11050294CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10380 IMPERIAL AVE
OWNER'S NAME: NARAYAN VENKATARAMANI& RAMAN
OWNER'S PHONE: 4083431047
L LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 3 jl�, i B
Contractor 1)% ate 1"
I hereby affirm that I am licensed u he 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 per the Cupertino Municipal Code, Section
9.18.
Signature _ w - Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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).
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,
-ts, and expenses which may accrue against said City in consequence of the
zing of this permit. Additionally, the applicant understands and will comply
.,n all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOF
!IT NO: 11050294
1( : DATE ISSUED: 05/31/2011
PHONE NO:
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH r— RESIDENTIAL COMMERCIAL r—
JOB DESCRIPTION: ADD 39 RECESS LIGHTS FOR EXISITNG SFDWL,FIELD
INSPECTOR TO VERIFY 200AMP EXISTING PANEL
Sq. Ft Floor Area: I Valuation: $1500
APN Number: 35719096.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:y3& 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
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. I 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 Codeys 25505, 25533, and 25534.
Owner or author e agent: r
�� Dater
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 Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional.
CITY OF CUPERTINO
W -M-7 FFF, FSTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10380 imperial ave. --7DATE:
05/24/2011
REVIEWED BY: bobs.
UNITS
APN:
BP#:
'EVALUATION: 1$1,500
y°PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION
1 REAP11
PERMIT TYPE:
WORK
To Clear Code Enforcement Case: add 39 recess lic ihts for existing sfd field inspector to verify 200 am
SCOPE
existing panel.
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Fixtures, Lighting
1BREMFIXT
39
#
$120
PME Unit Fee:
$120.00
PME Permit Fee:
$42.00
Work Without Permit? Yes 0 No
$162.00
TOTALS:
A
Travel Documentation Fee: I TRA VDOC
1 $120.00
Strong Motion Fee: 1BSEISMICR
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0hrs $42.00
A7nTG'. 71- form - Anand n.. fhn ;"fnrm"dA" nvnilnhly and ora nnhr nn octimnta t^nntart tho Dont far addn'1 info.
FEE ITEMS (P'ee Resolution 09-05/
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$120.00
PME Permit Fee:
$42.00
Work Without Permit? Yes 0 No
$162.00
A
Travel Documentation Fee: I TRA VDOC
$42.00
Strong Motion Fee: 1BSEISMICR
$0.50
0.5 hrs Admin./Clerical Fee
$39.00 (ADMIN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$367.50T
$39.00 TOTAL FEE:
$406.50
Revised: 04/29/2011
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org MISC
7 PLUMBING n MECHANICAL F ELECTRICAL ❑ MISCELLANEOUS
PRO CT ADDRESS l d v /
APN # /� C
OWNER NAPS
1
PHONE`
E-MAIL
STREET ADDRESS
C1TY, STATF zip
FAX
T
C NTACT NAME
PHONE
E- __
0 2
STREET ADDRESS
CITY, STATE, ZIP
FAA
1
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR
❑ CONTRACTOR AGENT Cl ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CPVTRACTOR NAME
LI SE ER
LI TYPE
BUS. LIC #
CO ANY NAME ,
E-MAIL
J
FAX
L
STREET.AD SS ,
CrrY, STATE, ZIP
PHO
z
AJ COUTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
"'SE OF SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial
SAN INTERFACE AREA
❑ Yes Cl No
FLOOD ZONE ❑ Yes ❑ No
a7RUCrURE:
DESCRIPTION OF WORK�.
r
' '
.
,1'
i
r
:r ,
4
CEDEEI2B w
FOTALVALU
� F
nature below, I certify to each of the foflo r-1 am the pr perty 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 t I have
read a Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cans c n.
sentatives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of ApplicandAgent -
Date:
SUPPLEMENTAL INFORMATION REQUIREDgga
A,fEPAfuc4pp_2011.doc revised 03/16/11
0;-- _.)
