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15020155I CITY OF CUPERTINO BUILDING PERMIT 1 BUILDING ADDRESS: 10172 BILICH PL I CONSTRUR: NAUTICA I PERMIT NO: 15020155 CT OWNER'S NAME: RAY ASHISH KUMAR AND NINIVA OWNER'S PHONE: 4083102899 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ _ Lic. # Z Contractor ✓'(a �.�,� �ErC v,�Date D 3A a 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. S ignatur Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 construct the project (Sec.7044, Business & Professions Code). I 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, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 1282 LIME DR I DATE ISSUED: 02/27/2015 SUNNYVALE, CA 94087 1 PHONE NO: (408) 667-1586 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT (2) WINDOW OPENINGS IN MASTER SUITE TO MEET EGRESS REVISION #1- ADD (2) WINDOWS @ LIVINGROOM- ISSD OTC 3/11/2015 Sq. Ft Floor Area: I Valuation: $3000 APN Number: 31621065.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRQM LAST CALLED INSPECTION. Issued by: Date: 3 14 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 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. I 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 Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25 , 25533, and 25534. c7 Owner or authorized agent: Date: S 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10172 BILICH PL CONTRACTOR: NAUTICA PERMIT NO: 15020155 CONSTRUCTION OWNER'S NAME: RAY ASHISH KUMAR AND NINIVA 1282 LIME DR DATE ISSUED: 02/27/2015 OWNER'S PHONE: 4083102899 SUNNYVALE, CA 94087 PHONE NO: (408) 667-1586 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT (2) WINDOW OPENINGS IN MASTER SUITE License Class Lic. #i �004 L TO Contractor AA/7o4/J/,2 5 E'r f t7u Date 01 27 r MEET EGRESS 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: $3000 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: 31621065.00 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS ERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROW—LA09p, CALLED IN TION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 7;7 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: /s with all non -point sour egulations per the mo Municipal Code, Section 9.18. t, Z/2�ly 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(x) 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 the Health & Safety Code, Sections 25505 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: d2 Z ) upermit is issued. 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, 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a--�cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS, O' 72 /1 /G APN # U J ! C H W �t OWNER NAME PHO/� 6 �'O rL f�Cv C� E-MAIL OS V U C/ STREET ADDRE§S 72 CITY, STATE, ZIP_ FAX CvPE?iI& tot c L- CA CONTACT NAME A AJ _ PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ DAINRR-BUILDER ❑ OWNTERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSET BUS. LIC# N— N °Ca1c;L1 2L COMPANY NAMEN ', E-MAIL I ( - J)(xi� FAX L OAI 2L)I_ (J ,"1 �`I o lC. Cut3 ,UJI STREET ADDRESS CITY, STATE, ZIP PHONE I Z Z L t-7 C— 62 ✓ w ti ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK J A, 0, s ry EXISTING USE PROPOSED USE CONSTR TYPE # 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 GARAGE AREA: DETACH ❑ ATTACH 9 DWELLING ULTT S: 1S A SECOND UNIT ❑ YES SECOND STORY E3 YES BEING ADDED? NO ADDITION? [:]NO i PRE -APPLICATION 1-1 YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑PES RECEIV Y :- TOTAL VALUATION: PLANN7NG APPL9 ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO .s - w£ 0 0 o a By my signature below, I certify to each of the following: I am the property owner or authorized ager act on the ro owner's behalf. I ave read this application and the information I have provided is correct. I have read the D ription of Work and verify rt is urate. I agree to comply with all applicable local ordinances and state laws relating to buildi ion. I authorize entat'ves of Cupertino to enter the above -idem .feed pr perty for inspection purposes. Signature of Applicant/Agent: Date: (72 ? /s SUPPLEME FORMATION UIRED`cK;TYPE .. _-xouTllvc:sLlP = 8 New SFD or Multifamily dwellings: Apply for demolition permit