B-2017-0292VA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0292
10382 N STELLING RD CUPERTINO, CA 95014-1644 (326 30 092)
JONATHAN WEI CHIH
SU
CUPERTINO, CA 95014
OWNER'S NAME: DAS DHANANJOYAND RAJPUT VIDYA
DATE ISSUED• 07/26/2017
OWNER'S PHONE. 408-596-1533
PHONE NO: (408) 255-8999
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO'
License Class 13 Lic. #681633
Contractor JONATHAN WEI CHIH SU Date 12/31/2017
7/26/2017 BLDG _ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH X RESIDENTIAL COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION
CONSTRUCT ATTACHED 2ND UNIT (576 S.F )
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3706 of the Labor Code, for the
performance of the work for which this permit is issued.
1 I have and will maintain Worker's Compensation hvsurance, as provided for by
3700 of the Labor Code, for the performance of the work for which this
4eSection
- .5 permit is issued.
Sq. Ft Floor Area: 576
Valuation: $100000.00
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
APN Number-
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 30 092
R-3 (Custom)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cup inoMuniciSection 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date
Issued by Jasmine Archbold
OWNER -BUILDER DECLARATION
Date: 07/26/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the properly, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate :of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25, 25533 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent: c'y
APPLICANT CERTIFICATION
Rate:
I certify that I have read this application and state that the above information is
AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORREAVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
rlI
I_Vrt:K11r4V I
ElNEW CONSTRUCTION ElADDITION "� ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10380 N STELLING ROAD FAPN,# 362 30 092
OWNER NAME PHONE E -MAH,
DHANANJOY DAS 408 596 1533 DHANANJOY.DAS@GMAIL.COM
STREET ADDRESS CITY, STATE, ZIP FAX
CONTACT NAME PHONIC E-MAIL
ADITI MUKHERJEE 408 455 3793 ARCH ITECTADITIM@GMAIL.COM
STREET ADDRESS 1448 S. STELLING ROAD CITY, STATE, ZIP CUPERTINO FAX
❑ OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT
I ElCONTRACTOR 11CONTRACTOR AGENT 91 ARCHITECT ElENGINEER ElDEVELOPER ElTENANT
CONTRACTOR NAME �A r� LICINSE NUMBER Sc� l tj 3 LICENSE TY BUS. LIC #14Of�1 �^
COMPANY NAME E-MAIL 2,. FAX
/
STREET ADDRESS CITY, STATE, ZIP
PHONE
C14
714600
ARCHITECT/ENGINEER NAME ADITI MUKHERJEE LICENSE
SE NUMBER BUS. LIC #
.
COMPANY NAME E-MAIL FAX
STREET ADDRESS ' CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
ATTACHED 2ND DWELLING UNIT- 576 S.F.
EXISTING USE PROPOSED USE - CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION
R1 R1 VN ($)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA 576 6. F..
BATHROOM KITCHEN - OTHER - - -
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/POR+AREAGARAGE AREA: DETACH
❑ ATTACH
#DWELLING UNITS: ISA SECONDUNTT ®STORY ❑YES
BEINGADDED? ❑N? ❑ NO
PRE -APPLICATION ®YES IF YES, PROVIDE COPY OF IS. THE BLDG AN E] YES RFC " '" TOTAL VALUATION:
PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO y'� $100,000
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on tht property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 2.22.17
SUPPLEMENTAL INFORMATION REQUIRED _ a .
Q ` = PL�IiT CHECK. TYPE,,
New SFD or Multifamily dwellings: Apply for demolition permit for LIVER CHE COI7 TEx ❑BI LDING PLAN REN ER1
permit for new building. building existing building(s). Demolition permit is required prior to Issuance of , .
rz .
p g, II'�XP$Ess� ❑ PiANNIN6PLANRE1�w� �
.
� X
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANDARII PUBLI vvoRi�s
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
�I43AdOR ❑ SANITARY Sj, E ISTRICT
submittal of Building Permit application. ik
Q.-ENVIRONMEITAT IiEALTJi
B1dgApp_2011.doc revised 06/21111