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14110014AN CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20984 ALVES DR CONTRACTOR: ALI'S CONSTRUCTION & PERMIT NO: 14110014 REMODELING OWNER'S NAME: GAMPALA RAVIKUMAR S AND CHITTAJALLU 1011 S DE ANZA BLVD DATE ISSUED: 03/25/2015 OWNER'S PHONE: 4084800602 SAN JOSE, CA 95129 PHONE NO: (408) 898-6474 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] ❑ LICENSED CONTRACTOR'S DECLARATION CONSTRUCT 2 STORY SFDWL 1ST FLOOR; 2308 SQ FT, u License Class Lic. # 90-q _ 1 3 3 2ND _ _ FLOOR 1972 SQ FT, BASEMENT 1458 SQ FT W/ ATTACHED Contractor i�//4 .7_5t^0Y15YIA�I(hYI DateO�/ �/ �� _ GARAGE 688 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. Sq. Ft Floor Area: Valuation: $900000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32631004.00 Occupancy Type: 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 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 F LAST CALLED 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 Issued by: Date: ✓ 211�—/ S 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. Signature Date ©3 ZF/ l� All roofs shall be inspected prior to anroofing material being installed. If a roof is Pe P RE-ROOFS:mg 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) 1, 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 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: 031-2-511F 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 CONSTRUCTION LENDING AGENCY 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION V t 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 �� (408) 777-3228 • FAX ('408) 777-3333 • building ftypertino.org 1 F-1 AnnITInN I -I Ar TPR ATInN / TI n REVISION /DEFERRED ORIGINAL PERMIT # u- -------- PROJECT ADDRESS 11 h(� OO ! /1 lVC5 /� 1L�Da�Y/l I / ) 7.1N fr 32Le� I CD4- 0)' OWNERNAME G/�VVQ PHONE q&J qto 06 , D/'U_nl I� n ,, E-MAIL YI A��6 0�(�i ►n(Al �• W/VL STREET ADDRESS /1/➢q g %�,��'Lp s �'r 1!i /�' CITY, STATE, ZIP e.,,Llm 09 I FAX CONTACT NAME ��i InQnt PHONE 1J00 V <3 61174 Dc E-MAIL STREET ADDRESS I�yr(J�C: C Yl� /],I,I �LV fl /' CITY, STATE, ZIP _m ' /�✓1 , q �I ZG1 CARCHITECT FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACT/OR AGENT ❑ ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /1 U � C," f IA(,�- 0 ,4 LICENSE NUMBER C40c(LJ 33 LICENSETTYPE BUS. LIC # COMPANY NAME /!U 9f l�%`nf J' Lit ID 97 �! rsr/I6Q<LQi('n E-MAIL /�l1S�C0`11STIJU _+1a A ZyQhOD•C4AA_ FAX STREET ADDRESS (o I 5 oe A->1za (1j� �+ ✓, CITY, STATE, ZIP *�,� �(jS2 > CA ' -15)2-( PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j 7aml'/` ' Vf / n®t I - hwe, EXISTING USE �� - _�_ r /1 1'�QIQJL P POSEq USE, / CONSTR fW ►^e,.' `�t'�F-iJ. TYPE /.`�M�^�4 #STORIES 3 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR Aft�f� 1) DEMO AREA TOTAL NET AREA qZ7. - I 2-3aBATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA 2Vl 4 PORCH AREA DECK AREA I TOTAL DECKIPORCH ARE I GARAGE AREA: ODETACH ❑ATTACH # DWELLING UNITS: IS A SECOND UNIT © YES BEING ADDED? ❑ NO SECOND STORY ❑ YES ADDITION? ❑ NO k PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ONO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY: TOTAL, VALIDATION: v/I•'/V'� 11/`-� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on t e property owner's behalf. I have read this application and the information I have rovided 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 Iding struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: - Date: to I39 SUPPLEMENTAL INFORMATION REQUIRED _ 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. _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureSTANDARD form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ LARGE ElMAJOR DING PLAN REVIEW PLANNING PLAN REVIEW UBLIC WORKS �SANITARYSEWERDISTRRA ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION iAADDRESS: 20984 alves dr DATE: 11/03/2014 REVIEWED BY: Mendez PC FEE ID APN: BP#: �d� *VALUATION: $900,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes • No PENTAMATION PERMIT TYPE: 1 R3SFD WORK construct 3 story sfdwl 1 st floor 2308 sq ft 2nd floor 1972 sq ft basement 1458 sq ft w/ attached SCOPE I garage 688. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 6,427 $3,698.65 IR3PLNCK $5,010.10 1R3IN.SP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,010.10 Suppl. Insp. Fee -0 Reg. () 01 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 6,427 $3,698.65 $5,010.10 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etch These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1,13) F-1 I 1'lxrrrtl7. Moo ('!r E]_L_ Man (:heck F1<", Permit F",,. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etch These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,698.65 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,010.10 Suppl. Insp. Fee -0 Reg. () 01 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR # new nits u $667.73 tt;°' 1" 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: 1PLLONGR $899.78 Select a Non -Residential Building or Structure 0 0 i Wfi ri FCC's Strong Motion Fee: IBSEISMICR $117.