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10110165 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10250 CALVERT DR CONTRACTOR:JAYAKUMAR RAJADAS PERMIT NO: 10110165 OWNER'S NAME: JAYAKUMAR RAJADAS 10250 CALVERT DR DATE ISSUED: 11/24/2010 OWNER'S PHONE: 6505757052 CUPERTINO,CA 95014 PHONE NO: _I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE] License Class Lic.# LREPLACE FURNACE W/AC IN SAME LOCATION 2.PANEL SERVICE UPGRADE 200 AMP Contractor 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: 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. Sq.Ft Floor Area: Valuation:$5500 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:37518021.00 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 WITHI L1SO4"YS OF PERMIT 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 YS F M LAST CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, r C costs,and expenses which may accrue against said City in consequence of the l Issued by: Date: 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. RE-ROOFS: Signature Date 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. 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 I,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: 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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.) rider's Name Z�/­4 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, —sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ting of this permit.Additionally,the applicant understands and will comply ..n all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date �� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C j--V�' PERMIT# l-*Air- OWNER'S NAME: XA �PT5 PHONE# �-- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business 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. T �1 am not using any subcontractors: l Signature Date Please check applicable subcontractors and complete the following information: V 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10250 calvert dr. DATE: 11/24/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$5,000 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY F"� , �. PENTAMATION FURN/AC USE: SFD or Duplex >,g .,t�a PERMIT TYPE: WORK re lace furnace in same location add new A/C unit SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 52 ry ce 5 q r rz too A4L"kX=) -Arp" TOTALS: 1 $189.00 Mech.Plan Check 0.0 hrs $0.00 "�`� _ ��= f <, F'•�,r,r Pf <'17 FMech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $42.00 Li NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resohitiofi 09-051 Ef'. 'i1.-10) FEE QTY/FEE MISC ITEMS Mon Check tllpeen07 PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 UJl_�tf'1tC'fio n Y"7\, F-1 Work Without Permit? 0 Yes 0 No $0.00 t'Ic�trnitr,�r l'c�<'}: Travel Documentation Fee: ITRA VDOC $42.00 Stronar Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Std.s Commission Fee: 1BCBSC $1.00 SS SUBTOTALS: $274.50 $0.00 TOTAL FEE:` 4$750 Revised: 11/08/2010 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333•building(u)-cuoertino.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the properly improvements specified at: SITE ADDRESSl o a5� L�/ c� ,,D6 APN BP# OWNER NAME OWNER ADDRESS c. I^ 4 Pry f+ DESCRIPTION OF WORK: �` �� �' We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) �_Zi-,I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my �7. nce coverage for injuries to workers on my property. 1 understand building permits are not required to be signed by property owners unless they are responsible for the cgnstruction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her nam instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �IX5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be 'con/sidered an"employer"under state and federal law. - 6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject 7110 serious financial risk. 7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfo ed under contract with a licensed general building Contractor. Z� 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 CITY OF CITY OF CUPERTINO is FURNACE/AC CUPERTINO PERMIT APPLICATION FORM b1101 t�� APN # D og I • o`er Date: Building Address: � �a ,3 �� /,� � �'� ,c /10 / C7-)L- Owner's Name: Phone #: 7-�7to oif—1 Contractor: Phone#: 'Iff 09 Fax #: Contractor License #: Cupertino Business License#: Contact: Phone #: Fax #: Building Permit Info: Elect �f Plumb Mech Residential Commercial ❑ Job Description: 10( 41 ga4) rja(4?- LVI For Re si ntial Installations: � Attic 1St floor D--- 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of Construction (Usage Class): f 5CV0 � Strapped ❑ On Platform ❑ Bonded � New Location Replacement©� Project Size: Express ❑ Standard Large ❑ Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. `� Revised 01/07/09