Loading...
12100087BUILDING ADDRESS: 22403 RIV-ERSIDE DR CITY OF CUPERTINO BUILDING PERMIT CONI'RACFOR: 1 PERMIT NO: 12100087 OWN6:R'S NAME: KAKAR DEEPAK AND MENON LEENA D, \'1'F, ISSUED: 10/102012 OWNER'S PHONE: 4088929990 I , I PHONE NO: ❑ LICENSED CON`rRACrOR'S DrC�.LAR�/ATION License Class r lD Lic. N °% % 3 / / rc" Contractor Date /O .1011% 1 hereby affirm Ihat I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of[ he 1usiness & Professions Code and that my license is in full force and effect. 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 die work for which this permit is issued. APPLICANT CERTIFICATION 1 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 '// -1_ ?1 fi„r [/ f'rr Date /0 ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am evennpt 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Cenilicate 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 cenify that in the performance of the work for which this permit is issued, I shall not employ any person in my manner so as to become subject to the Worker's Compensation laws of Cali forma. If, ter 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. r APPLICANI' CERTIFICATION 1 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. BUILDING PERMIT INFO: BLDG I- ELECT ❑ PLUNIB Ci MECII r RESIDENTIAL C CONINIERCIAL Fj JOB DESCRIPTION: REMOVE AND REPLACE MAIN ELE•ClRICAL PANEL (200 AMP) Sq. PI Floor Area: I Valuation: $2200 APN Number: 35603036.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CAL'L'ED INSPECTION. Issued by: /eft /V /f� // Date: �Q•�0. J `� RE-ROOFS: All roofs shall be inspected prior to any tooling material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of ALL ROOF COVERINGS TO RE CLASS "A" OR BE ITF,R DAZARDOUS NIATF,RI.0 S DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code. Sections 25505, 25533. and 25534. I will maintain cum plia nee with the Cu pertina Nl unicipal Code, Chapter 9.12 and the Ilealth & 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 Bav 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. Owner onmthoriied agcnl: CONSTRIICI'ION 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 Name Lender's Address ARCHITECT "S DECLARA'T'ION I understand my plans shall be used as public records. Date I Licensed CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777 -3228 t FAX (408) 777 -3333 • buildinGOCUOerino.orD ❑PLbm:BiNG ❑MECHANICAL ®ELECTRICAL ❑MISCELLANrEOUS IZl ouvE- -1 MEP MIsC PROTECT AODRESS 22 / o3 4 vee ;de Dr. I �.PNa 5 0 OWNER NAME peelpak Raba ✓ PHONE yob. 992. 9990 E -MAIL ' STIR= ADDRESS 22 y o3 Rive r 5 / e D Y. [I CTiY, STATE, ZIP (_ OPe;"V0 6,196 01'q I FAX CONTACT NAME KurNs P yl PHONE Nog- 21y.)577 E-MAIL enA rMi/ N '/Q %]oo'C01r1 STR"TADDAESS 6372. 1 /Mao(Qn Rd CITY. STATE. Z2 Sa 4G) °Se c 95/86 FAX ❑ OWNER ❑ OWNER- BUT:DER ❑ OWNERAGENT 19 CONTRACTOR ❑CONTRACTORA ❑ ARCI =' -CT ❑ aGINEER ❑ DEVELOPER ❑ TFNANT CONiRACTOA NAME Alec on S/�n uCENsE Nu"`ER 973 y7 q LICENSE TYPE CIO BUS. LCN COMPANY NAME Sh;ne Elect roc E eha r W'F h&ya Heo.coq FAX STREET ADDRESS / ('372 CITY, STATE- IIP a ^� OJG Gp• 95/2 P1Oh :'JA0B, q 1?- /i77 AACTCT/ENGA cR NAME I DCENSE NUMMER BUS. LIC,7 COWANY NAME E-MAIL FAX STREiT ADDRESS CITY•STATE, ZIP PHONE USE OF OSFD v DUi`LFX ❑ MULTFFAMILY PROIECTNwD- pl.AhTJ 0 Y'S I PROJECT OJ ❑ YES BUP.IHN'G: COMMERCW. URBAN PTERFACE AREA NO FLOOD ZONE ❑ NO Is=BLDG AN ❑ vEs DCHLA HOME? ❑ NO DESCATTION OF WORK ' e TOTAL VALUATION: �vv '� RECEIVED BY: A^ / By my signature below, I certify to each of :be following: I as the property owner or anchoized agent to act on the property owner's behalf. I have;, d this application and the information I have provided is cormeL I have read the Description of Work and vcizy it is ac=:.-. I agree m comply with all applicable local ordinances and sate laws relating t�o•Jbuilding conswcdon. I tboo ii�ze ryresenta:wes of Cupertino to enter the above- identi5ed urOppecl for inspection purposes. Si�vr -an::e of AppliranJAgemt: '/LL!/'i/ //fQ�+1 ��R•�s+•M Dare: � � • �d � G SUPPLEMENTAL INFOPUMATION REQUIRED 4 • OFFICE USE ONLY U J J < OVER- THE -COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR MEFAfscApp_2011.doc revised 06121111 F��� CITY OF CUPERTINO "Iff FEE ESTIMATOR —BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 22403- veR — rStde -Br DATE: 10/10/2012 REVIE\VED BY: Sean \ APN: BP #: 'VALUATION: $2,200 *PERMIT TYPE: Electrical Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD Or Duplex $45 PENTAMATION PER,MITTl'PE: 1REAP A WORK Remove and replace main electrical panel 200 amp). SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: 1EPERMIT Services 1ERT <200 Other Elec. Insp. 0.0 hrs $45.00 200 Amps $45 Permit Fee: SuppL htsp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tar: Administrative Fee: IdD,Vhv $42.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRAPDOC $45.00 Strong Motion Fee: IBSEISAHCR NOTE: This estimmte noes not include jeer due to other Departments (i.e. Planning. Public Works, Fire, Sanitary Server District, School District. etc.). These fees are baser/ on tine arelintinnn information available and ore only an estimate. Contact the Dent for addh'I info. FEE ITEMS (Fee Resolution I1 -053 E/f 711112) Mech. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: Plumb. Permit Fae: Elec. Permit Fee: 1EPERMIT Other Heeh. /nsp. Otter Plumb Insp. Other Elec. Insp. 0.0 hrs $45.00 klech. /up. Fee: Plumb. Lisp. Fee: Elce. help. Fec: NOTE: This estimmte noes not include jeer due to other Departments (i.e. Planning. Public Works, Fire, Sanitary Server District, School District. etc.). These fees are baser/ on tine arelintinnn information available and ore only an estimate. Contact the Dent for addh'I info. FEE ITEMS (Fee Resolution I1 -053 E/f 711112) FEE QTY /FEE MISC ITEMS Plan Check Fee: super. PC ree PME Plan Check: $0.00 Permit Fee: SuppL htsp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tar: Administrative Fee: IdD,Vhv $42.00 Work Without Permit? 0 Yes Q No $0.00 Advenceel Planning Fear: Travel Documentation Fee: ITRAPDOC $45.00 Strong Motion Fee: IBSEISAHCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $178.50 $0.00 TOTAL FEE: $178.50 Revised: 10/01/2012