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $36.00 SUBTOTALS: P10,429.26 $0.00 TOTAL FEE: I $10,429.26 Revised: 10/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14110014 20984 ALVES DR CUPERTINO CA 95014 (326 31 004) 1011 DE ANZA BLVD SAN JOSE, CA 95129 OWNER'S NAME: GAMPALA RAVIKUMAR S AND CHITTAJALLU DATE ISSUED: 03/25/2015 OWNER'S PHONE: PHONE NO: 408-4124309 LICENSED CONTRACTOR'S DECLARRATION BUILDING PERMIT INFO: License Class 11 Lic. #909433 BLDG ELECT PLUMB Contractor Date 07/31/2016 — _ _ COMMERCIAL MECH RESIDENTIAL 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. JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL 1 ST FLOOR; 2308 SQ FT, 2ND I hereby affirm under penalty of perjury one of the following two declarations: FLOOR 1972 SQ FT, BASEMENT 1458 SQ FT W/ ATTACHED t. I have and will maintain a certificate of consent to self -insure for Worker's GARAGE 688 Compensation, as provided for by Section 3700 of the Labor Code, for the REV#1 -ADD FIRE PLACE- ISSUED 5/31/2016 N ,Z performance of the work for which this permit is issued. 2. 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 Sq. Ft Floor Area: Valuation: $900000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 31 004 3 26 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations p upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/31/2016 Issued by: Legge ��Qp nn,,,, ,ll� Date: n9�v45 5 17J ��p lA. N ` 4tk�"� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF. -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/31/2016 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. 3. 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 material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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, tiqps 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 5/31/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance 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 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 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 5/31/2016 Professional �St.fys� CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408))777-3228 • FAX (408) 777-3333 • build ing(cDcupertino.org rTO N I 1' 1 I AT)T)TTTON F-1 I AT TFR ATTCTN / TT I]ll RF/ VTCT(1N / T)FFFRRFT) IU it WN PBL) --)j I ()R TC:TN A T . PF.R MTT it PROJECT ADDRESS /A +Q ,t\('je_!�> fy VI OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMEA I I Z /I ,�/1 ck� PHO, ,.y�l �Q Q !/ I E-MA&I `Q /J/T� ��n • _� STREET ADDRESS) CITY, STATE, ZIP $ F I ogqo 13 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA ` ) LICENSE NUMBS LICENSE TYPE BUS. LIC # ! � W COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP � PHONE DESCRIPTION OF WORKA4` G'd. - ,IA /,(do�Jy EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.ET. vpLCA"TION IS! 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 # DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY OYES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # ❑ 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 the prbperty ow er's behalf. I have read this application and the information I have d 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 I= relating to " d' g c nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature Applicant/Agent: Date: of SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER El 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 EJSTANDARD ElPUBLIC NN ORKS 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 ❑. DIAJOR 1:1SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_20.11.doc revised 06/21/11 /� CUPERTINO PURPOSE UTILITY RELEASE REQUEST 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 • building .cupertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cupertino.org/index.aspx?page-297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildingAcupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN BLDG PERMIT #: ' _ 1 i co / DATE: 12 1_3120( , SITE ADDRESS: Z(J �/ T 1 L �� S �L v U I 1� I/ (� �� _ o OWNER'S NAME: r S R N t9, t. , O t\f , PHONE #: FAX #: � t �.�' 0 — 06 O "Z MAILING ADDRESS (if different rom site address): 3 L7 CONTRACTOR: 'l 7iaiNti {1 PHONE #: .Gf b �� 8cl 8.6 /J FAX #: CONTACT:_ 4 \7\.S / l �i� C l 1 1 l At t L V PHONE #: FAX #: O\s I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner:1--\1......................................................Print:..-s.is1. i ...��.i�..1....(. ._L .%.L.l)..Date:........... .U.ILL.l Contractor:... j4.�..........................................Print:..........A..\.t......�h.kgA%................... Date: ... t.-�d3/16........ UtilityReleaseForm_2011.doc revised 08/09/11