13090218 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20128 PACIFICA DR CONTRACTOR:POWFUL PERMIT NO: 13090218
CONSTRUCTION
OWNER'S NAME: BOLLINENI NAIDU AND CONDI KAVITHA 1659 E SAN FERNANDO ST DATE ISSUED: 11/08/2013
OWNER'S PHONE: 4083936415 SAN JOSE,CA 95116 PHONE NO:(408)687-7607
s LICENSED CONTRACTOR' DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
ADD 593 SQ FT TO SFDWL,REMODEL(2)BATHROOMS,
License Class Lic.# ._ 173 SQ FT,THROUGH OUT SFDWL 420 SQ
,UPGRADE PANEL TO 200 AMP
Contracto iq s Date
I hereby affirm that 1 am licensed-under the provisions of Chapter 9 1115114-REV#1 -ADD(N)SKYLIGHT IN MASTER BATH,
(commencing with Scetion 7600)o(Division 3 of the Business&ProfessionsRAISE CEILING HEIGHT IN MASTER BEDROOM&
Code and that my license is in Cull force and effect. LIVING ROOM(580 S.F.)-ISSUED 1115114
I hereby affirm under penalty of perjury one of the fallowing two declarations.
I have and will maintain a certificate of consent to self-insure for Worker's e116
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:$80000
I 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.36928022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state tfiat the above information is PERNUT EXPIRES IF WORK IS NOT STARTED
correct,1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY 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 DAY M L LLED 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
granting of this permit. Additionally,the applicant understands and will comply e by: Dake:
with all no - • source regulations per the Cupertiho Municipal Code,Section
9.18.
RE-ROOFS;
Signatu44���.Date lla 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.
F-1OWNER-BUILDERDECLARATION
1 hereby affirm that I am exempt fromthe Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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(Sce.7044,
Business&Professions Code)
1,as owner of the 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 Hcalth&Safety Code,Sections 25505,25533,and 25534. I will
1 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 1 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 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,Sec • 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this e•
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 CONSTRUCTION LENDINQ 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 1 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.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION t 1 5
10300 TORRE AVENUE•CUPERTINO, CA 950143255 .
CUPERTINO (408)777-3228• FAX(408)777-3333• build inafCDcupertino.or4
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I Tl REVISIO EFERRED ORIGINAL PERMIT#
PROIECrADDRESS 7 1APNn
JF�J
OWNER NAME PHONE M E-MAIL
21 •
A 1A
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE Q FrMA]L
yrs
STREETADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ Ow m-EUD.DER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT W_I
CONTRACTORNAME MCENSENUMBER LICENSE TYPE BUS.LTC
COMPANY NAME E-MAIL FAX
STREETADDRESS CrIY,STATE,ZIP , PHONE
ARCHITECTIENGINEERNAME LICENSENUMBER BUS.LIC
44
COMPANY NAME fiMAii FAX
t
STREET AD DR 55 CITY,STATE ZIP PHONE
oILi
DESCRIPTION OF WORK
064.
EXISTING SE I PROPO USE CONSTR TYPE I ft STORIES
USE TYPE OCC. SQ.FT. VALUATION
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETARE4
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREI REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH
❑ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY [:]YES
aEDZGADDED? ONO .ADDITION? [:]No
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES "' """""'
=RECEIVEDBY_-='"'""° " ��'`` TOTAL VALUATION:
PLANNING APPL N ❑NO PLANNING APPROVALI-ETTER 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 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 budding c nstr=b0n. 1 authorize representatives of Cupertino to enter the above-id e fled property for inspection purposes.
�t] r �,yl i
Signature ofApplicant/Agent: �:�� Date: f! 1 -")
SUPPLEMENTAL INFORMATION REQUIRED PLACHECK TYPE
tt __ ROUTING SLIP.'
_New SFD or Multifamily dwellings: Apply for demolition permit for OVriR-TI cot>rTER `' ❑; 1wn niNG Pi nnLiaEw
existing building(s). Demolition pennit is required prior to issuance of building
permit for new building. fli ExexEss:,- i ❑ PIANNurGrtrarrREVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ;_0 STAKDARD ❑ PUBLIC WORKS,form if any Hazardous Materials are being used as part of this project. ° �r=
i 1="LARG>' ❑` FIR) DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior toiAaou` ;❑ sbsiTARx sEq'ERn1sTRICT
submittal of Building Permit application.
