Loading...
10110132 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7810 ORION LN CONTRACTOR:SHARMA GEETA R AND PERMIT NO: 10110132 PRAMOD K O ,R'S NAME: SHARMA GEETA R AND PRAMOD K 7810 ORION LN DATE ISSUED:11/22/2010 OWNER'S PHONE: 4082570533 CUPERTINO CA,CA 95014-5001 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# MECH r RESIDENTIAL r— COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE PACKAGED A/C ON ROOF WITH SAME SIZE AT (commencing with Section 7000)of Division 3 of the Business&Professions (E) Code and that my license is in full force and effect. ROOFTOP LOCATION. 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. Sq.Ft Floor Area: Valuation:$5500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36220016.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. 7 S ire Date Issued b Da OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed cont tors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Pqde,I must forthwith comply with such provisions or this permit shall be deemed r vo ed. Owner thq�y�ed agent: p Y p p Dater O APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above info tion is correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's tr "ding construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) L ae above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. Signature Date I understand my plans shall be used as public records. '�'� 'y ' �� 2L'" �p, Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36220016 . 00 DATE ISSUED. . . . . . . : 11/22/2010 RECEIPT #. . . . . . . . . : BS000012074 REFERENCE ID # . . . 10110132 SITE ADDRESS . . . . . : 7810 ORION LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SHARMA GEETA R AND PRAMOD K ADDRESS . . . . . . . . . . : 7810 ORION LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5001 RECEIVED FROM . . . . : PRAMOD SHARMA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY SHARMA GEETA R AND PRAMOD K ADDRESS . . . . . . . . . . : 7810 ORION LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5001 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 500 . 00 1 .00 0 .00 1. 00 0.00 1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 00 0 .00 1BSEISMICR VALUATION 5, 500. 00 0 .55 0 .00 0. 55 0 .00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148 .55 0. 00 148 .55 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 148 .55 DISCOVER --------------- TOTAL RECEIPT 148 .55 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7810 orion In. TD-ATE: 11/18/2010 REVIEWED BY: bobs. APN: BP#: /0 112-91,51:1Z *VALUATION: 1$5,500 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD Or DU12X 700 11, PENTAMATION FURN/AC USE: p 11-/(MR A l,'/_ I: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 TOTALS: $63.00 Mech.Plan Check 0.0 hrs $0.00 �.��_` Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrsL$42.00 t) :, �,, t�5 1; �, `,� 1 Li —L— NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 09-051 El. 7%1;'10) FEE QTY/FEE MISC ITEMS Phol E.hccn PME Plan Check: $0.00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 ('1'01zstt'cr(~ii,M I(/X F-] 1cozWiccr1 f CC' Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong,Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldy Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $148.55 $0.00 TOTAL FEE: $148.55 Revised: 11/08/2010 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(a)cuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ^�7$r O i / ( APN BP,# j OWNER NAME /RR D� C A^��AA OWNER ADDRESS "'7 CyP_ID� � Ct�c—g: i� C1 Cpl DESCRIPTION OF WORK: P�l��/ &-6T_ C '47c- 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 (DIR TIONS:Please read and initial each statement below to signify you understand or verify this information.) 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 in rance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not 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 otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her 7na a instead of my own. a 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license Tal bers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars($500), including labor and materials, I may be 1si6deredan"employer' under state and federal law. . I 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 un mployment compensation for each "employee." I also understand my failure to abide by these laws may subject me o serious financial risk. I understand under California Contractors'State License Law, an Owner-Builder who builds single-family esidential 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 lierformed under contract with a licensed general building Contractor. 8. 1 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. OwnerBuilderForm 2010.doc revised 04/14/10 1 understand I may obtain more information regarding my obligations s an"employer"from the Internal evenue 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 co itact the California Contractors'State License Board(CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for mo re information about licensed tractors. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that ithe party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this poposed construction activity, I will abide II 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 ormation 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. i our only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand thot if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, �ou 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 inforrr►ation.) 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 acce table to the city may be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: �'�' Date: �O ---•-------- -- -------------- - -- =---------------------------------------------- - (NOTE: The following Authorization--- ----- ---- For---m---is---required------ --- to---be---completed-------------by---the---prd-perty owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION 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 ay be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 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: 7alq e--Qto lel PERMIT# OWNER'S NAME: p L7 PHONE# '2-5 S --� 3 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 Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating i fZL Tc--ia Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTL a FURNACE/AC :.UPEI� TINO PERMIT APPLICATION FORM /1211e 9/J APN# -3W 1;?0 Ol Date: Building Address: �8 I D ©P- +D, r 14M G �r U PER:f i NJ S / `J Owner's Name: PP-A M 01 �HAPWA Phone#: 7,- 0 %S2)-?:) Contractor: - Phone#: Q(�I _ D S c� Fax* P (0 1_ I(OS0 Contractor License#: Cupertino Business License#: Contact: Ti Phone#: 9�Z-S' _ V 9 7_ 03849 rVI Fax #: Building Permit Info: Elect a , Plumb Mech Residential M Commercial Job Description: R&P LA c-E, A c,K A c-A E1' A(C. c,i�lK a o i�1 i I .I-� Sia N1 E S i Z-F— [9oi S`rirfkeuf 76P , For Residential Installations: Attic ❑ 1'c floor ❑ 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): $ . Soo -- O0 Un r Strapped On Platform Bonded New Location 0 Replacement Project Size: Express Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09