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14100117CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21647 RAINBOW DR CONTRACTOR: PATIL SURAS S AND PERMIT NO: 14100117 JAYASHREE S OWNER'S NAME: PATIL SURAS S AND JAYASHREE S 21647 RAINBOW DR DATE ISSUED: 10/22/2014 OWNER'S PHONE: 6505209128 CUPERTINO, CA 95014-4826 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION CONVERT (2) GARAGE DOOR TO ONE License Class Lic.# Contractor Date 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. I 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: $20000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36637002.00 Occupancy Type: Section 3700 of the Labor Code; for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I 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 WITHIlY.180 YY`' OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 7%S upon the above mentioned property for inspection purposes, (We) agree to save 180 DAy� 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 >>, Date: 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 Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. "❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, 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, Busme Professions Code) I, er of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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(a) 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 25505, 23, nd 25534. 1 i�`- �0} � d� _ Owner or autirorize� agent: Date: 7 permit is is ed. ce in the performance of the work for which this permit is issued, I shall riot em loy 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, I 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 I 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. r-----;� Signature Date ��zzZv) CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 g CUPEEtT[t1Q (408),777-3228 • FAX (408) 777-3333 • building aacupertino.org F-1 mmy rnN gTRIICTInN n ADDITION D ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS ✓lVaD- 11-4 APN # 00Z OWNER NAME PHONE Y✓� � 5� ✓���. E-MAIL _ STREETADDRESS J� CITY, STATE ZIP �C� FAX CONTACT NAME �yr [y)/� � f� - PHONE09_W Pq E-MAIL 160 _ ® (9 /-,ASA `'G STREET ADDRESS /,( � j� CITY, STATE, ZIP F EOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT I] ENGINEER 1:1 DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK AW 'TO oN b5 EXISTINGUSE PROPOSEn USE -CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEN40 AREA TOTAL NET AREA AREA AREA KITCHEN. REMODEL AREA OTHER REMODEL AREA BATHROOM REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA:❑ DETACH # DWELLING UNITS: , IS A SECOND UNIT [I YES SBCOND STORY ❑YES. BEING ADDED? - Q.NO ADDITION? E]NO_ PRE -APPLICATION. ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ElYES R HOME? NO RECEIVE'Y: ¢ s y s TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER ETCH following: the owner or authorized agent tg,.aC on the rooerty'owner's behalf. I have read this By my signature below, I certify to each of the at property application and the information I have provided is c rrec . I ave read the Description of Work and etify it is accurate. 1 agree to comply rith all applicable local the o� nspection purposes. ordinances and state laws relating to cons on. t iz resentatives of Cupertir Ito enter abe�ve=rtlent�IeF"operty Signature of Applicant/Agent: Date:i/ SUPPLEMENTAL INFORMATION REQUIRED pAtv�TYPE `_� IiozlTlz,osLl' dwellings: Apply for demolition permit for © OVER coIINZER ui%D7nG PL NREvrEw _ New SFD or Multifamily T>� Demolition is required prior to issuance Of building " _ 2 existing building(s). permit fl >?Nn`GrzTxEvIE permit for new building. ExEss Provide Hazardous Materials Disclosure s aI.DRn y ruslicwoRYzs r,'; _ Commercial Bldgs: a completed Materials being used as part of this project. QTRF DEPTx form if any Hazardous are �iA�icE of Planning. Approval Letter or Meeting with Planning prior to { Cl SANITARY SEWERDISTRICT _Copy rr k submittal of Building Permit application. V,ki NViIiQN:MENTHEAI,T.'H,. Y� m BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ikADDRESS: 21647 rainbow dr 3 f ech. /.s a 2 C beck DATE: 10/21/2014 REVIEWED BY: Mendez APN: BP#: / t0 / VALUATION: 1$20,000 *PERMIT TYPE: Building Permit Other Ph n 5 ps.p-Ll I PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 1"?ec. In'sp. F"Oe: PENTAMATION PERMIT TYPE: 1GENRES WORK convert 2 garage door to one SCOPE Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, flare, ,anitary Sewer utstrict, 3cnooa at 1 The-' foot nva hncad nvi tha nraliminary infnrmatinn availahle and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-05) Ef :' %;1'131 3 f ech. /.s a 2 C beck tit oub- Plan Chec° L'1 c:..Pl n Ch c1. Iv,'r. -'A per€t i Fee: ' ph nb7 pe"t snit f'ee: E'lec. t cnnit 7'_ee: 01'ter -V ch. Inas'p. Other Ph n 5 ps.p-Ll I Other kc. Ins.o. .Wee 3. nq;5 1' ;'B: phv?2L Inq). 71-ee.' 1"?ec. In'sp. F"Oe: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, flare, ,anitary Sewer utstrict, 3cnooa at 1 The-' foot nva hncad nvi tha nraliminary infnrmatinn availahle and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-05) Ef :' %;1'131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 ] hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (j) Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT Q,.O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _ 11,itlF:rS,1Ia ££�a 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 1�-�����t ���s•tr;rr�,>nt�tr€err /_'���. ,Strong Motion Fee: IBSEISMICR $2.60 2.0 hrs $286.00 Inspections 1STINSP Inspection, Hourly Bldo Stds Commission. Fee: IBCBSC $1.00 SUBTOTALS- $3.601 $429.00 TOTAL FEE:` $432.60 Revised: 08/20/2014 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISI N r) 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 J (4(1A)7772MA --PAY (402) 777-3333 • hi ildinnar-unertino.orn of Address 21 )(� I R©l)' m bo w 'Jyr, HA' J"` SND COMPLETED, UNTIL THIS; CERTIFICATE T TR1VF, TO THE BUILDING DIVISION PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907:2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. _1 __-r „ _ s„ ,. ..i„..,:cH At— f- of fhic efnfemenf Owner (or Owner Agent's) Name: 13 9� 1 1 /; � if 1161201C ,, tNV �(1 �Qi , `� l Signature ..................... °'`�.Il......):.................................................... ... Date: ........, ....... Contractor Name: Signature...................................................................Lic.