0.-EN'VIROIN7 IENTAL HEALTII -
BidgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20128 PACIFICA DR DATE: 01/1512014 REVIEWED BY: MELISSA
APN: 369 28 022 ;BP#: `VALUATION: $0
*PERMIT TYPE: Building Permit. PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE:
WORK REV# 1 ADD N SKYLIGHT'IN MASTER BATH RAISE CEILING HEIGHT IN MASTER BEDROOM
A'
SCOPE. & LIVING ROOM (580'S.F.)
Mech.flan Check Plrunh.Plan Check Elec.Plan Check
,ti11:c11.Permit Fee: Phtmb.Pe,mi1 Fee: F.lec,Perinil Fee:
Other A1ech.Insp. El--I---O;'
her Plumb Insp. Ll 011ier Elee.Insl1, El
Ilech.111sp.Fax Plumb. Insp. Fee: Eler.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These-fees are based on the pielinddha information available and are only an estimate, Contact the De t or addn'l info.
FEE ITEMS( ee Resolution 11-053 E . 7/1%13) FEE QTY/FEE MISC ITEMS
PlanCheck Fde: $0.00 Select a Misc.Bldg/9tructure
Suppl.PC Fee: (D Reg. Q OT 0.0 I hrs $O,Op or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feee Reg. .0 OT 0,0 his $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax. T7
.4.dininistr•ative Fee: 0
Work Without Permit? Yes E) No $0,00 0
Advanced Plannin&Fee: $0.00 Select a Non-Residential G
—10 Travel Documentation Fees: Building or Structure
Strom Motion Fee: $0.00 F 1 # Revisions
Bldg Stds Commission Fee: .$0.00 $834.00 1 fVSFDWL SFDWL
• SUBTOTAL$; $0.00 $834.00 TOTAL FEE: $834.00
Revised: 01/15/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20128 PACIFICA DR CONTRACTOR:POWFUL PERMIT NO. 13090218
CONSTRUCTION
OWNER'S NAME: BOLLINENI NAIDU AND GONDI KAVITHA 1658 E SAN FERNANDO ST DATE ISSUED: 11/0812013
OWNER'S PHONE: 4083936415 SAN JOSE,CA 95116 PHONE NO:(408)687-7607
09 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALEI
License Class ,1] Lic.# ADD 593 SQ FT TO SFDWL,REMODEL(2)BATHROOMS,
173
Contracto .v 4' ''' 4' c�Date ' SQ FT,THROUGH OUT SFDWL 420 SQ,UPGRADE PANEL
I hereby affirm that I am licensed under the provisions of Chapter 9 TO
(commencing with Section 7000)of Division 3 of the Business&Professions 200 AMP
Code and that my license is in full force aud•cffeet.
I hereby affirm under penalty of perjury one of the followiug 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:$80000
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 APN Number:36928022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 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 WITIIIlv 180 ERMIT 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 D ST 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 rr
granting of this permit. Additionally,the applicant understands and will comply sue e:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
5ignatu Date 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.
0 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two rcasous: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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(See.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements uuder 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.I2 and the
declaratious: Health&Safety Code,Section 25532(x)should I store or handle hazardous
1 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 complinuee with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, +c o `25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen :' Datcf ,c 1 ..1t
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l 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,1 CONSTRUCTION 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
forthwitli 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
1 certify that 1 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 Dale
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX(408)777-3333•building cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 2 1 2.CL Dn, t� APN H -3b a P�
OWNER NAME ^ )1� 5-1 1 1j,� (�(�O- L �{ n ]� jp� rJ 1 ��g.4 13.b 4(I S E-MAIL 1.. Vt CLdU& akDD .CDT
STREET ADDRESS 2-d L-c'!`f Pap °C"0 1�1J2 I V + CITY, STATE,ZIP /+ , - e I °'n D r�}'of Jam( FAX
CONTACT NAME 7 1- PHONE J v IKJ E-MAIL
t�6�tFA- r
STREET ADDRESS CITY,STATE ZIP FAX
ln
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 9<1CH rrECP ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC d
COMPANY NAME E-MAIL FAX
STREET ADDRESS CrrY,STATE,ZIP PHONE
ARCH ITEC U NGINEER NAME LICENSE NUMBER BUS.LIC A
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK R
`r
EXISTING USE PROPOSED USE CONSTR,TYPE 6 STORIES
USE TYPE OCC. SQ.FT. VALUATION(5)
EXISTG 6�pp$_ DEMO TOTAL
AREA 'A`RI?' AREA NIT AREA
lII?144715GLREMo + SRti�j�j�' p3t�,a?r}
—.1 !!VV
1. tC=ri 6 eaw
TOTAL DECKtPORCH AREA _ 6''L' ODErACH
Er.ACH
NDWELLING UNIT& IS A SECOND UNIT ❑YES 9ECO1IDSTAY [DYES
aEINGADDEDr NO ADDITION! NO
PRE-APPLICATI i: Y IF YES,PROVIDE COPY OF IS TI[E BLDG AN ❑YES ?RECEIVED BY::`�' ; ; TOTAL VALUATION:
PLANNING APP�IJ []NO PLANNING APPROVAL LITTER EICHLER HOME' ❑NO
By my signature below.I certify to each bf the following: 1 am the property owner or authorized agent to act on the property owner's behalf. i have read this
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 state laws relating to buildin construction. 1 authorize representatives of Cupertino to enter the above-idcntificd property for inspection purposes.
