B-2017-2071 • CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2071
1389 POPPY WAY CUPERTINO,CA 95014-5304(366 18 031) ALI'S CONSTRUCTION
&REMODELING INC
SAN JOSE,CA 95129
OWNER'S NAME: CHERUKUTHOTA CHANDRASEKHAR AND MANJULA . DATE ISSUED:12/04/2017
OWNER'S PHONE:415-694-9785 PHONE NO:(408)441-0967
LICENSED CONTRACTORS DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#909433
Contractor': ' • S :UC O► : : .u•I ► ► Date 01/31/2018 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:
KITCHEN REMODEL(250 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
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
3e'ormance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
4 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$15000.00
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 366 18 031
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 accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant nderstands and will comply with all non-point
source regulations per a Cupertino MunicipalCode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ,
S"g re � � ` / Date 12/4/2017 Issued by:,Abby Ayende
Date: 12/04/2017
� ./► : 1 1_ . I . .._ l1►
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFSt
following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is
1. 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:12/4/2017
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 not employ 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 Cupe o Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sed'ons 25505,2553 0.rid 255 4.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. er or authorized agent:./' i - '
APPLICANT CERTIFICAT ON IDate:12/4/2017
I certify that I have read this application and state that the above information is CO _Y
S _'UC O •VIM!C
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending a'y 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 12/4/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ill B
.., ,,.q:„ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
.
„sssY 408 777-3228 • buildin c}
( ) g-:cupertino.ora PEMIT rB- -
CUPERTINO REV E DEF#
• ❑ NEW CONSTRUCTION ❑ADDITION ,,ALTERATION E T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROIPCIADDRESS..45APN A ( P12
OWNER NAME PHO E E-MAIL
CHAOT/LA CHe$.UKcu-THOT,4 �t/S—��f —�'7 S1
STREET ADDR CITY,STATE,ZIP
1 ye) — — �U�E�
r NTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
AL?'S Coils 0CRON X04 33 i3
ISTREET ADDRESS - CITY,STATE, ZIP I
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E-MAIL PHONE BUS.LIC A
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0 ARCHITECT 0 OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER❑DEVELOPER ❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS C TY,STATE,ZIP PHONE
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{ Z;TChRi)' X114'0:DEL .0.27K.E-- 1FG'GZ. ..T-K
02. 50
3.7 FT.
DSINGLEiFAMILY/DUPLEX,1,' ;❑MULTI FAMILY ,❑INDUSTRIAL' ❑COMMERCIAL
' EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NETSF I
I, USE TYPE ;OCC SQ.FT. VALUATION(S)
REMODEL'' REMODEL KITCHEN] ;REMODELOTHR ” GARAGE 0 ATTACHED
BATHROOM SF SFI ,'i 0':'' 'SF 0 DETACHED ,1
EXTSING, 1 ❑YES1 SECOND STORY"ADDITION ❑YES
FIRE'SPRINKLERS 0 NO �E]CHLER'' ❑YES 0 N0 I ,,,
❑NO
DWELLING SECOND DWELLING' b yEs ❑ATf ACHEDI:DETACHED OTHER
UNITS: , UNITADDITON: 0 N ,' SF'
POOLS 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE ,❑PREFABRICATED
1 .
POOL-SF, SPA-SF I SPA ATTACHED OYES 112 NO I TOTAL-SF , :,
I BtrigAL�[I: 3,1%'`.1,01i
Commercial orMalli-Family Buildings viiih Public Solnimine'Pools renuires'Devarlmen!ofEnvirmvvrnlul Heal?!no, ova! (MA
,__I, ,
RE-ROOF EXISTINGROOF T s'PE; Ej BUILT UP IOOFi D ASPHALT SHINGLES WOOD SHAKES E WOOD SHINGLES TILE OTHER(SPECIFY) _ 'I
REMOVE/REPLACE❑NO IF NO. i:',PLYWOOD:❑h' '❑318" '', PLYWOOD TYPE: PITCH: ROOF CLASS ,j
! CI YE. A„OF LAYERS THICKNESSQB/8” OTHER ❑OSB ❑CDX OTHER :12 A fj
PROPOSED ROOF TYPE:❑BLTLT-LP.ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER 1
'
Pros ide'e signed copy ofithe:Cupertino's Tear=Off Policy SF. of SQUARES
I By my signature below I aerti fy to each hof t]-e following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this a'pplicatiori1 and the informatlion'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 . d state laws relating to building construction I authorize representatives of Cupertino to
enter the above'identifiedliprloperty for insp' ion purposes. I ackiowledgeed authorize all information containe• on t s application form
to be made available for public race'd ;:1 1 'i ,I
Signaturejof Fr-r717-
1Z1110 1' c r 40:. ,�� i I )te !'a �z_ .0 /
SUPPLEMENTAL INFORMATION REQUIRE A ' : '
*New SFD%Second Div ellingl�Ui its/Multl.fainlly Dwellings:A Demo 'on permit is required prior to issuance:of a building permit,fon all new construction,
' *Commercial Buildings Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as pa;t of this project.
'Copy of Planning ApprovalILetter or Meeting,with Planning prior to submittal of Building Permit application.,
*HOA-Provide a letter of!approval from the Home Owner's Association'
I 1 1! i .i 1 idi pi 1
11 ! II'I 1'I. ,
1 !' BPl�_
Bld A 2017.doc revised 08/017/7
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