08080214'CITY OF CUPERTINO
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BUILDING DIVISION PERNUT
j U,N'TR:4CT�OIiI Qi ION
BUILDING ADDRESS:
PERMIT N0,
7i83� BENETTI: CT
JMC ELECTRIC
08080214
NER'S NAME:
PERMO ISSUE DATE
PARIJAT CHI:TALE
1478 BIRD AVE
08/27/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC 1ENGiNEER:
BUILDING PERMIT INFO
REMOVAL OF EXISTING 100 AMP
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONnRd S DECLARATION
Chapter Y(cammcncing
--___.__ ___.�. .___..�_�.-. ____IOb.DeserapLOn
under
I hereby affirm Wtl an licensed under Provisions of
with Section 7000)rfDiviaon 3 of NC Business and Podssimu Code mrd mylito u
in full forte and effm. G I 0 ?O 3 �j
License CI IY.
Dam Con /L
I'S DECLARATION
AR DEC
I urdcivanJ my piw still be used a public mcrrds
stall
Licensed Pmfcuianal
OWNER-BUILDERDE Ce
umpl ConcoON
1 hereby .(Aero 1 undan W C s taw for Ibe
My
on 1.. s 3meal C : C
following mace.. leant. ]011.3. Business and Professions Code: My city m county
whim sequims ...L alms. impr demolw, nr repair -trucmm
n e, also such
he Pur o irguirtl W vision of for amh Permit m file a c..signedwstatement
out es its Recouped
Sq. Ft. Floor Area
Valuation
mmorming itpunuanttoticofDivionsNWConuhessadProliLaw(CMpter9
(coDivision] Professions Cade) or
6 exemiNSereianr, and the da alegodassand
Nat be u exempt Wmfrom and the naso for, W dlRcd eumptiou Any violation of
SaUon 1011.5 by airy applicant for a Permit subjects W applicant to a civil Poulty of
APN Number
Occupancy Type
P Y YP
nm mom Baan live hundred dollar, (SM.
0 1,ammof W pmpmy, m my mployce-wtth vngm u Wnsole comMmUm,
dW 0rsate (Sec. ]0l4, Badness
dr W wort,C d W suumme u ed.'s
Required Inspections
Li a Law dal
and Prtywh ons Cade: The ComncoYa Ldwho law dao nal apply if an roues
and
is
Wmon,andwho deftrollwokh offeedWosak 6u
man amwhobuilds provided AOC intendedec1mledan, fm
own emr,
Owner.
the Wilding or i prwenimpmvements
inove
however, the building improvement is sold within oa year or
for the Owner.
improve of
Wilder will love W When of proving Wt be did rot Wim m improve for purpose or
a
am.).
❑ 1, u owner of One property am uulusivcly contracting with licensed canoacros to
construct W projec (Sec. 7044, Businw and Pretensions Code:) The Cniioacm's U.
.
cense taw dos no, apply m an owner of property who Wilds or improves themen, and
who eomneu for such projem with a eonousm(O llenns4d punts. to W Conoaemf-
Lim. taw.
lamaemptundersce ,B&PCfmthismason
nes Data
WORKERS COMPENSATIONDEC RATION
1 thereby B. Order pcodty of perjury na of the following decimations:
❑ I ham and will maintain a Certifiamof Cauen,in self-iuum fm Wrhefa Compeer
wion, pm i for Section 1]00 of the labor Code, for W puformana rf W
r thismi
wort far wretch this Permit u iaual
1 have and will maintain Wmktf, Compenatian luurua, a required by Secure,
7700 clone labour Code, for the perfarmmuce oldie work fm which this permit is issued.
'
My Work es Compensation Inwnme carder and Policy number am:
CartW: Policy Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis acmhm reed iter be completed ![[be permit is faroue hundred dollars ($100)
m less)
1 u+tih that in W perfmmaae of W w h I'm which i- Permit u issued, l ,Asir Out
employ anypersan' ny mamerm boo tab' c t eWrrken Compensation
law -of Califomi Dm
A.Plicut
1AcC TO A CAf . lf. after and g u erdfsam of Exemption, you should
become act, the Worker's Compensation Provisions or W Labor Crede, you muss
ca p with -uch proviaiav m Nu permit scall rte deemed mwkcd.
