B-2017-0039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0039
10190 CALVERT DR CUPERTINO,CA 95014-3806(375 19 018) F LUNA
CONSTRUCTION
SALINAS,CA 93915
OWNER'S NAME: KOMPELLA VACHASPATHI P AND JACINTHA DATE ISSUED:01/18/2018
OWNER'S PHONE:408-386-5400 PHONE NO:(831)595-6590
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#538530
Contractor F LUNA CONSTRUCTION Date 08/31/2018 X BLDG _ELECT 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 full force and effect. JOB DESCRIPTION:
CONSTRUCT(N)2 STORY HOME WITH BASEMENT(3247 SF);
I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE(429 SF).
1. I have and will maintain a certificate of consent to self-insure for Worker's DEF#1 -TRUSSES-ISSUED 07/18/2019
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#3-FOUNDATION CHANGE FOR FRONT AND BACK PORCH;
performance of the work for which this permit is issued. WINDOW SIZES UPDATED-ISSUED 07/18/2019
2. I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-CHANGE BASEMENT BATHROOM LAYOUT AND
Section 3700 of the Labor Code,for the performance of the work for which this CONFIGURA`T'ION;INCREASE WALL HEIGHT-ISSUED 6/13/2018
permit is issued. REV#1 - CHANGES ON STRUCTURAL SHEETS-CHANGE RE-BAR
APPLICANT CERTIFICATION SIZE IN BASEMENT SLAB AND REDUCE BASEMENT SLAB KEY
I certify that I have read this application and state that the above BY 4"(SEE DETAIL 3/S3).-ISSUED 4/23/2018
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 Sq.Ft Floor Area:3676 Valuation:$450000.00
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:
Additionally,the applicant understands and will comply with all non-point 375 19 018 R-3(Custom)
source regulations per the Cupertino Municipal Code,Section 9.18.
..tea
Signature. �_ ��..�...�� -2 Date 07/18/2019
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
following two reasons: Issued by:Kim Dunbar
1. I,as owner of the property,or my employees with wages as their sole Date:01/18/2018
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed RE-ROOFS:
contractors to construct the project(Sec.7044,Business&Professions Code). 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
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 of Applicant:
performance of the work for which this permit is issued. Date:07/18/2019
2. 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.
3. 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 HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California. If,after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the
exemption,I become subject to the Worker's Compensation provisions of the California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety Code,Sections 25505,25533,and 25534.
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: -F'_
to save indemnify and keep harmless the City of Cupertino against liabilities, Date:07/18/2019
judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY
consequence of the granting of this permit. Additionally,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 07/18/2019
ARCHITECT'S DECLARATION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
10300 TORRE AVENUE 9 CUPERTINO, CA 95014-3255
/ 7
(408) 777-3228 e building@cuperfino.org PERMIT#B- 2-0
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Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
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RE-ROOF1 EXISTING ROOF TYPE: F-]BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SH ES❑TILE �THER(SPECIF-?)
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*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection urposes. I acknowle e and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date:
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 Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp-2017.doc revised 08101117
CONSTRUCTION PERMIT APPLICATION
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REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
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EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑ NO ❑ NO ❑NO
DWELLING SECOND DWELLING ❑YES [].ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS ❑FIBERCLASS ❑VINYL-LINED ❑GUNITE PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED YES ❑ NO TOTAL-SF
RECEIVED"BY TOTAL VALUATION:
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Commercial orMulti Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval `tt
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1�2, ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
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#OF LAYERS THICKNESS[]5/8" OTHER ❑OSB ❑CDX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
'Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
BY my signature ature 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 building construction. I authorize representatives of Cupertino to
Lnehe above-identified property for inspection purp 'es. I acknowledgg and authorize all information conta' ed on this application form
made available for public record.ure of Applicant/Agent: `� Y� ~' Date: 4�
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SUPPLEMENTAL INFORMATION REQUIRED
F
'New SFD/Second Dwelling Units/Multifamily Dwelling•A Demoli on permit is required prior to issuance of a bu' ding per it for all new construction.
'Commercial Buildings: Provide a completed Hazardous�'°1Vlaterials Disclosure form if any Hazardous Materials are ei
mng used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
'WHOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17