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13090120 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10402 CHISHOLM AVE CONTRACTOR:SIERRA STRUCTURE INC PERMIT NO: 13090120 OWNER'S NAME: JAIN JAYANT AND USHA J 2435 SHERWOOD WAY DATE ISSUED: 10/30/2013 OWNER'S PHONE: 4084667996 MEADOW VISTA,CA 95722 PHONE NO:(916)275-1971 Tr' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class__ Lia# `2 7 8 62 CONSTRUCT A ONE STORY ADDITION(824 SQ FT). Contractor .l1ttiC._t14� Date 16I I hereby affirm that I am licensed under the provisi s 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. Sq.Ft Floor Area: Valuation:$130000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32641075.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save t80 DAYS FR _A$,Y'CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, _�--�— costs,and expenses which may accwa�ainst said City in consequence of the granting of this permit. Addyti&i lly,tl}E applicant understands and will comply Issued Date: D 3a / with all non-point source ,, lations per the Cupertino Municipal Code,Section 9.18. ROOFS: any r Signature Date 1� 3u / All roofs shall be inspected prior to y 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 here y/.fr.rm'that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 ownerof 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(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 Ai,-"ity Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti unicip'al Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 . 2§533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this �= permit is issued. Owner or authorized agent: / Date: 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 CON6TRUCTION 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 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 CONSTRUCTION PERMIT APPLICATION �� V0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 • building(a CUPERTINCa cupertino.org ❑NEW CONSTRUCTION ®_**'ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /0 j r 0 q D `�$1��/�,5,O� LAPN�#� L4 / —/ OL /- OWNERNAME PONE E-MAIL j; PHONE E-MAIL. STREET ADDRESS CITY, STATE,ZIP O CONTACT NAME S Le �� PHON�^ -7 9 9 / E-MAIL �i^7 7�N �� � STREET ADDgg��SS /T T CITY,STATE, ZZIlP ��j QF7AX" ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ri LICENSE NUMBER LICENSE TYPE BUS.LIC# r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAM E-MAIL FAX U^-.) ASso /s3-T-5S STREET ADDRESS CITY,STATE,ZIP P ONE ,01n 6© /�C l-9-f�I�7 � cl �� }�57© -.2e 426 DESCRIPTION OF WORK #D h! 77 6?/\-) Oe- A /2 y n �� 5 SZ ,7o 7A,/6_ EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: El 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 [ED BY•. TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,1 certify to each of the following: I am the property owner or autho ed agen to a n roperty owner's behalf. I have read this application and the information I have provided is collect. I have read the Description of Work and verify' accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction.'1 autho e epresentatives of Cupertino to enter the above e--id ntifiyeddproperty for inspection purposes. Signature of Applicant/Agent: Date:— �� SUPPLEMENTAL INFOR TION REQUIRLD PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition pen-nit for ❑ OVEWTHE-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 TANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. El LARGE ❑ EIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc Devised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10402 CHISHOLM AVE DATE: 09/17/2013 REVIEWED BY: MELISSA APN: 326 41 075 BP#: ...JD o -2-0 *VALUATION: 1$130,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1R3SFDADD : USE: OTC. 0 Yes (F)No PERMIT TYPE: WORK ADDITION OF 824 S.F. NEW LIVING SPACE SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-I3,111-B,IV,V-B 824 $2,577.00 IR3PLNCK $1,617.00 1R31NSP TOTALS: 824 $2,577.00 $1,617.00 MECH,HOURLY () Yes +E! No PLUMB,HOURLY ( Yes Q.No ELEC HOURLY Q Yes Q No 7777 Ll I NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on the prethiniina information available and are only an estimate. Contact the De t or addh7 info. FEE ITEMS (Fee Resolution 11-053 Lf: 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. () OT FO.OThrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee,0 Reg. Q OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Q Yes (E) No $0.00 0 Advanced Planning Fee: 1PLLONGR $115.36 Select a Non-Residential Q 1. Building or Structure Stronj;Motion Fee: IBSEISMICR $13.00 Select an Administrative Item Bldp,Stds Commission Fee: 1BCBSC $6.001 1 SUBTOTALS: $4,328.361 $0.00 TOTAL FEE: $4,328.36 Revised: 08/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U PE RTI NO Fax:408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /©4yc)2 dJ4is-h c) ,4 v PERMIT# j OWNER'S NAME: Iq PHONE# il6 -2' 7.-'75.7 GENERAL CONTRACT R: BUSINESS LICENSE# ADDRESS: 2 r raac> CITY/ZIPCODE: T f7 7 -Z.r *Our municipal code requires all businesses working in the ci o have a City of Cupertino business Iicense. NO BUILDING FINAL OR FINAL OCCUPANC,Y,NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB C , RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: /o/ f L. Signature Date Please check applicable subcontr ctors and complete the following 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 Owner/Contractor Signature Date