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13070018CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21104 TULITA CT CONTRACTOR: C AND D FREITAS PERMIT NO: 130700/8 CONSTRUCTION OWNER'S NAME: ANJALI PALKAR 23610 MORREL CUT-OFF RD DATE ISSUED: 12/17/2013 O ER'S PHONE: 4087999350 LOS GATOS, CA 95033 PHONE NO: (408) 353-1900 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. IST FLR, License Class Li 2.`aS l7 2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F. Z ' �Z'13 Contrac fitoki� BALCONIES & PORCHES/578 COVERED /te I hereby affirm that I am licensed under the pr' visions 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 have and will maintain a certificate of consent to self -insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $914000 performance of the work for which this permit is issued. ave 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: 32628070.00 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 DA ED 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 113 granting of this permit. Additionally, the applicant understands and will comply Iss i'Z with all n oint regulations per the Cupertino Municipal Code, Section 9.18. l ��e y / RE -ROOFS: Sign 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 1 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 1 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 C Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S n 2 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Date: /a �` 7 permit is issued. Owner or authorized age 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 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, ARCHITECT'S DECLARATION 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 CUPERTINO SNEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.oM \ ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 21104 Tulita Ct. APN # 326-28-W 04-0 OWNERNAME Prasad and Anjali Palkar 408-799-9350 E-MULprasad.palkar@gmail.com STREET ADDRESS 1731 Calgary Dr LCITYSOTATE,ZIP Sunnyvale CA 94087 FAX CONTACT NAME Antoine Meo PHONE 925-963-8646 EMAIL. tonymeodesign@gmail.co STREET ADDRESS P.O. Box 610 CITY, STATE, ZIP Sunol CA(44586 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT fARCHITECT NGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEO r p��? LP LICENSE NUMBER LICENSE TYPE BUS. LIC a COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENG[NEER NAME Antoine Meo LICENSE NUMBER BUS. LIC k COMPANY NAME /� y G l7 R I E-MAn /- STREET ADDRESS �Jn�a CITY, STATE, ZIP O � � PHONE� DESCRIPTION OF WORK 6t4a r-� I -y 1-51- 30215r- k� 17C Z,A 2,113 Nk Ga-1/Gs IP&ak 66,3 EXISTING USE PROPOSED USE CONS TYPE II STORIES I !_7L,/_ ,,, / 2 JAREA USE TYPE OCC. SQ.FT. VALUATIONS) NEW FLO(O ► 3 NETTOTAREA3��� EAREAG 1 3 6 AREAS Z/ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEI AREA PORCH AREA DECKAREATOTAfL DtECVJPPORCH AREA GARAGE AREA: DETACH (l O G ]o l7 i-+ Z �TTACH # DWELLING UNnS. IS A SECOND UNIT El YES SECOND STORY JaYES BEING ADDED' a'NO ADDITION" NO , PRE -APPLICATION IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES _ TO AL VALUATION: PLANNNG APPL 4 ❑ NO P1,ANN G APPR�OVpAL LETTER C-1�',J E]CHLER HOMEY �jc NO By my Signature below, I certify to each of the following: I am the property owner or authori agent act on operty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and ver] is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP J New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD 13 PUBLICWORKS 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 BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION \ ADDRESS: 21104 TULITA CT DATE: 07/03/2013 REVIEWED BY: MELISSA PC FEE ID APN: 326 28 070 _ BP#: *VALUATION: $914,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes IS No I PENTAMATION 1 R3SFDW I PERMIT TYPE: WORK CONSTRUCT N 2 STORY SFD - 3,025 S.F. 1ST FLR 2,193 2ND FLR 926 S.F. ATTACHED SCOPE I GARAGE & 668 S.F. BALCONIES & PORCHES/578 COVERED OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,III-B,IV,V-B 6,722 $3,748.40 IR3PLNCK $5,040.88 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $5,040.88 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 �' 6f^ PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 6,722 $3,748.40 Construction Tax: IBCONSTAXR $5,040.88 N new units ,Vc, ,. Plan Check Phanh. Plan C'hcei Plan Check Mech. Permit Fee: Plarmh. Permil Fre: Elec. Permit l=ee: Other Meeh. Insp.ET-1- Other Plumb Insp.E]_L_ Orher Elec. Insp. Mech. Insp. Fce Plumb. hrsp. Fee: 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 preliminary information available and are only an estimates Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,748.40 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Feer Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,040.88 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 �' 6f^ PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 N new units $647.24 Administrative Fee: O 0 Work Without Permit? 