B-2017-1927 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1927
10412 LAS ONDAS WAY CUPERTINO,CA 95014-3130(369 28 033) CALIFORNIA HOME
BUILDERS&DESIGN
INC
SAN JOSE,CA 95112
OWNER'S NAME: RAGHAVAN VIJAY AND RADHIKA TRUSTEE DATE ISSUED: 11/08/2017
OWNER'S PHONE:408-425-7344 PHONE NO:(408)392-8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
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License Class B Lic.#882158
Contractor CALIFORNIA HOME BUILDERS&DESIGN INC Date 08/31/2018 X BLDG X 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:
(N)TEMPORARY POWER POLE(100 AMPS) •
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have an will maintain a certificate of consent to self-insure for Worker's
Co ens ti n,as provided for by Section 3700 of the Labor Code,for the
. .er r a e f the work for which this permit is issued. •
h e and w Il maintain Worker's Compensation Insurance,as provided for by
ec n 370 of the Labor Code,for the performance of the work for which this
l permit is issued. Sq.Ft Floor Area: Valuation:$100.06
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 369 28 033
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,jus,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in1..corfseq -hce of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the.applicant uniierstan..and w: comply with all non-point
source regulations e Cupe� . nnrcr.:. .rade,Section 9.18. 180 DAYS FROM LAST CALLEDIINSPECTION.
,pt 'r.nat -' Date 11/8/2017 Issued by:Abby Ayende
• Date: 11/08/2017
• a ► R-BI D R D _ IL •
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
•t. 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)
i. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
' •contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11/8/2017 • •
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I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
j ;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
.• '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 liazardous
• shall not employ any person in any manner so as to become subject to the
material. Additionally,should I use equipment or devices li emit hazardous
air contaminants as defined by the Bay Area r it Qua M� ,:e , nt District I
''Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino icipal Cod:,, 1,i,-.1p er 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safet -od Sections-25- i, ,• ; 53 .
''Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ®, caner or authorized agent:--------7).--
1k1 R (, )
APPLICANT CERTIFICATION= Date: 11/8/2017
I certify•that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 9.1'8. I understand my plans shall be used as public records.
Licensed
Signature Date 11/8/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO CA 95014-3255
4z.}'s (408) 777-3228 • build (c'
.in CLI eLtino.org PEMIT#B- � `��
CUPERTINO REV S DEFE
• ❑ NEW CONSTRUCTION%ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS I l 7— t✓U S do O c 9\-(1 APN A • N-Oa"
OWNER NAME \�r \\� r (�jL/Le PHOONNE (j E-MAIL `' 1
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STREET ADDRESS ✓✓ CITY, STATE,ZIP [ J ✓
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CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
CaG 110 Q1;I4 0 g--t 5 (3
ISTREETtADDRE •A- A CrrY,STATE, ZIP / Ql `�`� I
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•0 ARCHITECT 0 OWNER.0 OWNER AGENT,ECONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME +� II .. (� I E-MAIL
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STREET ADDRESSCITY,STATE,ZIP PHONE
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DECRIPTON
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INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF- SF SF ❑DETACHED
EXISTNG DYES EICHLER 0 YES SECOND STORY ADDITION DYES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER //��
UNITS# UNIT ADDITON: 0 NO S F e7 R //p(e.
POOLS 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED U -
POOL-SF SPA-SF I SPAATTACHED ❑YES ❑ NO I TOTAL-SF
RECE VED BY: ITO AL VALUATION:
Comnirrci»r orMuni-FamilyBuildings with Public SW 1))1111/7/C,Pools remiires Department o(Enuirmnoie»Inl Hoath anuro nlalAtio
(V7i,
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RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGL S 0 LE THER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 0 1" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
El F OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:,❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF «of SQUARES
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 cor - I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state la e ati.• to building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection • ..ses. I ac.. • •••end authorize all information contained on this application form
to be made available for public record. ���� 1
Signature of Applicant/Agent: _ Date: I 1 ififel°SUPPLEMENTAL INFORMATION Es a-E,
*New SFD/Second Dwelling Units/M' tifamily Dwelling • • Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
"HOA-Provide a letter of approval from the Home Owner's Association
,
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BldgApp_2017.doc revised 08/0//17