Signature of Applieant/Agent: Date:
SUPPLEMENTAL INFORMATTON REQUIRED
e _PLAN �r C-TYPE ROUTING SLIP,_
_New SFD or Multifamily dwellings: Apply for demolition permit for
I❑:c ER-TETE-COUNTER ' .BUILDING P LAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building =' -
permit for new building.
EXPRESS' ING�PLAN REVIEW.'
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD °+ ` P Icvvoxxs
form if any Hazardous Materials are being used as part of this project.
13 LARGE; rFI DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to alAaoii, SANITARY SEwES2DTST13IGT
submittal of Building Permit application.
F
r. .ENVIRONMF,NTAL IIEALTt[
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20128 pacifica dr DATE: 09/30/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$80,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? 0 Yes GG No PENTAMATION 1 R3SFDADD
USE: OTC. 0 Yes (F)No PERMIT TYPE:
WORK add 593 sq ft to sfdwl remodel 2 bathr000ms 173 s ftand through out sfdwl 420 sg ftupgrade
SCOPE panel to 200 amp
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) 11-B,111-B,IV,V-B 5931R3PLNCK $1,617.00 IR3INSP
TOTALS: 593 $2,577.00 $1,617.00
MECH,HOURLY 0 Yes G No PLUMB,'HOURLY Yes (!) 'No- > LEC,HOURLY 0 Yes Q'No
Me&Plan Check 111mirb, Plu+r C110c6- Elec.Plan Check 0.0 hrs $0.00
fblech.Pc>rsrr1'ree: Plumb..Permil Fee: Flee.Permit Fee: IEPERMIT
Oher Much.Insp. Other Plumb 1nsp, Other Flee.Insp. 0.0 hr�$47.00
.14ech.hup.Fec: Plumb. hrslz Fee: Vec.Imp,Fee:
NOTE:This estimate does not include fees due to other Departments(i.P_Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Tee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,577.00 =1 s.f. Remodel,Bath(<=300 sf)
Suppl.PC Fee: Q Reg. 0 OT 0.0 I hrs $0.00 $626.00 IREMRESBAT
PME Plan Check: $0.00 F-2-007 amps Electrical
Permit Fee: $1,617.00 $47.00 IBELEC200 Services
Suppl. Insp.Fee Q Reg. 0 OT 0.0 hrs $0.00 420 Js.f. Remodel,Other
PME Unit Fee: $0.00 $488.00 IREAflZESOTH
PME Permit Fee: $47.00
Cons,Imction Tax:
Adininistrative Fee: 0
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: IPLLONGR $83.02 Select a Non-Residential G
Travel Documentation Fee: ITRRYDOC $47.00 Building or Structure 0
Strong Motion Fee: IBSEISAHCR $8.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $4,383.021$1,161.00 , TOTAL FEE:. n 2
Revised: 08101/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408.777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 5 0 C PERMIT# OS 0721
OWNER'S NAME: rQPHONE#/ mB' -7907
GENERAL CONTRACTOR: mc.J v G for? BUSINESS LICENSE#
ADDRESS:jd CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors V)
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation 1V 47
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