0 Yes C) No $0.00 Advanced Planning Fee: IPLLONGR $941.08 Select a Non -Residential Building or Structure 0 Trm,el Documentation Fees_ Strong Motion Fee: IBSEISMICR $91.40 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $37.001 SUBTOTALS: $10,506.001 $0.00 TOTAL FEE: 1 $10,506.00 Revised: 07/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21104 TULITA CT CONTRACTOR: C AND D FREITAS PERMIT NO: 13070018 CONSTRUCTION OWNER'S NAME: ANJALI PALKAR 23610 MORREL CUT-OFF RD DATE ISSUED: 12/17/2013 OWNER'S PHONE: 4087999350 LOS GATOS, CA 95033 PHONE NO: (408) 353-1900 ❑ CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] �LINSED CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. 1ST FLR, License ClassLic. # MOMl7 2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F. GA//� ( l BALCONIES & PORCHES/578 COVERED Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 5/21/14 - DEF # I FOR TRUSS CALC'S- ISSD OTC 6/17/2014 (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: $914000 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: 32628070.00 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 ex es w 'ch may accrue again City in consequence of the derstands and will comply granting of is permit. AdditionWpeerti Issued by: Date: with a poi our egulatiMunicipal Code,Section 9. 7 `�' RE-ROOFS: S. 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, sho use eiJuipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as by a Ba i Management District I performance of the work for which this permit is issued. will maintain co ianc with th upertino Mu c 1 de, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & afety Cod ecti " Section 3700 of the Labor Code, for the performance of the work for which this Owner or aut n : Date: 6 permit is issued. d ` �� 1 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, 1 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 II CUPERTINO a*gl-1 7? - 3=g TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(@,cupertino.orq APN _ 7-2 , 7-0 32,�66 BP #:i3©7O� J l DAT ... VALUATION: APROJECT SITE(� ADDRESS: 2 LW 4 LUGITA 1. G C�,�, � C 4 1 Lk10 OWNER'S NAME:f Pr d s «d ?CMIC-a r PHONE#: g-ip$j 7qq -g rjs� FAX #: u A_ MAILING ADDRESS (if different from site address): S F CONTRACTR: G D r-kz l y,4s X?'R-Uoa'/di✓ CG PHONE #4 'k 35-3 _( 0a FAX #: CONTACT: .— l 6M 9( -Us PHONE #: 4/ p r/y 7 FAX #: A4 TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND7ANT (1 % VALUATION s �`�Q [BLDBONDS] CODE ❑ CHECK ❑ CASH BOND ND: 5K min -10K max EDITION: TCO EXPIRATION 6 � q-// FEE: $286.00/mo TOTAL FEE: $ 9 I/5 �° [1TEMPOCC] DATE (6 MONTHS MAX): sz/8 USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT VA sz/8 2 - ❑ APPROVED WITH CONDITIONS' Public Works - tt �..... -? ❑ APPROVED APPROVED WITH CONDITIONS' . .. ........................ Date:.....:.'..�.� Signature:..... 4 t e r: ❑APPROVED APPROVED WITH CONDITIONS' OTHER OTHER DEPARTMENT / AGENCY APPROVALS: anrnng . — Wil/ ,/� S ❑ APPROVED APPROVED WITH CONDITIONS"...,,:......... Signature: .,./'.`✓...................................... Date:..:...... ,: ire , ..f.. Scr..... J.Y.0 ...�5... Date:.....�T...-..�. Signature: �., �.,. []APPROVED ❑ APPROVED WITH CONDITIONS' Public Works - tt �..... -? ❑ APPROVED APPROVED WITH CONDITIONS' . .. ........................ Date:.....:.'..�.� Signature:..... 4 t e r: ❑APPROVED APPROVED WITH CONDITIONS' Signature: ................................ ........................ Date:...................... 60&;v (,(j Lup,ws csic-c c r *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or J buildings complete and ' compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date speci"d. If t ,s Trf�porary Certificate of Occupancy ex, the total amount of the bond may be forfeited and the non-compliance may resU6 an f e action. Owner ��Contractor Signature:..