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13040011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10111 CARMEN RD CONTRACTOR:QUAN'S ELECTRICAL PERMIT NO:13040011 OWNER'S NAME:.CHILLARIGE ANIL KUMAR V 10628 RANDY LN DATE ISSUED:04/02/2013 OWNER'S PHONE: 5109170957 CUPERTINO,CA 95014 PHONE NO:(408)366-1823 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALS License Class Lic.# PANEL UPGRADE 220 AMPS,REMOVE AND REPLACE FURNACE,ADD A/C UNIT 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:$4800 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:35701010.00 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 WIT8 DAYS 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 D OM LAST CALLED INSPECTION. 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 Issued by: Date: 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. twill. 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 3 700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:�� C� Dater 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.) Lender's Name 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, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. �y Signature 'JI "-_ Date GENERAL PERMIT APPLICATION MER COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 1\ .10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228.FAX(408)777-3333•building a5cuDertino.org �' ` MISC CUPERTINO 0 ❑PLUMBIN.G ❑MECHANICAL ❑ELECTRICAL IUSCE/L�LANEOUS PROJECT ADDRESS t®I( I C P m oj r D AM G L L J 1 U OWNERNAME � tl_ C�11LC_I�2C�L PHONE IY3�Qt?�OR�7 E_W-L &r,(PPYa``i�@ STREET ADDRESS 1 Q j(� C A-IR-M CA-1 K_ CITY, STATE,ZIP e� I FAX COI*TTACT NAME ,t �1�Q� l( C. l�L^� PHONE S�`Q-9 0^ O Q r. E-MAIL STREET ADDRESS l (I C M l"ir,j �'t1 CITY,STATE,ZIP l / FAX CA--t PEw% 1 rJU if ( PP OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT ❑ CDNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# cQW .VI CI `f��lovl e-\Oc - 20-10 fa X12 CAMPANY I.TAME C P,^ �-Q ^ � E-MAIL FAX STREET ADDRESS OG \ �t l7 CITY,STATE,ZIP ' PHONTE t 0S -521 C �'w C q v t �i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF k°I SFD.DUPLEX ❑ MULTI FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL - URBAN INTERFACE AREA NO FLOOD ZONE W NO EICHLER HOME? NO DESCRIPTION OF WORK a t t R (9S A 0" TOTAL VALUATION:. 9'3 "U o V 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 p o owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate.Lf agree to comply with all applicable local ordinances and state laws relating to building-construction. I au ori a repress�entatives of Cupertino to enter the above-identified propeiTy for inspection purposes. Signature of Applicant/Agent: �� ?L Date: SUPPLEMENTAL INFORMATION REQUIRED OFFI USE ONLY OVER-THE-COUNTER �' ❑ EXPRESS v U '� ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMIscApp 2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10111 carmen rd DATE: 04/02/2013 REVIEWED BY: mendez APN: BP#: "VALUATION: 1$4,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK anel upqrade 220 ams remove and re lace furnace add a/c unit SCOPE Mech.Plan Check 0.0 hrs $0.00 Ph....b.Plan C'hec'k Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Feer 1MPERMIT Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other Mech:Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elea Insp. 0.0 hrs $45.00 1 ech.Insp.Pee: Plumb. Insp.Fee: Lj Alec.Insp.Pee: NOTE.Thisestimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc These-fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l ink FEE ITEMS(Fee Resolution 11-053 E . 7� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl.PC Fee: Reg. ® OT 0.0 hrs $0.00 $133.00 1MFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 = # Mechanical Permit Fee: $0.00 $67.00 1 1BREMAIR A/C Units(<=10K cfm) Suppl. Insp.Feer Reg.. 0OT0,0 hrs $0.00 220 amps Electrical PME Unit Fee: $0.00 $67.00 1BELEC1000 Services PME Permit Fee: $90.00 Construction Tear: -1-T Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced PlanningFee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TR4VDOC $45.00 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00Al 1 i $178-501 O.9r,700MIJ $445.50 Revised: 04/01/2013 Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC Climate Zones 1 and 3-7 Site Address: Enforcement Agency: Date: Permit#: Conditioned Duct insulation Equipment T el List Minimum Efficiency2 Floor Area re uirement Thermostat Packaged Unit Over 40 ft of ducts Furnace ®AFUE �t, ®COP ®Indoor Coil Served by system added or replaced in Setback ® ®SEER HSPF (If not already present,must be Condensing Unit ® ®EER Resistance 1 D 0 sf unconditioned space Installed) ®Other [3 R 6 (CZ 1,3-5) 1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies:13 SEER,-78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. t Name: v\ 1 " �L.i �4:Y1 Signature: Company: Date: r 2( 1 Address: ` CQY 7 License: I t City/State/Zip: C �,�0 P (�� Phone: 2008 Residential Compliance Forms March 2010 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333-buildlnOQQ CUDertlno.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS (opt\ Co��t�nnQ,tn APN BP# OWNER NAMEti t OWNER ADDRESS P v\e r f-b"A (o,-,,.2 4 DESCRIPTION OF WORK: ' ' A*" 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.) -P,-1. 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 insurance coverage for injuries to workers on my property. �J— 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for t'he construction and are riot 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 p for ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name 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. A/ 5. 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 considered an "employer'understate and federal law. Uv 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 me to serious financial risk. Vr 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 performed under contract with a licensed general building Contractor. L_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. OwnerBuilderForn: 2010.doc revised 04114/10 4/'\ 9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors. 410. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. x_11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have,provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who.does not have a license, the Contractors' State License Board may be unable to assist you with any-financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil-court..It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date:L_ff 2t I --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHOkIZATiON OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following.person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Oi,ne-Euildei-Form 2010.doc revise:104114110 i C PLOT FLANS CRECKED CUPEUNCq' �r 2o -+e 6.8 P!'i.7'In �6�L:+'. 1 Y i APR 0 1 2013 ,.�Llra7 �t qq REVIE VIES,Ftis\CODECO aIANCE . 6LOG. DIFW. . s I O- FF E i I J ('1 Ott -C COMMUNITY DEVELOPMENT DEPARTMENT 0"1. i BUILDING DIVISION-CL PERTINO APPROVE This set of plans and specificationE MUST,be kept at the job site during construction. it is unlawful to make any changes or alterations on same,or to deviate oval from the Building'Official. E ►� Thn uta rnpina of this plan and specifications SHALL NOT bp h yid to psrmit or to be an approval of the violation of any islons of any City Ordinance or State Law. BY ----- _.,_ _-..DATE- 3 PERMIT NO. D N 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: (-I PERMIT# 136OU OWNER'S NAME: 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. 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 Electrical0. 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/ ontractor Signature Date