#...................................... Date: ................... Smoke and CO forin.doc revised 03118114 C, CUPERTINO WATER -CONSERVING PLUMBING FIXTU OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIt 10300.TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (4081777_338 : t,,,aa;,,,n..... Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which -are part of this Certification form, . . 1. Is your real property a registered historical site? 11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply,` Sign'below and skip the rest oft he form. Owner' natures Date: Signature:'_ No Question 2. 2. Does your real property have a licensedlumber certifying fying that, due to the age or configuration of the properly or its plumbing, installation ofwater-cons erving plumbing factures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division: Sign below and skip the rest of the form. Owner' Signature: Date: No Go to Question 3. 3. Is water service perinanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: . No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ,❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form, Owner' Signature: Date: Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. Myproperty is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building, On or before January 1, 2017, all non-compliant plumbing factures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a multifamily residential real properly. -See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing futures to be replaced with water-conseiving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing factures shall be replaced with water - conserving plumbing factures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a commercial real property, See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2014.doc revised 03118/14 OUPERTI NO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinoldcupertino.ong Dear Property Owner(s): An application for a building permit has been submitted in your name listing, yourself as the builder of the property improvements specified, at: J SITE ADDRESS '] P _ / RamDOW �Yl ° li APN OWNER NAMEOWNER Skhas'� l ADDRES r 7w . cbe�l°n� c Jza/ DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us atour official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AN DVERIFICATION-OFINFORMATION - (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- 1er" building permit that erroneously implies that the property owner is providing his or her own labor and material ;orally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by nlicensedperson and his or her employees while working on my property. My homeowner's insurance may not Ide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my ranee coverage for injuries to workers on my property. _2. 1 understand building. permits are not required to be signed by property owners unless they are responsible for construction and are ;not hiring a licensed Contractor to assume this responsibility. _3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. 1 understand that I may .ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her ie instead of my own.. _4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license fibers on permits and contracts. _5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be sidered an "employer" under state and federal law. i. I understand if I am considered an "employer" under state and federal law, I must register with the state and aI government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ployment compensation for each "employee." I also understand my failure to abide by these laws may subject serious financial` risk. "I 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family sidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by ensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for financial or personal injuries sustained by any subsequent owner(s). that result from any latent construction cts in the workmanship or materials. Owner:Builderl orm 2010.doc revised 04114110 T _9. I understand I may obtain more information regarding my obligations as an "employer" from -the Internal Bnue Service, the United States Small Business Administration;, the California Department of Benefit Payments, the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State nse Board (CSLB) at 1-800-321-CSLB (2752) or www.esib.ca.gov for more information about licensed. 10. I am aware of and consent to an Owner --Builder building permit applied for in my name, and understand that I ie party legally and financially responsible for proposed construction activity at the site address listed above. .11 . I agree that, as'the party legally and financially responsible for this proposed construction activity, I will abide I applicable laws and requirements that govern Owner -Builders as well as employers. /r 12. 1 agree,to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in'f©rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil, court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued IC-- Onn-7 n:., X Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued toverif y the property owner's signature. Property Owner's Signature:`_ Date: ----------------------------------- I - --------------------------------------------=---------------------------------------------------------- (NOTE The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, 1 hereby authorize the following: person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized. Agent: _ Address of Authorized Agent:. Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the ;city may be required to be presented when the permit is, issued to verify the property owner's signature. Property Owner's Signature: Date: OwnelBudderForm 2010.doc remised 04114110