°.[.....�..................... Date:.Sianature:.�.L:Da...!............S.. This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific area of the building specified above to provide a reasonable degree of safety to the occupants from fire and similar emergencies. Building Official:: F . ...........................-.... .........Print:... .............Date:.-C.,�Z.`/& DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file TempOccForm_2011 doc revised 717114 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 v B (408) 777-3228 • FAX (408) 777-3333 • building(a,cupertino.orq CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED OR]GINAL PERMIT H PROJECT ADDRES(((S2-I �� 7u l_ 4 C , APN d ''��� OWNERNAME "S'f C�� y 1 R L PHONE4 _ EMAIL` I IMQI� CC". srVr STREET ADDRESS CITE STATE, ZIP I u AX CONTACT NAME �i �S -/d orJS`l�t�(Iin/ PHONE a E-MAIL STREET D ESSTY, 2_3(oto Mai c` ©F STATE, ZIP L s -a C At FAX +0�35 -Zu' ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGE/NT ❑ CONTRACTOR XICONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME(? 0 t �J f� 7� n LICENSE NUMBER LICENSE TYPE BUS. LIC b S S, t COMPANY NA CII.. C�Ac.�:VCFC ��I �/]S E-MAIL CC _ T V ei�QS Oar FAX 4 353 mezzo STREET A4S CITY, STATE, ZIP vp P NE ki ARCHITECT/ENGINEERNAME PQ r� sq P4 (T7 e_0 ` 7`~ LICENSE NUMBER BUS. LIC N COMPANY NAME 7 E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK I 1 PE (,( / W C 0,4r- ILOc)f- 7-9-U-9 CA( -'Z5 EXISTING USE PROPOSED USE CONSTR. TYPE M STORIES USE TYPE OCC. SQ.FT. VALUATION (S) 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 GARAGE AREA: LJDETACH I] ATTACH I 9 WELLINGUt TI'S ISASECONDUNIT ❑YES SECOND STORY C] YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN S RE TOTAL VALUATION: PLANNING APPL 4 ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th prope mer's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construcno uthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicandAgent %M e£Ze1S L�.�e ��' Date: 2-1 r l y SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS x ," 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 ❑ MAJOR ❑ SANITARY SEwERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21104 TULITA CT DATE: 05/21/2014 REVIEWED BY: MELISSA APN. 326 28 070 BP#: `VALUATION: $0 PERMIT TYPE: fjAN CHECK TYPE: Alteration / Repair PRIMARY Dor Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: , WOR 5/21/14 -DEF # 1 FOR TRUSS CALC'S SCO 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 oreliminary information available and are onlv an estimate. Contact the Dent for addn't info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1 %13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $278.00 Deferred Submittal iDEFSUBN, Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 rhrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G) Work Without Permit? ® Yes (D No $0.00 Advanced _Plannin Fee: $0.00 Select a Non -Residential Building or Structure G Strong Motion Fee: $0.00 Select an Administrative Item 1 Bldg) Stds Commission Fee: $0.001 SUBTOTALS: 1 $0.00 $278.00 TOTAL FEE. --F-$278.001 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21104 TULITA CT CONTRACTOR: C AND D FREITAS PERMIT NO: 13070018 CONSTRUCTION OWNER'S NAME: ANIALI PALKAR 23610 MORREL CUT-OFF RD DATE ISSUED: 12/17/2013 OWNER'S PHONE: 4087999350 LOS GATOS, CA 95033 PHONE NO: (408) 353-1900 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT (N) 2 STORY SFD - 3,025 S.F. IST FLR, License ClasLic. #2SKY 2,193 2ND FLR, 926 S.F. ATTACHED GARAGE & 668 S.F. ,— BALCONIES & PORCHES/578 COVERED Convacto Date REV # I - DELETE 2 WINDOWS & ADD I WINDOW/CHANGE PLANS TO I hereby affirm that I am licensed under the provisions of Chapter 9 REFLECT CHANGE - ISSUED 6/1/15 (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: $914000 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 APN Number: 32628070.00 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 upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS LLED 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 l �' granting of this permit. Additionally, the applicant understands and will comply V: ate: with oint ource regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. a�llnon- 6W WT ' Signature Date /J All roofs shall be inspected prior to any rooting 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: 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. 