The URL can be used to link to this page

11090020 CITY OF CUPERTINO BUILDING PERMIT BALDING ADDRL;SS: 1 104 ELMSFORD DR CONTRACTOR:CALIFORNIA HOME PERMIT NO: 11090020 BUILDERS&DESIGN ONN NER'S NAME: KRISHNA ARVIND 1775 JUNCTION AVE DATE ISSUED:09/02/2011 °'tiT:R'S PHONE: 4082525128 SAN JOSE,CA 95112 PHONE NO:(408)392-8200 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG � ELECT F— PLUMB License Class_____ Lic.# —U21 �� (- MECH , RESIDENTIAL COMMERCIAL Contractor �,'��rV„�a 1J ou(e t�'!,jDate 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RELOCATE MAIN ELECTRICAL PANEL TO BACK OF (commencing with Section 7000)of Division 3 of the Business&Professions HOUSE ON Code and that my license is in full force and effect. THE NORTH SIDE. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and v%ill maintain a certificate of consent to self-insure for Worker's Compensation.as provided for by Section 3700 of the Labor Code, for the pciformance 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 Sq.Ft Floor Area: Valuation:$4000 permit is issued APPLICANT CERTIFICATION APN Number:36206003.00 Occupancy Type: I ccrtily that I have read this application and state that the above information is correct I agree to comply wth 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 PERMIT EXPIRES IF WORK IS NOT STARTED indentniIN and keep harmless the City of Cupertino against liabilities,judgments, costs.and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR eranting of this permit. Additionally,the applicant understands and will comply 180 DAYS F LAST C L ED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9 18- Issued by: �T-2—7� Date: Signauuc---- Date_ v 1. OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. if a roof is the follo"ing two reasons: installed without first obtaining an inspection,I agree to remove all new materials for L as o\Nmer of the property.or my employees with wages as their sole compensation, inspection. \v ill do the work.and the structure is not intended or offered for sale(Sec.7044, [business& Professions Code) Signature of App icant: Date: L as tm mer of the property,am exclusively contracting with licensed contractors to ��`q�f! ' constrict the project(Sec.7044.Business&Professions Code). ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I hay e and\%ill maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation.as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance ofthe work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or author' gent: / 101-11with comply kith such provisions or this permit shall be deemed revoked. ateL ? APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to huilding construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnif.N and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address 'nd expenses which may accrue against said Cuy in consequence of the of thu permit Additionally the applicant understands and will comply nth all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 18 1 understand my plans shall be used as public records. Signature_ Date Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: �/1' �—U �� `� PERMIT# OWNER'S NAME: PHONE# 2 i GENERAL CONTRACTOR: E BUSINESS LICENSE# Z Z ADDRESS: C, C jAc,,q CITY/ZIPCODE: q i *Our municipal code requires alL9_ s Wking in the city to have a City of Cupertino b siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:./ �T ignature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • buildingCcDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS C) y� C lie/'r-� 7 i n/O CR7A-PN # OWNER NAME' nn PHONE (f/ E-MAIL 5/1N'A 4- ?So2 J l� AVIN i�lf1M� � NtiA 6-M4 WNI STREET ADDRESS + ( d/ y/� CITY, STATE,ZIP FAX t f V" 1r (2 N"J CONTACT NAME PHONE E-MAIL � r:l s�1nrFl f�JZU �v 40'Z 2S S( 2 4?vin�'�� Mt►M� f1 N`A iC- �4AIC . c�M STREET ADDRESS CITY,STATE, ZIP TFAX ��qq /i �rtS> /� �� '� ccti Z r�r✓� �� _1 S o r4 cWOWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _.- LICEN,SE�BER LICENSE TYPE BUS.LIC � M f•�/z C� K k S 1C IV I N . ` Nf FAX COMPANY NAME E-MAIL C-AlIFO(Z/V,t'A 17 JM UI tPC,(Zs A A/i CA - KGME/3t�I STREET ADDRESS CITY,STATE,ZIP PHONE 1 --�--:?- ,5 -j- .1 c -7' r C; nJ A V� . .s A il/ ,T:; S 4,0 � � L. S L ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# CO_MPANY NAME E-MAIL ` FAX c''Z/\/.$ V'L-TING_ C 12 G V l? IA(d. `-.SC_ c- J S_ Q lit 0 iZ E STREET ADDRESS CITY,STATE,ZIP PHONE � C),5,-(D c- N c/V l r� S 41 Ste^ S /-A ry J- C A Vi 2- a DESCRIPTION OF WORK u<_� A -rt ni rG kA6:c 71 r 6-r7 C. l�t1 ti z-l M A 7- ii i r✓( C.) EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET.AREA J 1—,\D BATHROOM KITCHEN OTHER , l REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL 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 ADPL# [-]NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO Lt I cc)() 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 cpastrGction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: C �� Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for OVER-=-COUNTER E�_BUUMTNG PLAN REVIEW 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 ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06/21/11