SCOPE
—1
-tech. Plan Check
Plumb, Plan Check
Flee. Plan Check
.-tech. Permit Fee:
Plumb. Permit Fee:
Oct.. Permit Fee:
Ofhcr Ale ch, Insp.
Other Plumb Insp.Ll
01her Elec, Insp.
Alech. Insp. F'ee:
I Plumb. Insp. Fee:
I Elec. Insp. Fee:
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'l info.
FEE ITEMS (Fee Resolution 11-05.3 Ef. 7/1112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes (F) No
$0.00
L--L—J hours Plan Check, Hourly
$665.00 ISTPLNCK
Suppl. PC Fee: (F) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check: -
$0.00
Permit Fee: Hourly Only? 0 Yes IS No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consli-uction .Tar:
Adrninistrative.f*ee:
Work Without Permit? Yes No
$0.00
Advanced Planning Fee:
$0.00
0 hours Inspections
$1,197.00 ISTINSP Inspection, Hourly
Travel Documentation Fees:
Strong; Motion Fee: IBSEISMICR
$6.00
Select an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
1 $9.001$1,862.00
TOTAL FEE.
$1,871.00
Revised: 10/01/2012
CUPf HT INO
Q0, NTRACTOR / SUBCONTRACTOR LEST
Building (Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
*Our municipal codle requires all businesses working in the city to have a City oTCauperhd® business license.
NO BUILDING FINAL OR (FINAL OCCU FANCY ENSPIECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CIT1Y cCUN RTINO
BUSINESS LICEE. / .9-azr"'., o
I am not using any subcontractors:
rc Date
Please check applicable subcontractors and c ete the Te llowtng information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
BUSINESS LICENSE #
*Our municipal codle requires all businesses working in the city to have a City oTCauperhd® business license.
NO BUILDING FINAL OR (FINAL OCCU FANCY ENSPIECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CIT1Y cCUN RTINO
BUSINESS LICEE. / .9-azr"'., o
I am not using any subcontractors:
rc Date
Please check applicable subcontractors and c ete the Te llowtng 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
ntractor Signature
Date
CONTRACTOR / SUBCONTRACTOR LRST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
Wi
PERMIT #
OWNER'S NAME: h.
PHONE #
GENERAL CONTRACTOR:4U 1),j
ADDRESS:
BUSINESS LICENSE #
CITY/ZIPCODE:
*Our municipal code requires all businesses working ince 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 NTRACTORS HAVE OBTAINED A C1 OlF C7RTlNO
BUSINESS LICENSE.
I am not using any subcontractors: C ® ,
nature Date
Please check applicable subcontractors
the following inffbrmation:
V
SUBCONTRACTOR
KUMNIESS NTAKE
BUSINESS LffCIENS E #
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