1 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 theC11061,440 Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & SafetyCo a 05, 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this f/ Date:,6 '—r —/—'5permit is issued. Owner or authorized agent: . 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 1 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertinLg ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI tR REVISION /DEFERRED ORIGIINIAL PERMIT # S O T CiL L PROJECt ADDRESS 11'4_A 11A APN 9ZZ C)^a �(✓ OWNER NAME PHONE /E799 qs- E-MAIL 0g��r�1'-V STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE O J y E-MAIL e l ( ^TZ) AOL. STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRAC 0RNAMELICENSE E q -7 t IC LSTYPE BUS. LIC N COMPANY NAME E-MAIL((�� } �c Cr a l.2 cV . c FAX STREET ADDRESSZ 2.36 STATE, CITY, A, IP (,c� v� �-' PHON ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 1 I)PSCRIPTIff 0WORK c e l � �, 1.� � � � I C VJ� e� � EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR, AREA DEMO AREA TOTAL NET AREA - BATHROOM REMODEL AREA KITCHEN. REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; DETACH ❑ ATTACH k DVVELLING UMTS: IS A SECOND UNIT ❑ YES BEING ADDED? El NO SECOND STORY ❑ YES ADDITION? E] NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLALTTNG APPL X []NO PLANNIIJG APPROVAL LEITER IS THE BLDG AN ❑ EICHLER HOME? ❑ NO ., y, ". _ _., ' ` - ^ -. TOTAL VALUATION: By my signature below, I ce e 01 ng: I am the property owner or authorized agen ac on t e property owner's behalf. I have rea application and the inf ation vi d is c rrect. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state ws relating etc ns ction. I authorize represee natives of Cupertino to enter the abgve-,den fled pr ope for inspection purposes. Signature, of Applican ! �- d /� 7)$ Date: SUPPLEAdEI�ITAL TON REQUIRED New SFD or Multifamily dvvellinQ�s: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. P P>; Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project, �o ' . _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06121111 corn CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13) ADDRESS: 21104 TULITA CT DATE: 06/01/2015 REVIEWED BY: MELISSA btech. Permit Fein APN: 326 28 070 BP#: 13070018 `VALUATION: Iso FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Plumb. hrsp. F-ce. PENTAMATION 1GENRES PERMIT TYPE: WORKREV # 1 - DELETE 2 WINDOWS & ADD 1 WINDOW/CHANGE PLANS TO REFLECT CHANGE - SCOPE ISSUED 6/1/15 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13) FEE Phwfb. PlaoChcc°ti MISC ITEMS btech. Permit Fein Plumb, Permit Fee, -lec_ Perrnir Per- __L_ 071We ' AACh, InspED__L_ Ocher Plumb Jose Other Elec. Ins/ F-1 14ech. Insp. Plumb. hrsp. F-ce. Elec°. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT ro.fl hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con.mwctlon Tax. Aclininistrative Fee: 0 E) Work Without Permit? C) Yes C) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure A Trm,el Doc ulnentation Fees. Strong Motion Fee: $0.00 Select an Administrative Item �J=__ Bldg Stds Commission Fee: $0.00 x. SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Rev sed: 05/07/2015 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: �.I 10 1. U (-I-T , UT, PERMIT # 13 C -i v(o 1 OWNER'S NAME: ttsa�C> �� � PHONE # $ W3-,960 GENERAL CONTRACTOR: C -*D art' )..,.tST-xu BUSINESSLI ENSE# XIC14 ADDRESS: X_34/C) ok®rl - . CITY/ZIPCODE: oS Qf)Z?5 0,0 5�13 *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 ot using subcontractors. CI, e- A �i�/T.�S Z" 10 —,LS- -K -/S -K S ell /rs; ,EP /scL,e.; Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME g, BUSINESS LICENSE # abinets & Millwork -b2 3.35' Cement Finishing _ Electrical 2(a Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping 51 V_ Lathingj�* t �! �,$ �✓4�S TEN° i�l/( ie c e a to c Masonry Painting / Wallpaper Paving Plastering _ - -7 , g - 795a _� lumbing L 49e 0 4 K M31,V6 Roofing Septic Tank Sheet Metal _ o _S z _ 2-0 Sheet Rock �l C 1 C' ,+¢�. /� 2- S a - Ti1e 0U7W,¢ / r 3 4 a R A �-�og_Zog_�zza ner / Contractor Signature Date