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11090100 (2)COVERSHEET 11090100-D 6283 SHADYGROVE CT PERMIT # DATE /T PROJECT(31 RWPM'W, AppLicAw An ALino4 , - PA 6( W-cf Yi t— OWNER --a'vv-2- Me M M Fffm-gi V MJ M M WA MeIAZ AM / US 10M m MOM, FAM rdA 1431 "If/-' �A F�00 mmm r 1-71-7 �, �e 6 APN# )'/Y— RES. (LVNG) (GARAGM comm. SQ. FT. MM T.I. SQ.Fr. RES. REMODEL CONTACT -I- c; PHONE# '71�e- FAX CaaWWh cis VALUATION (Cost of Project) READ. PAID NOTES: CONSTRUCTION TAX (Y) (N) LEI OX, SCHOOL FEES (Y) (N) /0 (Y) (N) HEART OF THE MY M TMALFEES ISSUED BY DATE CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6283 SHADYGROVE CT OWNER'S NAME: ANSHUAM NAGUNAEI OWNER'S PHONE: 4088065633 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie.4 .192_1? iA Contractor 0,(�/� (7 Date I hereby affirm that 1 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 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which ma ccrue against said City in consequence of the granting of this permit. Ad i io ally, the applicant understands and will comply with all non -point source r u tions per the Cupertino Municipal Code, Section 9.18. Date/6 (, ❑ O{VNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shal I 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: C&C CONSTRUCTION PERMIT NO: 11090100 210 GREENDALE WAY STE 2 DATE ISSUED: 10/26/2011 SAN JOSE, CA 95129 PHONE NO: (408) 687-6945 BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r MECH r— RESIDENTIAL I— COMMERCIAL r— JOB DESCRIPTION: ADDITION OF MASTER SUITE(445SQFT)&ADD TO EXISTING BEDROOM(51SQFT);REMODEL BEDROOM (51SQFT) Sq. Ft Floor Area: I Valuation: $70000 APN Number: 37541027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appli Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 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 Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professiona CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinct(cDcuoertino.org ❑ NEW CONSTRUCTION DITION ❑ ALTERATION / TI ❑ REVISION / DEFER ORIGINAL PERMIT # PROTfRESt � H fl 1% y E1�1� -/ �� APN# -75 1 0 0t OWNER NAME P 8'_ 1) �S E-MAIL �O i 1l�C�y ^' / V 6 O jilLl�Vf �YIGLiC S ADDRESS � S►-1 A✓E CT CITY, STATE, ZIP 0 / f F_2N T n FAX CO ACT NAME PHONf-o y SZO 1 jj STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT O<C=CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N ,C /C LICENSE LICENSE TYPE BUS. LIC # r ` ( O COMP AME EMAIL FAX S ADDRESS v CITY, STATE, ZIP s PHONE -6 S Y�co ARCHITE T/ENGINEER NAME LICENSE NUMBER BUS.0 # C ANY NAB E dy-a / Q FCJ Z S V S G At -%l O STREET ADDRESS CITY, STATE, ZIP 0 LP?NE - 5 20 - q OR DESCRIPTION OF WORK �� ( `f r0 ��l—C/ �Ci � S � V✓J l� 4 T �� / EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES r USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG AREA NEW FLOOR AREA 14 4 Ol � DEMO AREA TOTAL NET AREA / BATHROOM REMODELAREA KICC`IHEN REMODEL AREA OTHER REMODELARE4 PORCH AREA DECK AREA __FTOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? [:]NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO A 7a o o a 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 con I have read the Description of Work and verify it is accurate. I agree to comply with all applical?le local ordinances and state laws relating to building cons I authorize representatives of Cupertino to enter the above -identified property for inspection p oses. - Signature of Applicant/Agent: MP�I - Date: Seel 1 t SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE )POUTING SLIP ❑ OVER-THE-COUNTER PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D—STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARD �_ DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ARY SEWER DISTRICT submittal of Building Permit application. ❑ ENvmoNMENTAL HEALTH . BldgApp_201 Ldoc revised 06121111 CITY OF CUPERTINO FM_7 FEE ESTIMATOR — BUILDING DIVISION i9iADDRESS: 6283 shady grove ct. DATE: 09/15/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$70,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE• P 2nd Unit? ', Yes No OTC? 0 Yes �No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK I sfd add master suite 445 s.f. add to exisitnq bedrorom 1 51 s.f., remodel bedroom 1 51 s.f. SCOPE OCCUPANCY TYPE: TYPE OF CONSTIL FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 496 $1,482.00 IADDPLCK $1,205.00 IADDINSP TOTALS: 496 $1,482.00 $1,205.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No FR Li NOTE. This estimate does not include fees due to other Depts (Le. Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resohuion 11-053 Ef. . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,482.00 51 s.f. $392.00 Remodel, Other IREARESOTH Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,205.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (:"r>ugrffafion "I'ax trintini.s!rcrte„c bee: 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: PLLONGRNGR $64.48 Select a Non -Residential Building or Structure 0 0 i Trtfi>Lf 1.1fxfffn<.rmfrioa Strong Motion Fee: IBSEISMCR $7.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $2,761.48 $392.00 TOTAL FEE: 1 $3,153.48 Revised: 09/02/2011