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10080203CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10471 WESTACRES DR OWNER'S NAME: RAJESH GEORGE IER'S PHONE: 4085823185 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor �Date 1 r I hereby a rr that I am licensed under the provisions of Chapter 9 (commenci 'th Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. CONTRACTOR: r I PERMIT NO: 10080203 f%T DATE ISSUED: 08/27/2010 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ELECTRICAL UP -GRADE FROM 100AMP TO 200AMP SERVICE, STUC CO PATCH & PRIME & PAINT 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 regulations per the Cupertino Municipal Code, Section 9.18. r Signatur Date I L, 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) I, 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 -nnify and keep harmless the City of Cupertino against liabilities, judgments, , 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 regulations per the Cupertino Municipal Code, Section 9.18. Sq. F t Floor Area: APN Number: 35914032.00 Valuation: $900 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date: -27_ J.,d RE -ROOFS: All i oofs 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 insp ection. Sigi tature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 111; Lve read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain cor rpliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Sal ety Code, Section 25532(a) should I store or handle hazardous material. Ad litionally, should I use equipment or devices which emit hazardous air cor tandnants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the He rlth & Safety Code, Sections 25505, 25533, and 25534. a a�1 er r ag 1 Date: (cj CONSTRUCTION LENDING AGENCY 6,-reby affirm that there is a construction lending agency for the performance of work's lot which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I r nderstand my plans shall be used as public records. Signature Date I Licensed Professional CITY OF CUPERTINO FFF. ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: --7DATE: t'ln;fzh- ��t ,� t'lrcc k —7 REVIEWED BY: Ph'I'z Citc"A APN: BP#: 'VALUATION: $900 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex p It>i �I, PENTAMATION 1REAP14 I USE: � �<<%�� `IRI--!- PERMIT TYPE: WORK ELECTRICAL UPGRADE WITH STUCCO PATCH/PRIME & PAINT SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID t'ln;fzh- ��t ,� t'lrcc k —7 QTY Ph'I'z Citc"A BP FEES Elec. Permit Fee: IEPERMIT Temporary Power 1 ERT<200 Other Elec. Insp. 0.0 hrs $42.00 1 ,r„">, t ec $42 1e`t'117i7 1`C:'E': PME Unit Fee: $42.00 PME Permit Fee: $42.00 ui7)irm'titw lCts` .'1t`WIS!iC((1 1Tf'0c11' I'e' : Work Without Permit? ® Yes No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $42.00 So (in", ;1'11�Ilorl F("': NOTE• These ees are based on the reliminary information availai Pie and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff: 7/1/10 h P11411; t ,<��-, t'ln;fzh- ��t ,� t'lrcc k —7 Elec. Plan Check 0.0 hrs $0.00 Ph'I'z Citc"A t Elec. Permit Fee: IEPERMIT �; ::F-1 ter, t'irrr„F r',>.1,L Other Elec. Insp. 0.0 hrs $42.00 v",.r. 1 tz?, ,r„">, t ec $0.00 NOTE• These ees are based on the reliminary information availai Pie and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff: 7/1/10 FEE QTY/FEE MISC ITEMS Ph'I'z Citc"A Slip"d, PC 1c F71 PME Plan Check: $0.00 1e`t'117i7 1`C:'E': PME Unit Fee: $42.00 PME Permit Fee: $42.00 ui7)irm'titw lCts` .'1t`WIS!iC((1 1Tf'0c11' I'e' : Work Without Permit? ® Yes No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 So (in", ;1'11�Ilorl F("': Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $127.00 $0.00 TOTAL FEE: $127.00 Revised: 8/17/2010 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: lot: APN ........: 35914C32.00 DATE ISSUED.......: 08/27/2010 RECEIPT #......... BSOOOC11313 REFERENCE ID # 1008003 SITE ADDRESS 10471 WESTACRES DR SUBDIVISION ...... CITY CUPER- I NO IMPACT AREA ...... OWNER RAJES11 GEORGE ADDRESS . 10471 WESTACRES DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: JOHN 3 MCDOWELL 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 ____ 1BCBSC ------------- VALUATION ---------- 900.00 ---------- 1.00 0.00 1.00 42.00 0.00 0.00 lEPERMITFE FLAT RATE 1.00 42.00 0.00 0.00 42.00 0.00 1ERT<200 UNITS 1.00 1.00 42.00 42.00 0.00 1TRAVDOC FLAT RATE ---------- -----42_00 ------0_00 ---------- 127.00 0.00 127.00 0.00 TOTAL PERMIT METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 127.00 --------------- 127.00 REFERENCE NUMBER -------------------- `"I SA VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 402 TEMPORARY POWER CITY 0'F CUPEiZTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Green Building: Please complete relevant portion of the Green B ' ding/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. oints Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 Date: Building Address: 104") cs-+ +mss bV- �,o c q;�o Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA:(Exterior work only) Yes ❑ No ❑ If yes, 3rovide letter from HOA Ker;s NF--s V to Pon #: Cntractor. NCboU)71 1 Phone Fax: Contractor License #: 3 4� ( 9g Cupertino Business License #: Contact: Phone: Fax: Residential Commerciale Job Description: Ctr 1C VIL j Ccco Rt6 Building Permit Info: 'Bldg Elect Plunlb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: J [� 1-A, 1-B ❑ II/= -A ❑ II/VI B, IV -HT, V-Bq00 �- Valuatio,� Square F t e: I'So Project Size: Express Standard ❑ Large ❑ Majo Green Building: Please complete relevant portion of the Green B ' ding/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. oints Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 N. Fiooring 1. Select FSC Certified Wood Flooring 1 IAQ'Health pts y=yes! 2. Use Low VOC, Water -Based Wood Finishes . 2 IAQ'Health pts y--yes- eses.S.0se S. 0199�_ 3IAQ'Health pts y='es 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y --yes 5. Use Engineered Sheet Goods with. no added Urea 4 Resource pts y --yes Formaldehyde 61AQHealth pts y --yes 6. Use Exterior Grade Plywood.for Interior Uses 1 IAQHealth pts y --yes 4IAQHealth pts y --yes B. Use FSC Certified Materials for Interior Finish 4 Res ource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 ReE:ource pts y --yes 10. Install Whole House Vacuum System 3 IA(UHealth pts y --yes N. Fiooring 1. Select FSC Certified Wood Flooring 6 Resource pts y=yes i. iirPdd>f>Iflevals,fMs 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y --yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ Health pts y --yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y --yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y --yes Total Points Available: Total Points Project Received: G: nbuildir idellnes/remodelerslgreenpointsfina1212D4protected.xls 49� i CUPERTINO CONTRACTOR / SUB CONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: vyttiyx1,S M PERMIT # os 0 '3 OWNER'S NAME: (sl-% G60r6 F PHONE # 33 I j j GENERAL CONTRAC R: h �CMCbaLLT. Ji BUSINESS LICENSE # ADDRESS: C..cL C -T l\ 'AE. 1�\U ( (,jZ' A Q r)S.I . CITY/ZIPCODE: t-�h Cj*f-*L CAqSOSJ *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 A UBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. V� 76/101 C) I am not using any subcontractors: bcuk 4 Signa ure Date Please check applicable subco tract rs and complete the following information: v i Owner / Contractor Signature 7 o1U Date 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 v i Owner / Contractor Signature 7 o1U Date