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