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13120172 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20211 SUISUN DR CONTRACTOR:SUNSATIONAL PERMIT NO: 13120172 SUNROOM OWNER'S NAME: JUMANA&ZOAIB RANGWALA 1825 MAPLEGROVE LN DATE ISSUED: 12/19/2013 OWNER'S PHON-E: 5106681817 TRACY,CA 95376 PHONE NO:(408)4394514 11 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ CONSTRUCT PATIO ENCLOSURE 132 SQ FT License Class_ Lic.# ?��I�f1 Contractor_'�2,1:c Jf),,2!/` MQ,411)ate/,,A-CB^bP.-- -ral � 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. 1 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:$9500 yS�eve and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this r permit is issued. APN Number:36928015.00 Occupancy Type: 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 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 FROM 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 / granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature b, Date3 All roofs shall be inspected prior to any roofing material being installed. If a roof is j' installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 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) I,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 of the 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 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 1 performance of the work for which this permit is issued. will maintain compliance with the upertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti s 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorizeD eg�, permit is issued. d Date:/ID agent: 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,] 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the l 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•build ingacupertino.orq 0 ❑NEW CONSTRUCTION 0 ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# OWNERNAME /} - /I _h V PHONE 5/D � �, /� &MAIL STREET ADDRESS l V CITY, ST TE,ZIP FAX CONTACT NAME 5 PHONE E-MAIL 3/ 7� co STREET ADDRESS CITY,STATE,ZIP FAX l� J ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT dcONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER 3 .y-6 LICENSE TgE BUS.LIC N COMPANYNAME _ E-MAIL FAX G d STREET ADDRESS CITY,STATE,ZIP PHONE _ ARCHITECT/ENGINEER NAME FLICENSE NUMBER BUS.LIC# COMPANY NAME 10,2 / &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE +16 ae DESCRIPTION OF WORK 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 =DECKIPORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTA,LyVALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO vJ S L) 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 informationI 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 to uilding construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/AgenC Date: SUPPLEMENTAL ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for -.[fi OVER-THE-COUNTER NG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of build' g permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 ❑ "OR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HF,ALTH BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 20211 suisun dr DATE: 12/19/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$9,500 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1R3SFDADD USE: I I PERMIT TYPE: wORK construct patio enclosure 132 sq ft SCOPE M,, Plan Check Phrmh. I'I a t_'hcch 1/cc. Plan Check ,tech.Permit Fee Plumb. Permit Fee: Elec. Permit lige: Other tbfec•h.Insp. Ocher Plumb Imp. Other Bee.Insp. 9lech.Imp, Fee: I'hamh. Ina p.Fee'. Elec.Imp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate, Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 327 s.f. Patio Cover/Sun Room Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 $834.00 IPATIOENCM Metal, Enclosed PME Plan Check: $0.00 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 Construction Tar: Admitri:strative.Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Ttwwl Documentation Fees: Building or Structure i Strong Motion Fee: IBSEISMCR $0.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.95 $834.00 TOTAL FEE: 1 $835.95 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: y�Jk.t �2 PERMIT# �J '2.CJ I _72— OWNER'S 7Z,OWNER'S NAME: PHONE # GENERAL CONTRACTOR:— Sj/?!jc,t BUSINESS LICENSE# ADDRESS: 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors Signat e-� Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation 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