B-2017-2141 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO:B-2017 2141
7712 OAK MEADOW CT CUPERTINO,CA 95014-5201(366 26 014) HOME DEPOT U S A
INC
ATLANTA,GA 30339
OWNER'S NAME. KIRLOSKAR MOHAN ARVIND AND VRINDA PANDIT TR DATE ISSUED:12/13/2017
OWNER'S PHONE:408-821-0149 PHONE NO:(770)433-8211
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class B.C-39.C17 Lic.#602331
Contractor HOME DEPOT U S A INC Date 09/30/2018 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
REPLACE WINDOW(1)-LIKE FOR LIKE TO MEET EGRESS,
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE PATIO DOOR(1)
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
f-'erformance of the work for which this permit is issued.
have and will maintain Worker's Compensation hnsurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
ermit is issued. Sq.Ft Floor Area: Valuation:$2739.00
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 36626 014
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 understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Sectio. °:18. 180 DAYS FROM LAST CALLED INSPECTION
7.2
,�Signature Date 12/13/2017 Issued by.Jasmine Archbold
41111 „..- Date: 12/13/2017
6/O ° 1 It 1 • t•T tI
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
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:12/13/2017
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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and .534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner o"r authorized agent:
APPLICANT CERTIFICATION 'Date 12/13/2017
I certify that I have read this application and state that the above information is S' ` I 11 •• `
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constr9pt.n lendi a .gency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is i due 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, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 12/13/2017 Professional
,
CONSTRUCTION PERMIT APPLICATION
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\e'li.4a./ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 9$014-3255
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(408)777-3228 • building@cupertino.oxg PEMIT#B-'Z C�v q-- - zAtti
CUPERTINO
❑ NEW CONSTRUCTION 'Q ADDITION /0 ALTERATION ❑T.I. ❑MEP ❑RE-ROOF 0 SWIMMING POOL/SPA
PROJECT ADDRESS '7 1 -K S/1 Jl 6-TA-DO
A O �- APN#
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OWNER NAME j r PHONE
0 H-AA r_,12_1 50.5 t- idq 422'(-O ci E-MAIL
STR DDRESS A/ CITY, . ATE:ZIP c�
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CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
.1-6,4e \c , 0 5 A i- Pc-F07 05 6132-3 5 I
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ISTREET ADDRESS CITY,STATE,ZIP C �7 I
E-MAIL PHONE,O {q ( p `5 0 I BUS.LIC# 1
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0 ARCHITECT 0 OWNER 0 OWNER AGENT CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT ,
7
CONTACT NAME ...------- E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
0 6 `i Ge WIt_-2-e7 L") ,4 a,./A 1-2-I) GA 74S S Slc-q2?- 2_6 4
DECRIPTON A7 I 0 '>
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INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
2
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING
0 YES EICHLER ❑YES SECOND STORY ADDITION OYES
FIRE SPRINKLERS 0 NO - ❑. NO 0 NO
DWELLING SECOND DWELLING ❑YES 1 0 ATTACHED DETACHED(OTHER
UNITS# UNIT ADDITON: 0 NO I S F I _
POOLS1 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF
IkE.C.ETVED BY: II; TO�TAL,� UATION:
Commercial or Multi Familt Buildings with Public Swimming Pools requires Department of Environmental Heath approval - ) (( 7
RE-ROOF EXISTING ROOF TYPE: 9 BUILT-UPID ROOF ASPHALT SHINGLES WOOD SHAKES 9 WOODSHINGLES❑TILE OTHER(SPE I )
I ',z" 318" PLYWOOD TYPE: PITCH: ROOF REMOVE/REPLACE❑NO I IF NO PLYWOOD ❑ ❑ ,12) A
❑ S #OF LAYERS THICKNESS❑5/8" OTHER. ❑OSB ❑CDX OTHER
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 T 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. .-=-o led_e .,-._.-o-: - all information contained on this application form
to be made available for public record. , 3
Signature of Applicant/Agent: _ Date:
SUPPLEMENTAL INFORMAT QIIIRED
*New SFD/Second Dwelling Units/Nlultifamily Dwellings:A 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
BldgApp 2017.doc revised 08/01/17