B-2018-0370 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0370
10353 ALPINE DR CUPERTINO,CA 95014-0922(326 15 l t l) SHOTA MJAVIA
SAN JOSE,CA 95136
OWNER'S NAME:KALJE MTIN AND SONALI N DATE ISSUED:03/22/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Le.#926194
Contractor SHOTA MJAVIA Date 12/31/2019 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is In fuB force and effect. JOB DESCRIPTION:
UNIT -SECOND FLOOR REMODEL BY CONVERTING ONE
I hereby affirm under penalty of perjury one of the following two declarations: BEDROOM INTO 2 BEDROOMS(44 S.F.);ADD NEW WINDOW(l)
r. I have and will maintain a certificate of consent to self4iiame for Worker's UNIT B-FIRST FLOOR REMODEL BY CREATING ONE NEW
Compensation,as provided for by Section 3700 of the Labor Code,for the BEDROOM,LAUNDRY ROOM,AND A UTILITY ROOM(364 S.F.);
performance of the work for which this permit is issued. RELOCATE 40 GAL WATER HEATER AND FURNACE INTO
2. I have and will maintain Worker's Compensation Insurance,as provided for by PROPOSED UTILITY ROOM;ADD NEW WINDOW(l)
/� Section 3700 of the Labor Code,for the performance of the work for which this REV#I-UNIT B-CHANGE LOCATION OF SHEAR WALL-ISSUED
�1/ —it is issued. 5/25/2018
Vt(�f APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$30000.00
1 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 APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 326 15 111
inspection purposes. (We)agree to save 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 this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,the applicant understands and will comply with all ll non-point
source regulations per the Cupe yunicipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5125/2018
IIERDECLARATION Issued by:ABBY AYENDE
OWNERBUIL
Date:03/22/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
A. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for installed without fast obtaining an inspection,I agree to remove all new materials for
sale(Saa7044,Business&Professions Code) inspection.
r. I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code), Signature of Applicant
I hereby affirm under penalty of perjury one of the following three declarations: Date:5/25/2018
r. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
performance of the work for which this permit is issued,
r. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534.I will
s. I certify that lin the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner an as to become subject to the Health&Safety Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California,if,after making this certificate of material.Additionally,should I use equipment or devices which emit hazardous
exemption,I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code,I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked. the Health&Safety Code,Sections 25505,25$3 nd 25534.
APPLICANT CF,RTIFICATION Owner or authorized agent: //
I certify that have read this application and state that the above Information Is Date:5/25/2018
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there Is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes.(We)agree of work's for which this permit is issued(Sec.3097,Civ C.)
to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City In
consequence of the granting of this permit.Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 5125/2018
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
Is (408)777-3228• building@cupertino.org PEIVIIT#B-� -p
CUPERTINO REV#J_ DEF#_
❑NEW CONSTRUCTION ❑ADDITION ❑,AALTE1yR�ATIO+�NN[:1 T.I. [:1 MEP ❑RE-ROOF E]SWIMMING POOL/SPA
PROJECT ADDRESS APN tl
OI f 1 G. V 4,/I l'"1 L
Z0
OWNERNAME PHONH( ahl E-MAIL
kzJ
STREET ADDRESS CITY,STATE,ZIP
CONTRACTORNA�jM/E� ❑OWNER-BUILDER COMPANY NAME l LICE NSE NUMBER LICENSE TYPH
STREET ADDRESS CITY,STATE,ZIP
E-MAIL PHONH BUS.LIC I
Q ARCI-BTECT Q OWNER[]OWNER AGENT Q CONTRACTOR AGENPQ ENGINEER Q DEVELOPER[]TENANT
CONTACT NAME EMAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
.CRIPTON
[]SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY []INDUSTRIAL []COMMERCIAL
RXIS'I'ING USE EXISTINGSF NEWFLOORSF PORCHSF DECKSF DEMO SF STORIESA TO'TALNETSF USE TYPE OCC SQXT. VALUATION((;)
REMODEL REMODEL KITCHEN REMODELOTlili GARAGE []ATTACHED
BATHROOM SP SF SF SF Q DETACHED
EXISING []YES EICHLER Q YES sECONDSTORYADDITION []YES
FIRE SPRINKLERS[INO Q NO []NO
DWELLING SECOND DWELLING AYES❑ATTACHED[]DETACHED OTHER
UNITSA UNITADDITON: QNO SF
POOLS []FIBERGLASS[]VINYL-LINED[]GUNITE []PREFABRICATED
POOL-SF SPA-SP SPA ATTACHED❑YES ❑NO TOTAL-SP
RECEI BY: TOTA VALUATION:
Cvrnrner'unl arM Jfi-Frzrr ilv Enild's.4hRr4]ic SWsPmfs Nm[WDenn'Me fvf Erroiranurmrfn7 HantM1 nlyrnval / ,,,sv'
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SH W GLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IFNO PLYWOOD❑r�' ❑3/8" PLYWOOD'1'YPE: PITCH: ROOF CLASS
❑YES
AOF LAYERS THICKNESS❑5/8" OTHER ❑OSB —COX OTHER_
OTHER_— '12 A
PROPOSED ROOF TYPE:[]BUILT-UP ROOF[]ASPHALT SHINGLFS Q WOOD SHAKES 11WOOD SFRNGLES Q OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF not 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 correct,I have read the Description of Work and verify it is accurate.I agree
to comply with all applicable local ordinances and sta w re ating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for insfjon s. I nowledge and authorize all information contained on this application form
to be made available fox ublic record. _(;//
Signature of Applicant/A
SUPPLEMENTAL INFORMATION REQUI516
New SFD/Second Dwelling Units/Multifamily 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 Ownrr s Association
BldgApp2017.doc revised 08101117