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11100142 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10401 E ESTATES DR CONTRACTOR:MIKE COUNSIL PLUMBING PERMIT NO: 11100142 INC OWNER'S NAME: KANNAN CHANDRASEKAR AND PADMANABHAN 1915 O'TOOLE WAY DATE ISSUED: 10/18/2011 NER'S PHONE: 4083065215 SAN JOSE,CA 95131 PHONE NO:(408)272-4900 O LICENSED CONTRACTOR'S DECLARyA�TION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB License Class Q Lic.# �y 1 F r MECH RESIDENTIAL COMMERCIAL Contractor M_tA L —Date _�'�1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SFD,PANEL UPGRADE TO 125 AMP (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:$5115 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. APN Number:36913044.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply withall ci and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and here a�}thorize representatives of this city to enter upon the above mentioned prope fof inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmlessth City f Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expen wh' may ccru against said City in consequence of the granting of thi e i dditi nally the applicant understands and will comply with all non- int c reg u tion per the Cupertino Municipal Code,Section Issued by 9.18. moo/ Signature Date RE-ROOFS: L OWNER-BUILDER DECLARATION 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 I here affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Cod ctions 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertin unicipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532 sh old I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additiona sho I use uip ent or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contain an d rued th ay Area Air Quality Management District I will main in co lia a wi th Cupertino Municipal Code,Chapter 9.12 and the permit is issued. He h& ty ode, ec ons 25505,25533,and 25534. 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 n r a ori !� Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ins--nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION C nd expenses which may accrue against said City in consequence of the giu__iig of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \` (408)777-3228• FAX(408)777-3333• building(5cupertino.org ` MISC CUPERTINO []PLUMBING MECHANICAL ELECTRICAL DMISCELLANEOUS 1 PROJECTADDRESS r\ ib. ' '�* nC/� I - L-4' {. INNER NAME �G P� ��`r E-MAIL sTREsr ADD 1 sCs o\ G_ �j�c�. s P�{L�C D q S O��TATE,ZIP FAx CONTACT NAME O E-MAIL STREETADDRESS STATE ZIP ^ w 6Z FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR I tONTRACfORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE ER LICENSE TYPE BUS.LIC# L l: lt�L COMPANY NAME ,� E-MAIL FAX STREETADDRESS CITY,STATE,ZIP l O PHONE y 11 t sem" 09 Z ARCHITEC IENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF ❑SFD ar DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WO \ ZS w` TOTAL VALUATION: i� s>�' RECEIVED BY: By my signature belo ,I certify to eac f fol I am property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have ro * ed' rrec d hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ' n strut, I orize representati pertino to enter the above-identified property for inspection pudposes. Signature of Applicant/Agent-', Date:1 O "�_ -4, O 71EN Aj Rk23XAnON REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS Y U W ❑ STANDARD S U ❑ LARGE a ❑ MAJOR 1EPMIscApp_2011.doc revised 06121111