15040138CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10657 LARRY WAY
CONTRACTOR: NICE & RIGHT
PERMIT NO: 15040138
CONSTRUCTION INC
OWNER'S NAME: KASAMSETTY KISHORE AND POTTURI SUDH
P O BOX 2285
DATE ISSUED: 04/20/2015
OWNER'S PHONE: 4088610928
CUPERTINO, CA 95015
PHONE NO: (408)861-0928
PLICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALL TEMPORARY POWER
p
License Class_ Lic. # a ( 4-S a
Contractor P-16 f{% a6 S%.Date QlaOl IS
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: $200
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: 31602011.00
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
WITHIN 180 IT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 FROM L D INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
said City in consequence of the
costs, and expenses which may accrue against
Issued b
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
_ -- 6--�-
— --
918.
R -ROOFS:
Signature — Date Iv-
All roofs shall be inspect nor 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. I 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
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: `a`
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
CONSTRUCTION LENDING AGENCY
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
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
918.
Signature Date
CUPERTIND
F__
/�i
GENERAL PERMIT APPLICATION \
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION `Tt
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building.Ca7cupertino.o g �7
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❑ OWNER ❑ OwNER-BUMDER ❑ OWNER AGENT
ONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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LICENSE NUMBER
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COMPANY NAME
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USE OF ElSFD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑YES
IS THE BLDG AN El
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BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? NO
DESCRIPTION OF WORK
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TOTAL VALUATION:O
By my signature below, I certify to each of the following: I am the property owner or agent to act on the r 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
and state laws relating to building construction.
I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
ordinances
Signature of Applicant/Agent:
Date: f�
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PLEMENTAL INFO TION REQUIRED,
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MEPMiscApp_2 011. doc revised 06/21/11
CITY OF CUPERTINO
i'i I I T'i QT7(M A Tn12 — RITTI .DIINf iITVICInN
La,ADDRESS:
10657 LARRY WAY
DATE: 04/20/2015
REVIEWED BY: MELISSA
Plan Check Pee:
APN: 316 02 011
BP#:
*VALUATION: $200
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
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PME Plan Check:
PENTAMATION 1 REAP14
USE:
Permit &?e:
PERMIT TYPE: i
WORK
INSTALL TEMPORARY POWER
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1 ERT<200 100 Amps $48
TOTALS: $48.00 _
:llc-ch. Ptari Check
Rlech, Merril Fete:
Other d/c:c°h. tnsp,
alech. lriah. F<�e:
111unib. Placa Check
Plumb. Permil Fee:
other. Plumb Insp.
1'111111b. Inas/1. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $48.00
1>1ec. Pzsp, Fee:
NOTE: This estimate does not inetude fees due to other Departments (Le. rtanntng, ruottc rvorKs, sere, aun[[ury .ewer �a�uscy gra nvv.
_. ..I . __ _ ___ .._ _ ___.____ ('natant tho vont fnr add"'/ info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
-_--
MISC ITEMS
Plan Check Pee:
Sul�k�l. l'C' I tie
PME Plan Check:
$0.00
Permit &?e:
:.?Zqyd, f,1sp Pee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
COFlstruch.oil Tax.,
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
A(Awnc•ecl Planning ]Fees:
Travel Documentation Fee: ]TRAYDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldp- Stds Commission Fee: IBCBSC
$1.00
$190.50
$0.00 ,�' TO FEE:.
.. ,
$190.50
Revised: 04/01/2015