13110004CITY OF C UP ERTINO BUILDING PERMIT I
BUILDING ADDRESS: 7495 STANFORD PL CONTRACT" R: NEWHOME PERMIT NO: 13110004
OWNER'S NAME: SAIKAT SAHA 148242 ARCADIAN ST I DATE ISSUED; 02/18/2014 1
OWNER'S PHONE: 4088937703 1 FREMONT, CA 94539 1 PHONE NO: (408)421-9808
❑ LICENSED CONTRACTOR'S DECLARATION
License ClassC}_ Lic. # 3 Z
Contractor /t/HAAT A( 6 0)4 Date d -Zf 12-OZ41
y
1 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.
1 hereby affirm under penalty of perjury one oft he 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 t understands and will comply
with all non -point sou regulatr er ino Municipal Code, Section
9.18.
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
842 SQ FT ADDITION TO REAR OF SFDWrL, REMODEL
OFFICE AREA 100 SQ FT, PANEL UPGRADE 200 AMP,
INSTALL NEW FURNACE.
Sq. Ft Floor Area: Valuation: $96000
APN Number: 35932046.00 Occupancy Type:
P]ERId'if]IT ]EXPIRES IF WORK IS NOT STARTED
ED
WITHIN l IF PERMIT ISSUANCE OR
180 DAYSlFl[8 (LAST CALLED INSPECTION.
Issued by: Date, e: 12de/4
P
RE -ROOFS:
Signat Date if 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
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, 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, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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
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(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 Cupertino Mr nicipa[ Code, Chapter 9.12 and
the Health & Safety Code, Section 5 t 2553
Owner or authorized a Date:--C7�
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
�v
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 o build inciAcupertino.org
1, EED
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PR CT AD
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OWNER NAME
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREETADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LTC #
COMPANY NAME v i r
EMAIL 1 _
FAX
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STREETADDRESS
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DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE NSTR TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
N l
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA i Igo
V
o
AREA �
AREA a-�
— "�0 2
, V g
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6
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL 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
1S THE BLDG AN ❑ YES
R.ECEIV BY: -` -
TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLERHONIE? ❑NO
J
By try 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 thi
application and the information I have provided is correct. I have Wad the Description of Wo and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construc 'o . auth 'ze representativ upertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF0RMATI0N QUIRED
PLAN C IECK TYPE ROUTING S[ ie
New SFD or Multifamily dwellings: Apply for det on permit for
Q TNG REVIEW
_
existing building(s). Demolition permit is required prior to issuance of building4-
oV ER TxE CouNTER PLAN
permit for new building.
Q EXPRESS,:,NNINGPLAN REVIEW
•.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD BLIC 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
SANITARY DISTRICT
submittal of Building Permit application.`
MAJOR SEWER h ,,:
• ❑ z"ENVIROND'IENTAL HEALTH -. .
BldgApp_2011.doc revised 06/21111
?'4TrnPW CNTP 1"TrTUb1PTrb1PTr'\T?th
OCCUPANCY TYPE:
�L..SL IL A 1%.Y -LL' \L.. V A I Ilu ll lLl N SLY
FEE ESTIMATOR - BUILDING DR VISffCN
]PIER AREA
s.ff.
PC ]FETES
ADDRESS: 7495 STANFORD tab.
DATE: 11/01/2013 REWEWIED BY:
Mendez
R-3 (Custom)
APN:
BP#:
0 0
*VALUATION:
1$96,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
$1,617.00
PRIMARY
SFD Or Duplex
2nd Unit?
Yes No
PIENTAMATION
1R3SFDADD
USE:
OTC?
�No
0 Yes °
PIEI[BMIT TYPE:
WORK 842 SQ FT ADDITION TO REAR OF SFDWL REMODEL OFFICE AREA 100 SQ FT
PANEL
SCOPE UPGRADE 200 AMP
Administrative Fee:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
]PIER AREA
s.ff.
PC ]FETES
PC FEE H)
ISP FEESBP
FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
842
$2,577.00
1R3PLNCK
$1,617.00
1R3INSP
floc. Insp. Fee:
$1,617.00
Suppl. Insp. Fee:G Reg. COT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Conso-action Tax:
Administrative Fee:
Work Without Permit? Yes No
$0.00
TOTALS:
842
$2,577.00
Travel Documentation Fee: ITRA VDOC
$1,617.00
Strong Motion Fee: IBSEISMICR
MECH, HOURLY 0 Yes (E) No
PLUMB, HOURLY 0 Yes (D No
ELEC, HOURLY () Yes 0 No
hfech. Plan Check
-e,11.
Phunb. Plan Check
Elec. Plan Check 0.0 hrs $0.00
Permit Fee:
Ft
Plumb, pemil Fee:
Elec. Permit Fee: IEPERMIT
Orher Alech, Insp.
Of her Plumb Insp. �
Other Elec. Insp. 0.0 hrs $47.00
,11ech. Insp. Fee:
Phuuh. h1ap. Fey •
floc. Insp. 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 an the nreliminary information available and are onlv an estimate Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13)
FEE
QTY/FEE
MffSC RTEMS
Plan Check Fee:
$2,577.00
=s.f. Remodel, Other
$418.00 IREMRESOTN
Suppl. PC Fee: (j) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
EiKl amps Electrical
$47.00 IBELEC200 Services
Permit Fee:
$1,617.00
Suppl. Insp. Fee:G Reg. COT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Conso-action Tax:
Administrative Fee:
Work Without Permit? Yes No
$0.00
Advanced Planning Fee: IPLLONGR
$117.88
Select allon-Residential
Building or Structure
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$9.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$4,419.48
$465.00
TOTAL FEE:
$4,884.48
Revised: 10101/2013
4'C. 19J
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.Bmn1��lIlIlAg 11 �1�j��lIl'f1MeEnt
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephoner 408-777-3228
Fax:. 408-777-3333
JORB ADDRIESS: 2-4 S
PERMIT # 0
OAR°.1;:..�'
PH0l
GEN kAL:CLRLlRACTOR'—
,SINESS LICENSE #
AWA[ M : C ) � S . ih( N T
CITY/CODE:
*Oar-muugtmicip l -code requires zU businesses working in the city -to have i� City off Cuper4nno gusittso llnc¢05e.
No IE NAIL Ol[8 FINAL OCCUPANCY I NS PIECTTONS) WMIL IEIE SCE El<DU LIEIID itiN1['IDL T'IHOE
GEARAL CONTRACTOR AND ALL SUBCONT7i8ACT 03CS HAV E ,0I3T'AMIlD A C Er1Y CIF CU PIERTTFi®
II -arm not using any subcontractors:
Sigmataun e
IP)iease check -OI pHeable saubcoau rzctoirs.mad compRe>te the ffb lows mg kffbirmm nom.
Date
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SECDR1` RA CT OR
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BUSHPTIEss ILIICIENSIE #
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Cement Finishing
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Excavation
Fencing
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Septic 'yank
Sheet fetal
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Date