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13040021 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10466 S TANTAU AVE CONTRACTOR:CALIFORNIA HOMES PERMIT NO: 13040021 AND KITCHEN DESIGN r OWNER'S NAME: BRAHMAJI POTU 1775 JUNCTION AVE DATE ISSUED:04/03/2013 OWNER'S PHONE: 4084463255 SAN JOSE,CA 95112 PHONE NO:(408)392-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11 License Class_ Lic.# : � TEMPORARY POWER POLE Contractor � ��!� Date I hereby affirm that I am licensed under the provisions o£Chapter 9 (commencing with Section 7000)of Division 3of 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 consentto 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:$300 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:37509048.00 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 WITHIN 180 DAY ERMIT 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 DAYS ST CALLED INSPECTION. indemnify and keep harmless the City'of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said Cityinconsequence of the granting of this permit. Addition ant understands and will comply Is ate: with all non-point sour ations Cupertino Municipal Code,Secti 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 withwages 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. I will 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 de ' hich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code;for the air contaminants as defined by the Bay Area . ual' anagement District I performance of the work for which this permit is issued. will maintain compliance with the Cu . o Muni ' Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 05,255 534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized age Date: 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 certificatel 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 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. Signature Date GENERAL PERMIT APPLICATION �O MEP . COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION V` .10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 a O CUPERTINO (408)777-3228-FAX(408)777-3333• buildinci(@CUDertino.or4 IJ MISC ❑PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN n OWNERNAME nn PHONE E-MAIL YoS Lr - 6' 2 STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE j E-MAIL of .gyp,... STREET ADDRESS CITY.STATE,ZIPC n FAX ❑ OWNER ❑ OWATER-BUILDER ❑ OWNERAGENT El CONTRACTOR %KCONTP ACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /'I O^ f� LICENSE NUMBER b LICENSE TYPE BUS.LIC# Q Ll 57 COMPANYNAME J EMAnsrmdn(yr�(k0 2S co �oa , w• FAX 3�Z.&�20 \ Ca�� -o�, De. STREET ADDRESS CITY,STATE,ZIP r- PHONE v CIS aZ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC'# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WIIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORT: Ny TOTAL VALUATION: Do By my signature below,I certify to each of the following: I am the to o er or authorized agent to act e property o s behalf. ave read this application and the information I haveprovided is correct. I hav the D cription of Work and verify it is accurate. I agree to with all applicable local ordinances and state laws relating to building constructio uthorize re esenta 'e of Cupertin to enter the above-identi ed pr pei try for inspection puiposes. Signature of Applicant/Agent: Date: SUPP.W3eNTAL Ili TION REQ RED OFFICE USE ONLY OVER-THE-COUNTER I- ❑ EXPRESS U v ❑ STANDARD U ❑ LARGE ❑ MAJOR NIEPA&cflpp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10466 S TANTAU AVE DATE: 04/03/2013 REVIEWED BY: MELISSA APN: 375 09'048 BP#: *VALUATION: $300 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP14 USE: PERMIT TYPE: WORK TEMPORARY POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $45 TOTALS: $45.00 '`,' A OR Xfech.Plan Check Plumb.Plan Check Elee.Plan Check 0.0 hrs $0.00 Lfech. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT F� Other•R9ech.Insp. Other Plumb Insp. Other Elec.Insp. 0.0 �hrs �$45,00. Allech.Insp.Fee: Plumb. h,sp.Fee: Elec.Insp.fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the preffinWdna information available and are only an estimate. Contact the Dept-for addn7 info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check lee: SZf1)1)1. PC Pee PME Plan Check: $0.00 Permit Fee: SuP)Pl, Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Constrztclion Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 A Strom Motion Fee: . IBSEISMICR $0.50 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 $178.501 $0.00 $178.50 �' Revised: 04/01/2013 Building Department City Of Cupertino 10300.Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax:408-777-3333 CONTRACTOR/ SUBCONTRACTOR-LIST JOB ADDRESS: 6 PERMIT#` ' OWNER'S NAME: b PHONE# cam$ Z- Z GENERAL CONTRACTOR::5 BUSINESS LICENSE# 6 ADDRESS: ILI CITY/ZIPCODE: *Our municipal code requires alLbusinesses 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 OR: CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 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 ntra o igna u Dat