for OVERTHECbUl\TER BUILDIj�GPL NREVIEW existing building(s). Demolition permit is required prior to issuance of building - permit for new building. h 0 E7iPRESS a PLAn�INGPLANRE�2EW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ID sTANnARD r ❑ PUBLiC,VORKS t _ form if any Hazardous Materials are being used as part of this project, 3 fY LD LARGED ;; r � FJRE DEPT asy f � �� 1 � _ Copy of Planning Approval Letter or Meeting with Planning prior to k r ��17AJOR ' ❑:SANITARY SE 'F.RDJSTRICT submittal of Building Permit application. Bld;App_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-)cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATIONTT / TI VISION / EF ERRED /C4� N4� \17 ORIGINAL PERMIT # /33070 I S S' PROJECT ADDRESS (� l ,l r —7 2- APN 4 OWNER NA E PH04 °� 1g'5 E-MAIL S S -310 STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME — & C G PHONE �o E-MAIL N rS STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ oN?.'ER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LICENSE NUMBER LICENSE TYPE BUS. LIC # .������ LJ �026z COMPANYNAME E-MAIL FAX _ STREET ADDRESS CITY, STATE, ZI PHONE 12 L v N < ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE 4 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: DETACH ❑ ATTACH R 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 TO , PLATNNINGAPPL9 NO PLAN7NING APPROVAL LETTER EICHLER HOME? NO By my signature below, I certify to each of the following: I am the property owner or authorized agent act o e property owners 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. I agree to comply with all applicable local ordinances and state lays relating to building c on. I authorize representative rtino to enter the above-ident' led p operty for inspection purposes. S ignature of Applicant/Agent: Date: d SUPPLEME ORMATION REQUIRED $ - - „PLANCHECICTl'PE �".+= ' �� �_itOUTSIvGSLIP - New SFD or Multifamily dwellings: Apply for demolition permit for y#� { 3 OVERTE{ECOU�TER)-m 0Pkp,z tEA�w existing building(s). Demolition permit is required prior to issuance of building x Y � z * � pennit for new building. ExPREss rL�it tuiG rLAt�1iEVIEH Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CJ sr+l\DARD j ❑ OBilcvoRlcs } _ z form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to �1Li JbR } d k Ts flSAI�TTARY SE ER DISTRICT submittal of Building Permit application. a ❑"_ERYiRO1i7�fENTHEALTH�;:_, �_:.,t�.:��+ .-r.�.;_�.., =.n BldgApp_2011.doc revised 06/11/11 CITY OF CUPERTINO rm--7 FEE ESTIMATOR — BUILDING DIVISION IlaADDRESS: 10172 bilich way DATE: 02/27/2015 REVIEWED BY: Mendez APN: BP#: VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: T hrs PENTAMATION 1 GENRES PERMIT TYPE: WORK construct 2 window openings in master suite to meet egress SCOPE 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/U13,1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $859.00 Lj Suppl. PC Fee: e) Reg. Q OT F0,0 T hrs $0.00 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/U13,1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $859.00 Window / Sliding Glass Door 1WINmEWSTR New (Shearwall/Masonry) Suppl. PC Fee: e) Reg. Q OT F0,0 T hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT rooThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _.- 0 Work Without Permit? © Yes (E) No $0.00 Advanced PlanninL Fee: $0.00 Select a Non -Residential Building or Structure l i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldp, Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $1.501 $859.00 ' TOTAL FEE: $860.50 Revised: 02/14/2015 L H C ARCHITECTURAL DESIGN & CONSTRUCTION Architecture Design. Construction 13937 Lynde Avenue, Saratoga, CA 95070 Tel: (408) 867-9331 Fax: (408) 867-9331 Feb. 6, 2015 Project: Chen Residence Renovation 1✓%� 19771 Bixby Drive Cupertino, CA 95014 Subject: Field observation As the architect of record, I had provide the structural field observation for the above mentioned project for the following items in the renovation & the addition area: 1- The epoxy anchor bolts & dowels. Base upon the observation performed, it is my professional judgment that the work was substantially in conformance with the approved building plans. Sincerel , Hau-Ching Liao Project Architect