M
C13
6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35719096.00
DATE ISSUED.......: 05/31/2011
RECEIPT #.........: BS000013608
REFERENCE ID # ...: 11050294
SITE ADDRESS .....: 10380 IMPERIAL AVE
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............: NARAYAN VENKATARAMANI& RAMAN
ADDRESS ..........: 10380 IMPERIAL AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: VENKATARAMANI NARAY
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
----------
-ADMIN
-------------
HOURS
----------
0.50
----------
78.00
----------
0.00
----------
78.00
----------
0.00
1BCBSC
VALUATION
1,500.00
2.00
0.00
2.00
0.00
1BREMFIXT
NO. FIXTURES
39.00
240.00
0.00
240.00
0.00
1BSEISMICR
VALUATION
1,500.00
1.00
0.00
1.00
0.00
1EPERMITFE
FLAT RATE
1.00
84.00
0.00
84.00
0.00
1TRAVDOC
FLAT RATE
1.00
84.00
0.00
84.00
0.00
----------
TOTAL PERMIT
----------
489.00
----------
0.00
----------
489.00
0.00
METHOD OF PAYMENT
-----------------
CHECK
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
406.50
82.50
---------------
489.00
VOICE ID DESCRIPTION
-------- ----------------------------
304 ROUGH ELECTRICAL
REFERENCE NUMBER
--------------------
#167
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL 512 FINAL HANDI-CAP
COMMUNITY DEVELOPMENT DEPARTNENf
BUILDING DIVISION - CUPERTINO
APPROVED
PROJECT DATA - RESIDENTIAkset of plansandspecifications MUST be kept at the
SUI
COMMUNITY DEVELOPMENT DEPARTMENT • �r ftruction. It is unlawful to ma':� any
a erations on sane, or io dovi�-:e
10300 TORRE AVENUE • CUPERTINO, CA 9501 e'#om, without approval frorn the Building
(408) 777-3228 • FAX (408) 777-3333 • building ug tino.oro
CUPtEfMNO Sta mfpinng of this plan and sr;=;- fications '�,,,a,.(_ ^:^T
be held to permit or to Le an r, vai o* th;:
Existing
Proposed
Floor Area: First Floor:s. f. s.f.
Second Floor: S. f. s. f.
Garage s.f. s.f.
TOTAL: s.f. s.f.
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N
Is privacy protection planting required for the project? --
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code (based on the 2009 International Residential Code)
2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code)
2010 California Electrical Code (based on the 2009 International Electrical Code)
2010 California Energy Code
2010 California Green Building Standards Code
Cupertino Municipal Code
ProjectData-Residential.doc revised 03/09/11
IS
OT any provisions of any Cit r 4
PROS
#
J'
OWNER NAME
PHONE
STREET ADDRESS
CITY, STATE, ZIP
APPL,j,CA14T NAME
i ` KU"PgONE ' E-MAIL
S ET A1�UNI'1J
�If
IP FAX
, _ C11;�
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 113--OMRA=R ❑ coNTRAcroRAGENT ❑ Apc=cr ❑ ENG; EER ❑ DEVIIAPER ❑ TENANT
—S`'
14
?%.
2 `d':u :•.li.} wT n .nExr iS & %
EXISTING USE(S):
-57z
PROPOS":
OCCUPANCY(S):TYPE
OF f
PARCEL
CONSTRUCTION: �/
AREA:
F'�
F.IItE
N
WUI AREA: FLOOD AREA: �IESN�AREA: �SPRINKLERS:
"
Existing
Proposed
Floor Area: First Floor:s. f. s.f.
Second Floor: S. f. s. f.
Garage s.f. s.f.
TOTAL: s.f. s.f.
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N
Is privacy protection planting required for the project? --
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code (based on the 2009 International Residential Code)
2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code)
2010 California Electrical Code (based on the 2009 International Electrical Code)
2010 California Energy Code
2010 California Green Building Standards Code
Cupertino Municipal Code
ProjectData-Residential.doc revised 03/09/11
IS
10`
107 A ai n p4111 -W
G
I
P-�
-37
f�
��i(✓lrl U
r.�
BADRoo
IA' X 2:2
$ATS
$' Y- Iqa
/FNkJ*A"t�� NW�YAI
10560 lw�Te�\u\t, 7k�f=
Gup�.KT i gyp, c P-1 q5v t J1
(A 00) 0,�-�-
BF-D ROON\
l3'- 6"
BF-pACOM
1n5�-ad 3C NeA,4J H 4,o
15 6401rw�, 41CK� tio2clvcx-�
6 i wt� ear Ucr�m �
15 f3 I �i�0 v
.MC,4-+-
A9,4n -P"¢C
�wo ;�;v �N
0 tic A K �Z�--
Izl�:7
r
vct'�c.Y��
l�cs�2 y�-