10070181CITY OF CUPERTINO BUILDING PERMIT
I BUILDING ADDRESS: 6137 BOLLINGER RD
OWNER'S NAME: ANJALI & RONAK BHATT
`iER'S PHONE: 4085170970
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic
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.
I have and will maintain Worker's Compensation hrsurance, 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 constriction, 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.
Signature 94N!!! Date 4`'kla
1 Ll OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
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 hrsurance, 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 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
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 revokeds
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
piify and keep harmless the City of Cupertino against liabilities, judgments,
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. (� , y
Signature iq� �!'_ Date *'N" kO
CONT 2ACTOR: ANJALI & RONAK BHATT PERMIT NO: 10070181
6137 B 3LLINGER RD DATE ISSUED: 07/27/2010
CUPE]ITINO, CA 95014 PHONE NO:
BUIL])ING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB I WSCRIPTION: RESTUCCO ALL AROUND THE HOUSE 160 LINEAL
FTX9= 440SQFT NEW PANEL ELECTRIC BREAKERS
Sq. Ft Floor Area: Valuation: $4000
APN Number: 37538011.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
Vr/ITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issue&
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installe 3 without first obtaining an inspection, I agree to remove all new materials for
inspect .on.
Signati re of Applicant: 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
Califoi nia 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 I store or handle hazardous material.
Additi malty, 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.
Own r or authorized agent:
races- 17f�� Date: 141
CONSTRUCTION LENDING AGENCY
I hereb � affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender •'s
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licens :d Professional
5 ITEMS OF 5
CITY OF CUPFRTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN 3753807.1.00
DATE ISSUED.......: 07/27/2010
RECEIPT #.........: BS000010985
REFERENCE ID # ...: 100701E;1
SITE ADDRESS .....: 6137 BC>LLINGER RD
SUBDIVISION .......
CITY .............. CUPERT::NO
IMPACT AREA .......
OWNER ............: ANJALI & RONAK BHATT
ADDRESS ..........: 6137 BOLLINGER RD
CITY/STATE/ZIP ...: CUPERT=:NO, CA 95014
RECEIVED FROM ....: RONAK PIAVINCHANDRA
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: ANJALI & RONAK BHATT
ADDRESS ..........: 6137 BOLLINGER RD
CITY/STATE/ZIP ...: CUPERT=:NO, CA 95014
TELEPHONE ........
OPERATOR: patg
COPY ## : 1
FEE ID UNIT
QUANTITY
AMOMIT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
4,000.00
----------
1.00
----------
0.00
----------
1.00
----------
0.00
1EPERMITFE FLAT RATE
1.00
x:2.00
0.00
42.00
0.00
1ERT<200 UNITS
1.00
2:2.00
0.00
42.00
0.00
1STUCOAPP SQ FEET
1,440.00
5;,9.00
0.00
539.00
0.00
1TRAVDOC FLAT RATE
1.00
2:2.00
0.00
42.00
0.00
TOTAL PERMIT
----------
666.00
----------
0.00
----------
666.00
----------
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CHECK
666.00
--------------------
#3:.7
---------------
TOTAL RECEIPT
666.00
CITY OF CUI'ERTINO
FM_7 FEE ESTIMATOR -BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS:
FLR AREA
s .ft.
DATE:
REVIEWED BY:
BP FEES
APN:
BP#:
"VALUATION: 1$4,000
PERMIT TYPE: Building Permit
$0.00
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
$0.00
OVERTHE
COUNTER. 0 Yes ® No
APPLICATION 1R3SFDW
TYPE:
MECHANICAL Q Yes Q No
PLUMBING O Yes (E) No I
ELECTRICAL O Yes (E) No
�W
w
$0.00
Suppl. Insp. Fee:O Reg. 0 OTF0.0Thrs
p0
$0.00
3�
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
0
$0.00
0.0
$0.00
$0.00
PME Plan Check:
$0.00
200 amps
$42.00
Electrical
IERT<200 Temporary Power
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OTF0.0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
TOTALS:
0
$0.00
$0.00
$0.00
P.!'.d7 P/.r,' Check
�.lc ".. I�Ia;1 Chel•A..
t«p. I 7F] ___j
NOTE: These fees are based on the nreliminary informatinn availahio and ara nnh, nn actisnnto rn"mn jt t%o 71 i f r ,,,4,1.,
FEE ITEMS (Fee Resolution 09-051 Ef. 7/1/09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1,440 s.f.
$539.00
Restucco
ISTUCOAPP
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
200 amps
$42.00
Electrical
IERT<200 Temporary Power
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OTF0.0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
Acoustical Fee: Q Yes Q No
$0.00
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
Q
0
Travel Documentation Fee: ITRA VDOC
$42.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$85.50
$581.00 1
TOTAL FEE:
$666.50
Revised: 7/22/2010