CONMUCDON LENDING AGENCY
1 thereby unm that Orem u I coitswcunn krdin6 ageiey for W pMrmuncerf
W wort for which door permit is issued (Sec. 3097, Civ, Q
Lamicfa Name
Toodues Adders,
I tartly that I have mW this application and sum thv the show infooradon in
comet. 1 agree in comply with dl city W county oNinanm-and -WC laws muting m
Wilding conswctian, and hereby authodm mpremnarives of our city to moor upon tie
I w -mentioned property, for inspaclon purposes
(Wo) agree to ave, indemnify and kap harmless W City of Cupertino against
liabilities. Judgments. chits and upcmas which may in any way amm against said City
in consequence of W granting of this permit
�7
APPLIND WILL COMPLY WITH A�NOaP01
Issued by: Date
LATIONSANDS
Re -roofs
Sigrmum PlicanVConuac Dam
HAZARDOUSMATERIAISDISCLOSURE
Type of Roof
1 amdal
Cg euoputroure m Indole .VOM
byCupertino
peri noMuni Municipal
definer by tiro Cupertino Municipal Code. Chapter 9.1x. and W Haw and safety
and
de. Sabo. 25532Gj7
❑Ya 0 N
All roofs shall be inspected prior to any roofing material being installed.
Will W applicant our future Wilding Occupant on, equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hw.andons air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
P
Dimicff
OYa ON.
I have mal W Woodiness mamriW iequncomms under Chapter 6,95.fft Califor-
nia Health d: Safety Code. Sections 25305.25511 and x5534.1 undcaantl Natif the Wilding
docs nw curmmly v a .nares dal It h my maponsibililY b notify the eau mf the
requimmcna 6 uatbemetpdorm' -ofa 'Ream.(
ignature of Applicant Date
All roof coverings to be Class'A' or better
Ownerurauth axd,gem Dam
•
�t Q--
CUPEKTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
SRO �0 2 IV
APN #
Ve ? 0�-od
Date:
a7 c�
Building Address:
e��1'�-ry
Mailing Address (if different from building address):
Owner's Name: �
a.-�- C h � ��f��
Phone #:
Contractor: /
5MCCl2C�!^��
Phone: lfU� `I7 L — 7 78 C
Fax: Ifo
Contractor License #: C—) 0 70a3 qG
Cupertino Business License #: e-4" 1 C 7
Contact: SOvI CIO-yk
Phone: -7
08—' / _ 775)0
C7
Fax:
Residential Commercial ❑
Job Des iption:
et& -t 17 va/ o+
�
S-e�V1'Ce l atye(�
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class).
Occupancy Type:
I -A 1-B 11/III/V-A II/111 B, IV -HT V -B
OW L12 K OCC l�J
Valuation: 4 ;� OOc—�) Square Footage:
Project Size: Express 4Standard Large Major
Green Building: Please complete relevant portion of the Grren BuildinglLEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www. build itgreen.o rg
Revised 7/01/08
0
•
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee 1D
Fee Description
Fee
Group
Permit Type
1GENRES or
iGENCOM
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
I WIN REP
Replacement windows/sliding glass
door ea R windows
B
I WINMEWSTR
New Window -structural shear
wall/mason (includes plan ck fee)
B
I EPERMITFEE
Electrical Permit Fee
E
IMPERMITFEE
Mechanical Permit Fee
M
IPPERMITFEE
Plumbing Pesmit Fee
P
I ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
I PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
r
1 BSEISMICR
Seismic Residential
B
IBSEISMICO
Seismic Commercial
B
/
ITRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
5of5
L
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
loJ
Building Department
JOB ADDRESS: I g PERMIT #
OWNER'S NAME: " ct a PHONE
GENERAL CONTRACTOR: -V" I FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
C __
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheock
Pe
Date
• 3 ITEMS OF 3
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32649028.00
DATE ISSUED.......: 08/27/2008
RECEIPT #.........: BS000005917
REFERENCE ID # ...: 08080214
SITE ADDRESS 21834 BENETTI CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL, RECEIPT :
AMOUNT
---------------
82.08
---------------
82.08
REFERENCE NUMBER
--------------------
visa
6
OWNER ............:
PARIJAT CHITALE
ADDRESS ..........:
21834 BENETTI
CT
CITY/STATE/ZIP ...:
CUPERTINO CA,
95014-1221
RECEIVED FROM ....:
ANDREW DEETH
CONTRACTOR .......:
CLARK, JON
LIC #
21427
COMPANY ..........:
JMC ELECTRIC
ADDRESS ..........:
1478 BIRD AVE
CITY/STATE/ZIP ...:
SAN JOSE, CA
95125
TELEPHONE ........:
(408)971-7786
FEF: ID
-
UNIT QUANTITY
-----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
IBSEISMICR
--------
VALUATION 2,000.00
------
0.50
0.00
--- --
0.50
-
- ---
0.00
1.EPERMITFE
FLAT RATE 1.00
40.79
0.00
40.79
0.00
].'FRAVDOC
FLAT RATE 1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
-----82.08 ------0.00
---
82.08
------0
00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL, RECEIPT :
AMOUNT
---------------
82.08
---------------
82.08
REFERENCE NUMBER
--------------------
visa
6