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13030013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10553 FARALLONE DR CONTRACTOR:PETER CONSTRUCTION PERMIT NO: 13030013 OWNER'S NAME: JAYESH&KOMAL BHATT 5925 TOMPKINS DR DATE ISSUED:05/162013 OWNER'S PHONE: 4082509387 SAN JOSE,CA 95129 PHONE NO:(408)529-6412 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL C1 COMNIERCIALD License Class 13 Lic.# Pj `] go CONSTRUCT A 444 SQ FT ADDITION AND 45 SQ FT FRONT Contractor C vate PORCH TO(E)2 STORY RESIDENCE. I hereby a rrm that 1 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 cull force and effect. I hereby affirm under penalty of perjury one ofthe 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 ofthe work for which this permit is issued. Sq.Ft Floor Area: Valuation:$60000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this APN Number:36939034,00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 180 DA F M 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 l granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source re ulations er the Cupertino Municipal Code,Section 9.18, 1/ RE-ROOFS: Signature Date `f U r� 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Dale: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner ofthe property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(See.7044, Business&Professions Code) 1,as owner ofthe property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(See.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 or the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Sarety 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 definer)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 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 u 25534. Section 3700 ofthe Labor Code,for the performance ofthe work for which this �G J Owner or authorized agent: Date: permit is issued. I certify that in the performance ofthe 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 ofcxemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions ofthe 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(See.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 ofthe I understand my plans shall be used as public records. granting ofthis 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10553 FARALLONE DR CONTRACTOR:PETER CONSTRUCTION PERMIT NO: 13030013 OWNER'S NAME: JAYESH&KOMAL BHATT 5925 TOMPKINS DR DATE ISSUED:05/16/2013 OWNER'S PHONE: 4082509387 SAN JOSE,CA 95129 PHONE NO:(408)529-6412 LICENSED CONTRACTOR'S DECLARATION SOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] ' X711—F s 7 CONSTRUCT A 444 S FT ADDITION AND 45 S FT Li rise Class Lic.f1 Q Q FRONT Contractor Date.-Z.!��G PORCH TO(E)2 STORY RESIDENCE. I hereby affir hat I am licens d under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions REVISION##I-REVISE BATHROOM LAYOUT-ISSD OTC Code and that my license is in full force and effect. 1/28/2014 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 Arca: Valuation:$60000 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 1 APN tuber:36939034.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION a� I certify that I have read this application and state that the above ��tlon is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinan E to laws re[ 'ng WITHIN 18U DA PERMIT ISSUANCE OR to building construction,and hereby authorize representati of cit - liter upon the above mentioned property for inspection purposes. ree to save 180 DAYS F LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against]i tGties,judgments, costs,and expenses which may accrue against said City in consequence of the granting ofthis permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations the Cupertino Municipal Code,Section 9.18, r RE-ROOFS: I halur Date �'2. r/ All roofs shall be inspected prior to any roofing material being installed.If a roof is Y installed without first obtaining an inspection,I agree to remove all new materials for inspection. 13OWNER-[BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following live reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner ofthe property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(See.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). 1 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 ofthe 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 1 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 Mauagement District I performance of Elie 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 25505,25. 3,and 25534. Section 3700 ofthe Labor Code,for the performance ofthe work for which this A�4 permit is issued. �lvlier or'buthitrtzetll 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 Califomia. If,after making this certificate of exemption,1 CONSICTION[,ENDING 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(See.