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11070028 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10131 PHAR LAP DR CONTRACTOR:AMERICAN KITCHEN& PERMIT NO: 11070028 BATH OWNER'S NAME: ARCHANA RAO 1758 JUNCTION AVE UNIT D DATE ISSUED:07/06/2011 OX't'NER'S PHONE: 4088345211 SAN JOSE,CA 95112 PHONE NO:(408)436-8151 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TEMPORARY POWER AT NEW PERMANENT ELECTRICAL METER License Class Lic.# J 30 LOCATION. ContractorCNS Date 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: Sq.Ft Floor Area: Valuation:$100 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 performance of the work for which this permit is issued. APN Number:32639059.00 Occupancy Type: 2. 1 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. PERMIT EXPI SIF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 18 S OF PERMIT ISSUANCE OR 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 180 DAYS F LAST CALLED INSPECTION. 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, Issued by: Date: costs,and expenses which may accrue against said City in consequence of the granting of thiLvermit. Additionally,�sper the applicant understands and will comply with all non- t souino Municipal Code,Section 9.18. RE-ROOFS: SignaturDate 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. C� OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 -by affirm that 1 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 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2 1,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. 1 1 have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the 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 performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25.533,and 25534. 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 O er r nth ted permit is issued. Date: (� 3 1 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 f hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ?g of this permit.Additionally,the applicant understands and will comply with a-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 32639059. 00 DATE ISSUED. . . . . . . : 07/06/2011 RECEIPT #. . . . . . . . . : BS000013970 REFERENCE ID # . . . : 11070028 SITE ADDRESS . . . . . : 10131 PHAR LAP DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ARCHANA RAO ADDRESS . . . . . . . . . . : 10131 PHAR LAP DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JOHN GILLETTE CONTRACTOR WARTENBERGH, JOE LIC # 21316 COMPANY . . . . . . . . . . : AMERICAN KITCHEN & BATH ADDRESS . . . . . . . . . . : 1758 JUNCTION AVE UNIT D CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 436-8151 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 100 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1ERT<200 UNITS 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 . 50 0 . 00 174 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 174 . 50 1039 --------------- TOTAL RECEIPT 174 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER 0 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISIONFla ADDRESS: 10131 phar lap dr. DATE: 07/06/2011 REVIEWED BY: bobs. APN: � :O=BP#: `VALUATION: $100 rPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: PERMIT TYPE: WORK temp power at permanent electrical meter location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $44 TOTALS: $44.00 Elec.Plan Check 0.0 hrs $0.00 - Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 11-053 IS—' 7.1.-'111 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: 0 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $ Strom Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg?Stds Commission Fee: 1BCBSC $1.00 $41.00 IADMIN SUBTOTALS: $129.50 $41.00 TOTAL FEE: 3fl ��~'�� Revised: 07/01/2011 ��'� GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building(dJ cupertino.org A 7WRW"MIsc CUPERTINO ❑PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS PRO CT ADDR) f/lAlt LAP �, APN# /_ _ `� OS O ERVNAME h P}I NE r SZ.i J (� E-MAIL /! J ;'/'rt /6i 4-()(-, , STREET ADDRESS CIY, STATE,ZIP FAX / CONTACTy Li , PP �' 3 E I44M. Y S ET5AjTSS CITY,STATE, IP FAX 5 �f J�t aG ✓ .!/ S f}sv o S h. C, - 9 // Z $ 6 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT ONT CTOR NAME � LICENSE ER LICEN� TYPE BUS.LIC# — / CAA l��'Gl•�R�) J !, COMPANY NAME E-MAIL FAX _f "r 6 IrlADD SS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN YES IS THE BLDG AN YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHI ER HOME? O DESCRIPTION OF WORK C:) IT �Cj,"tz_ 4r Vr,,cs/ TOTAL VALUATION: Ida ffZ fl RECEIVED BY: By my signature below,I certify to each of the following: I am the roperty owner or authorized agent to act on the property owner's behalf. I have read this application and the information ro ed' cone ave read escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re mg to b i n thorize repr sentatives of Cupertino to enter the above-identified property for inspection putposes. Signature of Applicant/A Date: `l� UPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W 9-0—VER-THE-COUNTER ❑ EXPRESS Y U w 11STANDARD U ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 06121/11