13120121-EXPIREDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10080 CARMEN RD I CONTRACTOR: PARIKH BUILDERS, INC PERMIT NO: 13120121
OWNER'S NAME: KAMDAR JAY AND HEMA J TRUSTEE 22092 SAN FERNANDO CT I DATE ISSUED: 01/27/2014
OWNER'S PHONE: 4083753676
❑ LICENSED CONTRACTOR'S DECLARATION
License Class_ Lic. # 910 69 (,
Contractor perc i Qr " k.1 PA L � ►. c . Date • 2 i - 1 �{
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.
�— Date 7 -
❑ 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.
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
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
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,
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.
Signature Date
CUPERTINO, CA 95014
PHONE NO: (408) 219-8984
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
CONSTRUCT SITE RETAINING WALL (4 FT IN HGT AND
130
FT IN LENGTH).
Sq. Ft Floor Area: Valuation: $13000
APN Number: 35709060.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WIT 180 DA T ISSUANCE OR
180 YS FR AST CA ED INSPECTION.
Issued by: Date: /' 271G
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 Applicant: 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 25505, 25533, and 25534.
Owner or authorized agent: Dater
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION v\
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C
(408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org
NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS /V o
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OWNER NAME� K 0, PHONE E -M4
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNTERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑( ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ✓7
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LICENSE NUMBER
F7777 E
BUS. LIC R
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER ` /-� `
BUS. LIC # /
COMPANY NAME
E-MAIL // _ (111101�6� v5 Q �� �
FAX
STREET ADDRESS Or -!I" e
CITY, STATE, ZIP
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DESCRIPTION OF WORK
e:�2d
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# 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
s DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BELNGADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNLNGAPPLS ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLERHOME? ❑NO
RECEIVED
TOTAL VALUATION:
/ vo.
By my signature below, I certify to each of the following: I am the property owner or autborize a_ party owner's behalf. I have read this
application and the information I have provided is correct. -I have read the Description of \NI kand verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' constructio I autho ' presentatives ofCup ino to enter the above -Identified property for inspection purposes.
Signature of Applicant/Agent: Date: �V
SUPPLEMENTAL FO ATI RE UIRED
PLAN CHECK TYPE
ROUTING site
❑ OVER-THE-COUNTER
❑ BUILDINGPL4N REN7Ew
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
❑ PLA.1\ING'PLAN REVIEW'
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STAND -ARD
❑ rLBLIC'NV,6RKS "
form if any Hazardous Materials are being used as part of this project.
❑ LYIzcE i.
❑FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
V
p nrAloR
❑ saxrrARY sEmVERDisTRICT,
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
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 addn'l info.
FEE ITEMS (Fee Resolution 11-053 E, . 7'1/131
ADDRESS:
DATE:
REVIEWED BY: bobs.
Plan Check Fee: Hourly Only? (F) Yes 0 No
APN:
BP#: p?
"VALUATION:
Iso
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
$0.00
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
Construct new 130' lineal feet retaining wall
SCOPE
0.0
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 addn'l info.
FEE ITEMS (Fee Resolution 11-053 E, . 7'1/131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? (F) Yes 0 No
$0.00
hours Plan Check, Hourly
$278.00 /STPLNCK
Suppl. PC Fee: 0 Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
130 1.£ Fence
$973.00 1FENCEMAS> Fence, Masonry >6'
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
rsrr°t��°rsr�ir lay _TT
0
E)
Work Without Permit? O Yes 0 No
$0.00
._advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
Strong Motion Fee:
$0.00
Select an Administrative Item
BI& Stds Collmlissio(l i'e�::
$0.00
SUBTOTALS: 1
$0.001$1,251.00
TOTAL FEE:
$1,251.00
Revised: 10/01/2013