B-2017-1270 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1270
11430 CHARSAN LN CUPERTINO,CA 95014-4974(362 10 061) FUTURE VISION
REMODELING INC
VAN NUYS,CA 91406
OWNER'S NAME: PARASURAM YEGNASHANKAR AND RAMYAY DATE ISSUED: 10/24/2017
OWNER'S PHONE:650-743-2672 PHONE NO:(800)485-4919
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class B Lic.#991840
•
Contractor FUTURE VISION REMODELING INC Date 04/30/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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:
2ND FLOOR ADDITION-CANOPY(307 SF)WITH LOCAL SEISMIC
I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE AND NEW TRANSOM WINDOW AT FRONT DOOR.
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
•x
r� 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
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 10 061
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 accrueiagainst 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 •
sour, ,regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Date 10/24/2017 Issued b :
Sign. e / ss Abby y Ayende
Date: 10/24/2017
OWNER-BUILILER DELL ' ON
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons:, All roofs shall be inspected prior to any roofing material being installed.If a roof is
a. 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: 10/24/2017
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
permit is issued.. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
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
shall notemploy any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
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
•exeihptioh,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. •,,. or authize agent:
APPLICANT CERTIFICATION ate: •24
I certify that I have read this application and state that the above information is CONSTRUCTION LENDI NCY
correct.I agree,to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
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
Code,Section:9.18. , I understand my plans shall be used as public records.
Licensed
Signature Date 10/24/2017 Professional
\ / CONSTRUCTION PE-RM[l tePLICATION
,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
/4,,„-c./94...„
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(44+08)777-3333•bulldin cu rtino.or rye t 1�1r"O
❑NEW CONSTRUCTION Pi.ADDITION 'EJrALTERAT R''/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
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DESCRIPTION OF WORK
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,EXISTING USE: , 1 PROPOSED USE CONSTR.TYPE i STORIES
i:: ? USE TYPE OCC. . SQ.FT. VALUATION($)
I
EXISTO NEW FLOOR' ; DEMO TOTAL - ,
AREA.' ;I I AREA , AREA NET AREA
BATHROOM KITCHEN OTHER
IREMODELAREA REMODEL AREA REMODEL AREA
1 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: {]DETACH
+i fI. I Li ATTACH
it DWELLING UNITS: , IS A SECOND UNIT ❑YES SECOND STORY ❑YES - '
',i , ' BEINGADDED? ONO ADDITION? ONO
PRE-APPLICATION DYES W YES PROVIDE COPY OF IS THE BLDG AN 0 YES RE d+ED yt...,.., ;..: •r 1 O .1 V III,,,���JJJATION:
PL'ANNINGAPPLS ONO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO - -',y -' _ •. I 00 Q
i By my signature below,I certify to each of the following: 1 tun the property owner or authorized agent to act on the property owner's behalf. I have mead this
appLcation and the information I have provided is correct. I have readJbe-Dcserig•ion of Work and verify it is accurate. I agree to comply with all applicable local
orduiainces and state laws relating to building co ..traE[bn, .auttrofize representat•v_es of Cupertino to enter the above-identifi l property for inspection proposes.
•Signature of Applicant/Agent; 1 � Date log,/p J 9
SUPPLEMENTAL INFOvIATION REQUIRE'�$' '' _pypr.Q;EEK TYPE = tOLITING`SLIP
New SPD tihlyIultifamilyldwellings: Apply for demolition permit for
-;�.OvER-THE-COLR'litX-•':-"•'„ c1 BIrOliNGPLA}�'REVIEIY
. I existing buildmg(s). Demolition ptrmit is required prior to issuance of building :if.:.;:_:,•154:`=: ;
permit for new building. -•q''EXPRESS.I .'Q•PLANNING:PLAN REVIEW.:•'
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -I0-_:STANDARD' `• :;' :` ;:C1•.PUBLJC'c ORXcs
form if any Hazardous Materials are being used as part of this project, -0.-..-I. :..; :
} LARD$ _;1.``c,,-�:ti:=- _ _:0 t,FIRE;DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ••.i s :
submittal of Building Permit application. .(-,;37,'MAJOR : ;,}:. ❑ SANITARY SEWER.DISTRICx
I. �;•,:... • .'CI:-EN``VIRON'NLENTAL:HEALTIi''°'''
BldgApp_2011.doc revised 06/21/11