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13030065CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20932 FARGO DR CONTRACTOR: SIGURA PERMIT NO: 13030065 CONSTRUCTION INC OWNER'S NAME: SUNIL SHIRVASTAVA 614 NATIONAL AVE DATE ISSUED: 03/14/2013 OWNER'S PHONE: 6503918451 MOUNTAIN VIEW, CA 94043 PHONE NO: (408) 736-7952 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL El ❑ LICENS � D CONTRACTOR'S DECLARATION License Class Lic. # ! ATTACHED ' GRANNY UNIT' KITCHEN REMODEL (94SQ ��j Contractor S� Orn4 1C4,e`N Date �/ `3 FT). REMOVE (E) WINDOW IN KITCHEN AREA 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 Sq. Ft Floor Area: Valuation: $8500 performance of the work for which this permit is issued. 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 APN Number: 32630113.20932 Occupancy Type: 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 WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter for inspection to 180 DAYS FROM.LASTVXLLED INSPECTION. upon the above mentioned property purposes. (We) agree save indemnify and keep harmless the City of Cupertino against liabilities, judgments, r rye costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issyeed by Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ,� RE -ROOFS: Signature Date f 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 1, 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, Business & Professions Code) I, as owner 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. 1 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 25505,25533,41UI5534. � �✓• `.� Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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. Signature Date CITY OF CUPERTINO IOWA Ti Ti Ti Ti C'TTA/i A rrnIP — RTTTT .IANC DIVTCION LNADDRESS: 20932 FARGO DR. DATE: 03/13/2013 REVIEWED BY: MELISSA Nfech. Perntil Fee: APN: 326 30 113 BP#: J 0,30 69 S *VALUATION: $8,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Plrnnb. hap. rec.' PENTAMATION 1 R3SFDREM PERMIT TYPE: USE: $0.00 PME Plan Check: .WORK ATTACHED'GRANNY UNIT' KITCHEN REMODEL 94SQ FT). REMOVE E WINDOW IN KITCHEN SCOPE AREA NOTA: 77tis esttntote does /tot tnetnae fees aue to ower Uepartnten[s (i.e. riattrung, ruuuc rr ulna, rlaG, uNaaaaa.•y ..• •• • a, _�.. !'.,toot iho non/ far addn'1 info. ."131MAj G{ln • 1/l CJG GCJ NIG VNJcaa via aa•v a•.•a...s...... FEE ITEMS (Fee Resolution 11-053 E . 7/1112) Xk,ch. Plan Chcck � Phemb. Plaut Check Elea, Plait Check Nfech. Perntil Fee: Phnnb. Petanit Fee: lilec. Permit rec. Other Heck hasp. Othwr Plumb hasp. Other Elec. Insp, 11eclt. Lisp. Fee: Plrnnb. hap. rec.' Elec. Insp, Fee: NOTA: 77tis esttntote does /tot tnetnae fees aue to ower Uepartnten[s (i.e. riattrung, ruuuc rr ulna, rlaG, uNaaaaa.•y ..• •• • a, _�.. !'.,toot iho non/ far addn'1 info. ."131MAj G{ln • 1/l CJG GCJ NIG VNJcaa via aa•v a•.•a...s...... FEE ITEMS (Fee Resolution 11-053 E . 7/1112) ... ........._ FEE .._... .__ _ QTY/FEE __._ MISC ITEMS Plan Check Fee: $0.00 94 s.f. $600.00 Remodel, Kitchen (<=300 sf) 1REMRESKIT Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes ) No $0.00 Suppl. Insp. Fee -.(j) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee:. $0.00 PME Permit Fee: $0.00 1 L Cotzslt'uclion Tax: F71 Adjl,ihihsSlralNe Fec: 0 Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure. .0 Troi,el Doca iw7ilotioo Fees: Strong Motion Fee: IBSEISMICR $0.85 = hrs $266.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.85 $866.00 TOTAL FEE: $867.85 Revised: 01/01/2013