B-2016-2651 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2651
7678 RAINBOW DR CUPERTINO,CA 95014-5247(366 l l 030) PERFECT HOMES
CONSTRUCTION
SAN JOSE,CA 95136
OWNER'SNAME:MAHADEVAPPA RAJENDRA AND PALLEDA KALPANA M DATE ISSUED:01/13/2017
OWNER'S PHONE:408-242-1625 PHONE NO:(408)8364457
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lie.#E56533
X BLDG X ELECT_PLUMB
Contractor PERFECT HOMES CONSTRUCTION Date 02128/2019
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is In fufi force and effect. JOB DESCRIPTION:
1ST FLOOR ADDITION OF LIVING ROOM/GUEST BDRM/OFFICE/2.5
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOMS(672 SF);FRONT COVERED PORCH(44 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's INTERIOR REMODEL(MASTER BEDRM/OFFICE/LIVING RM)(524
Compensation,as provided for by Section 3700 of the Labor Code,for the SF);ADD(2)BAY WINDOWS IN BEDROOMS;(N)SKYLIGHT IN
performance of the work for which this permit is issued. KITCHEN;(N)FURNACE/A/C IN ATTIC;(N)PANEL UPGRADE IN
tI have and will maintain Worker's Compensation Insurance,as provided for by SAME LOCATION(200 AMPS);RE-ROOF(E);TEAR-OFF;CDX;
— Section 3700 of the Labor Code,for the performance of the work for which this COMP SHINGLES(20 SQ);(N)STUCCO ON EXISTING PORTION OF
permit is issued. RESIDENCE(1240 SF).
APPLICANT CERTIFICATION REV#1-REPLACE(3)SKYLIGHT WITH SUN TUNNELS-KITCHEN,
I certify that I have read this application and state that the above MASTER BEDROOM AND HALLWAY BATHROOM-ISSUED
Information Is correct.I agree to comply with all city and county ordinances 4/12/2018
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for Sq.Ft Floor Area:672 Valuation:$150000.00
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 of this permit. APN Number: Occupancy Type:
Additlonally,the�ppnd understands and will comply with all non-point 366 1l030 Deferred Submittal(R-3),R-3(Custom)
source regulatiohe Cu rtino Municipal Code,Section 9.18.
Signature Date 411212018 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
fallowing two reasons: Issued by:Kim Dunbar
1. I,as owner of the property,or my employees with wages as their sole Date:01/13/2017
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) RE-ROOFS:
2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.Ifa roof is
contractors to construct the project(Sce.7044,Business&Professions Code). installed without fust obtaining an inspection,I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations:
inspection.
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 Signature ofApplicanC
performance of the work For which this permit is issued. Date: 29L /
2018
z. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
s. I certify that in the performance of the work for which this permit is.issued,I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any malmer so as to become subject to the I.have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California.If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534.I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I most forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(x)should I store or handle hazardous
be deemed revoked. material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defiued by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:411212018
judgments,costs,and expenses which may accrue against said City In CONSTRUCTION LENDING AGENCY
consequence of the granting of this permit.Additlonally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit Is Issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 4/12/2018
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CONSTRUCTION PERMIT APPLICATION
0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• building@cupertino.orQ PEMIT#B-�- �I
CUPERTIN0 REV# DEF#
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECTADDRESS 8 ;6%N^V wj /Z- APN I
OWNER NAME e,�: �.. _ PHONE 40�.14
STREETADDRESS CITY,STATE,ZIP l•'
RCONTRACTORNAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
7—" C1 c,—v l ! ,6
STREET ADDRESS �l CST L/N CITY,STA- ,,7zT "-6
E-MAIL 1PHONE Ig7�l�J• BUS.LIC k
M C- MeC Cori/1
❑ARCHITECT O OWNER O OWNER AGENT ACCNFERACTOR AGENT O ENGINEER O DEVELOPER O TENANT
CONTACT NAME &MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
S7/lnliT�zt�l I 1 C-t'�- d3S` '7d':9-&33-300?
ES PTON r
._.LnS CL Nbtyj /n 1,744— S' Le 1�2T > K l e
V60 `j'
OSINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY []INDUSTRIAL ❑COMMERCIAL
EXISTING USE I EXISUNG SF NEW FLOOR SF PORCH SF DICK SF DEMO SF S'TORIESp TOTAL NET SF USE TYPE. OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR I GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ONO
0
FIRE SPRINKLERS 0 NO NO
DWELLING SECOND DWELLING DYES O ATTACHED O DETACHED OTHER
UNIT" UNIT ADDITON: O NO S F
POOL$ 0 FIBERGLASS 0 VINYL-LINED 0- _ GUNITE 0 PREFABRICATED
POOL-SG SPA-SF BPAA'ITACHED YES ❑NO TOTAL-BF
RG LVED EY: TOTAL VALUATION:
RS-ROOF EXISTING ROOF TYPE: ❑BUILT-UPROOF❑ASPHALT SHINGLES E]WOOD SHAKES WOOD SHIN LES TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑�' 03/6" PLYWOOD TYPE: PITCH: ROOF CLASS
[:1 YES #OF LAYERS_ THICKNESS❑518" OTHER ❑OSB ❑CDX OTHER -•12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 11 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF dof 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 state laws relating to build ag construction. I authorize representatives of Cupertino to
enter the above-identified property for mapectic Pur oses. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: t. Date: ,Z /
SUPPLEMENTAL INFORMATION REQUIRED
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 Plamnhng prior to submittal of Building Permit application.
"HOA-Provide a letter of approval from the Home Ow—r s Association
BldgApp_2017.doc revised 08/01/17