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ofthis 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 ofthis 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 /j5 10300 TORRE AVENUE-CUPERTINO.CA 95014-3255 CUP&R 10. (408)777-3228•FAX(408)777-3333•buildingftupertino.Orp �/L ❑NEW CONSTRUCTION [:] ADDITION ElALTERATION/TI El REVISION/DEFERRED (ORIGINAL PERma a p1�7U'ADDRESS � ) APN1 ZI - . �l OWNERNAhtB� L {� r� !09!;&M. X le �'' � � . nDHkEs F .?r a l h m S-D 1 FAX 059 fe , ILC S..yTRMADDRESS CITY,STATE,ZIP I OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT ROWy LIk.9T 7 LICENSE TYPE BUS.LIC N COMPANY NAME E-MAIL FAX �'�- R C n9 6 . co STREETADDRFS.S 1 �SIATE zip - r PHONE 7 ARCHirECfIENG WEER NAME LICENSE NUMBER S BUS.LIC it COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,IIP PHONE tl)I�.Og O F7 V 'U i2pe-in 23DO M ,1P R F �3 e EXISTING USE PROPOSED USE CONSTR TYPE /STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTO NEW FIGO DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KrC OTHER REMODELAREA REMODELAREA REMODELAREA POR AREA DECKAREA TOTALDECX(FORCHAREA OARAGERW DETACH 5 ATTACH b DWELLING UNITS: IS A SECOND UNTT E)YES SECOND STORY (]YES BEINGADBED7 ONO ADEIrrIONl ONO PRE APPLICATION ❑YES IP YES.PROVIDE COPY OF IS THEBLDG AN OYES RECEIVED BY: TAI Y 1LUA'R0 PLANNINOAPPLN ONO PLANNING APPROVAL LETTER EICHLERI[OMET 0 N ` a 00 vco o f\ By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's beha . I have read Ibis application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and statoaw.ST I ting to build' c ction authorize representatives of Cupertino to enter the above-identified property for inspection purposes. at-re pptieantM Illiite .3 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TH&COUNTER ❑ BUILDING PIAN RLMEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPRFss ❑ PLANNING PIAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBucwORKS To—an 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 submittal Of Building Permit application. C1 MAJOR 13 SANrfARYSEwERDISTRICT ❑ RNVIRONbtENTALHF.ALTN BldgApp 1011-doc revised 06121111 CONSTRUCTION PERMIT APPLICA'T'ION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building0cupertino.org CUPERTINO I - ❑NEW CONSTRUCTION CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT if Jqi& E 5 r APN A gl 97 _ T PHONE E-MAIL STREET ADDRESS CRY,STATE,ZIP FAX CONTACT NAME PHONE EMAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNN�F3SR 1r�3y OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11commCrORAGENT ❑ ARCHITECT IJ ENGINEER 11 DEVELOPER 11 TENANT C4N7ILSCtUR9AME� C r+ LICENSENUMH¢R LICENSE TYPE BUS.LIC N moo;, �jti COMPANY NAME &MAIL FAX STELE ET ADDRESS CITY,STATI;ZIP PHONE ARCHfrECTlENGINE£RNRME LICENSE NUMBER BUS.LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE .09O 01 DSS@IjITIS�h 01?WORK V J 'imylV 42 �I P Id IMSTING USE PROPOSED USE CONSTR TYPE I STORIES USE TYPE OCC, SQ.FT. VALUATION(S) E ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORC11 AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH O DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY YES HEINGADDED? ❑NO ADDMON? [:]NO PRE-APPLICATION DYES EF YES.PROVIDE COPY OF ISTIIEBLDGAN [I YES -RECEIVED 4OTd VALUA O PLANNING A13PL 0 ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO - . T iF By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro erty owner's behalf. 1 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 buildin c tru ti n. I authorize representatives of Cupe to t cute he above-identit%ed property for inspection purposes. SignetureofApplicantlAgent.�. �. o o -"�''` DateMp�� WQW`b" SUPPLEMENTAL INFORMATION REQUIRED cllEcx TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TTI&COUNTER ❑ BUILUINC PLANREVIE{V existing building(s). Demolition permit is required pri0•r to issuance of building/ permit for new building. ❑,EXPRESS El'.PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 •STANDARD' "xPUBLICNVORKS form if any Hazardous Materials are being used as part of this project. ❑,FLARE; ,. I ❑pFrrtEnErr _Copy of Planning Approval Letter or Meeting with.Plaming prior to ;❑ NUJOR, ElSANITARY SEtiVER DISTR[GT submittal of Building Permit application. - - E]:ENVIRONMENTALIrEALTn. BldgApp 2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10553 faralIone dr DATE: 03/0412013 REVIEWED BY: mendez APN: BP#: 3 'VALUATION: $60,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No PENTAMATION SFD or Duplex OTC? O Yes 1 R3SFDADD USE: O No PERMIT TYPE: WORK add 444 sq ft toe 2 story sfdwl added to living rm create an open roam 1 bedrm 1 full bath and E4]5 SCOPE I sq ft to front porch OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 489 yl6j17D IADDPLCK $1,230.00 1ADDINSP TOTALS: 489 1 $1,512.00 $1,230.00 MECH,HOURLY O Yes G No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Mech.Plan Check Plumb.Plun Cheek Elec.Plan Check Af4clr. Perwit Fee: Plumb,Permit Fee: lilec.Permu Fee: Other,Llech. Insp.' Other Plumb Insp. Other Elce.Insp. Li Mech.hasp.Fee.• Plumb. fuse.Fee: Flee.Insp.Fee: NOTE:This estimate does trot include fees drre to other Departments(Le.Planning,Public;Forks,Fire,Sanitary Sewer District,School District,eta). Tlrese ees are based on the prefintina information available and are onl an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eli`' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,512.00 Select a Misc BIdglStructure Suppl. PC Fee: Q Reg. Q OT Fo.0 hrs $0.00 or Element of a Building PME Plan Check: $0,00 Permit Fee: $1,230.00 Suppl. Insp. Fee:Q Reg. Q OT 1 O.Q 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tqx: T-1 Adininistrative Fee: Work Without Permit? O Yes (F) No $0.00 Advanced Plannigg Fee: IPLLONGR $63.57 Select a Non-Residential Travel Documentation Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $3.001 1 SUBTOTALS: $2,814.571 $0.00 TOTAL FEE: 88It4*5;7� Revised: 0110112013