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10040057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10834 E ESTATES DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10040057 `IWNER'S NAME: SUNDAR RAJAN DATE ISSUED:04/08/2010 NER'S PHONE: 4084394933 PHONE NO: ❑ LICEN D CONTRACTOR'S DECLARATIONF BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. c MECH RESIDENTIAL COMMERCIAL Contractor �a e "'- "� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:200A SERVICE UPGRADE (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:$1900 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. APN Number:36922007.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 our :gU1;atiorWVpr1he Cupertino Municipal Code,Section / Issued by! Date: 9.18. ✓ � ----- L��—/(./ v Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner an riz Compensation laws of California. If,after making this certificate of exemption,I ✓ Dater/ (/ 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 revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save it' -nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the gi-aing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulatio per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36922007. 00 DATE ISSUED. . . . . . . : 04/08/2010 RECEIPT #. . . . . . . . . : BS000010138 REFERENCE ID # . . . : 10040057 SITE ADDRESS 10834 E ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUNDAR RAJAN ADDRESS 10834 E ESTATES DR CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM DOUGLAS WARMBOE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- --- ------ ---------- ---------- ---------- _____ 1BCBSC VALUATION 1, 900 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0 . 00 127.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -- --------------- -------------------- CREDIT CARD 127.50 VISA --------------- TOTAL RECEIPT : 127 .50 CITY OF CUPERTINO CITY OF CUPEf�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: �-3 �0 9 I�A �w Build' Address: d r Ma ling Addres (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's ame: Pho a#: e dIA Contractor: Phone: Fax: Contractor License : D, G'J19 Cupertino Business License#: Contact: Phone: �G'�'L? ;W3 3 _036',2 Fax: Residential Commercial Job Description: 0 V�r6 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage ass): Occu ancy Type: 1-A, 1-B ❑ II/III/V-A ❑ 11/111 B, IV-HT, V-B [t�— Valuation: Square Footage: Project Size: Ex ress Standard ❑ Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: - For help, contact Build it Green at www.buildit reen.or - ', Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 M.Indoor Air Quality and Finishes 1.Use LowMo-V6C Paint 1 IAQ/Health pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p 3.Use Low/ND VOC Adhesives 3 IAQ/Health pts y--yes p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y--yes p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Heafth pts y=yes p 7.Seal all Exposed Partioleboard qr MDF 4 IAQ/Health pis - es p B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 1 1 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes p t 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0 4.Install Natural Linoleum in Place Df Vinyl 5 IAQMealth pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0 1 ! ! Total Points Available: 1401 1301 57 Total Points Project Recelved:i 01 01 0 G:datalprogs/greenbuiidingguidelines/remodelers/greenpointsfinal212D4proteaed.As Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: E PERMIT# C>Q OWNER'S NAME: y�yRAI-till PHONE # `0 GENERAL CONTRACTOR: ^ — BUSINESS LICENSE # ADDRESS: , /Lf 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. /' I am not using any subcontractors: 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