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13080136I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21810 ALMADEN AVE OWNER'S NAME: RAVI SUNKARA OWNER'S PHONE: 4086506115 LICENSED CONTRACTOR'S DECLARATION License Class Lie. # 0 G Contractor 10 M_ 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 Insurance, 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 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, 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 re lations per the Cupertino Municipal Code, Section 9.18. Ilk p Signature Date ❑ 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 Insurance, 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 revoked. 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 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 Date CONTRACTOR: PRO QUALITY PERMIT NO: 13080136 BUILDERS, INC 1325 E JULIAN ST STE A DATE ISSUED: 08/19/2013 SAN JOSE, CA 95116 PHONE NO: (408) 298 -8983 JOB DESCRIPTION: RESIDENTIALLJ COMMERCIALE] TEMP POWER Sq. Ft Floor Area: I Valuation: $1200 APN Number: 35715034.00 I Occupancy Type: I PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 0 DAYS OF PERMIT ISSUANCE OR 180 DA OM LAST CALLED INSPECTION. Issued by: Date�� ? RE- ROOFS: 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. Signature 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 California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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. Additionally, 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 2 25533, and 25534. Owner or authorized agen . _ _ - Date: CONSTRUCTION LENDING AGENCY I 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.) Lender's Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingCa)cupertino.org ❑ PLUMBING []MECHANICAL ELECTRICAL ❑ MISCELLANEOUS ME P MISC PROJECT ADDRESS O I v j O VVArn D. /I . ii �C' �/'� APN k5 cod OWNER NAME /7t�l' /'U1,��1 v 7 VI. PHONE Z��,Q -�!/5 (ZIIPP E -MAIL STREET ADDRESS CITY, STATE, FAX CONTACT NAME n� �t l/�UI �i l / PHONE U J/J) _ &� ( �•- E -MAIL ;O— 'P/ IA Y� L STREET ADDRESS ( 5T. /�/ CITY, STATE, ZIP Ge /'//� FAX ❑ OWNER ❑ OWNER- BUILDER OWNERAGENT 11 CONTRACTOR ❑ CONTRACTOR AGENT 11 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r�( � / LICENSE NUMBER LICENSE TYPE -�J 'C7owk BUS. LIC # r(, COMPANY NAME E- MAILAV-`j s Pr y(� I�� QC I 7 A46o- FAX STREET ADDRESS /J y� WTI / CITY, STATE, ZIP /� �i^,C /) , J PHONE R. ARCHITECT/ENGINEENJAME LICENSE NUMBER BUS. LIC# COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF MFD or DUPLEX ❑ MULTI- FAMII.Y BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ONO PROJECT IN ❑ YES FLOOD ZONE ZE NO IS THE BLDG AN ❑ YES EICHLER HOME? K NO DESCRIPTION OF WORK % y�� ( /`/ fbwO TOTAL VALUATION: A� RECEIVED, BY: 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 co ect. I ve read the Description of Work and verify it is accurate. I a ee to comply with all applicable local ordinances and state laws relating to building co I uthorize representatives of Cupertino to enter the above den fied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE EN ORMATION REQUIRED OFFICE USE ONLY w OVER- THE - COUNTER a E ❑ EXPRESS V W ❑ STANDARD zV a ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 7'i i iP 1V CTTM A rrnR — RI TTT .11INf 111VIRION imiADDRESS: 21810 Almaden DATE: 08/19/2013 REVIEWED BY: Sean UNITS APN: BP #: 'VALUATION: 1$1,200 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p $47 PENTAMATION 1REAP14 PERMIT TYPE: WORK I Installation of a temporary ower pole 100 amp). SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE-j-, QTY UNITS BP FEES Temporary Power 1ERT <200 SuPhl. PC Fee 100 Amps $47 PME Plan Check: $0.00 „ • Perin it Fee: 3j ,Supp/. 111sp Fee .. � PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction Tax.- TOTALS: i , l= $47.00 �5. ,M1eeh. [lion ('heck Plumb. Plan Check F1ec:h. Permit Fee: Plumb. Permit Fee: Other ;tlech. Insp. Other Plumb Insp. - 1�ech. Insp. Fee: Plumb. Insp. Fee: IMTF e Thfc vcti ante does not include fees due to other Departments (Lc Planning, Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 ��s$47,00� Elec. Insp. Fee: Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are,7In!y an estimate. Contact the Dept for addn'1 info. FEE ITEMS (fee Resolution 11 -053 E . 711112) FEE QTY/FEE-j-, MISC ITEMS Plan Check Fee: SuPhl. PC Fee PME Plan Check: $0.00 „ • Perin it Fee: 3j ,Supp/. 111sp Fee .. � PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction Tax.- Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fees: A Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 _ar $186.50 $0.00 E $186.5.0 Revised: 07/01/2013