08010067 CITY OF CUPERTINO ��,a� rt>R„.a7?�vc�;ra��, .a1sx�.`R;r-va=� Y".�(-�Py-K ,�• ��s,��. +r �T- `
BUILDING DIVISION PERMIT PA+�ai\J,1�L1Vyv`1f O,44A•A '1TA :Av
BUILDING ADDRESS: re PERMIT NO.
10383 S BLANEY AVE WILLOW GLEN ELECTRIC INC 08010067
OWNER'S NAME: PERMITISUEDATE
ANIL KUMAR 1085 WARREN AVE 01/11/2008
NE: SANITARY NO. CONTROL NO.
ARCHTECTENGiNEER: BUILDING PERMIT INFO
200 AMP PANEL UPGRADE BLDG O D O 0
uoo LICENSED CONRACIOR'S DECLARATION - lob Description
e uJ 1 Mxeby affirm Nu 1 am IkcwM under provisions of Chapter 9(commencing
eZZ with Section 70f)(1)of Division of the Business and Pmfessipom M Code.smy license is
n? in full forte and circuit. � IGiI -/0
Z License CIww,, Lk.♦ /
Dale )/t1/ l Gaa IEC
As&hall M aid
DECLARA ION
I undersmnJ my plans shall M uacJ u public records
hcid LiccnSJ Pm@ad2nal
0 3 OWNER-BUILDERexemptDE DECLARATION
1 maxo aRcm that 1 1. exempt from Ne CanmacroM1 License Law for td
2O which m moon.Permit
t TIIn L5,BatlnGa up Prof&-ail h.Ter Any city as county
9 fr`. with rets mu•permm ac consun,tlter,improve,do permit
t or mash any umnum
z y prior m its museum.pursuant
ure a mquirte Pro inion rot fmwoh permit Licime rile a signed swcmwt
�< tharmulkcuscJ pSetion70D)of Didmts of Cite ConmurosandPuc LawlCImPrG9 Sq.Ft. Floor Area Valuation
B that anis.gwiNStttion 7andth Oasis for
the
theegeinwandon.AnyonaCde)m
that he V exempt ihemrosm and Cite baro(or t aileged exemption.Any violaJon of
Sedan 7031.5 by airy applicant far a permit subjects the applicant to a civil pmalty,of APN Number Occupancy Type
was mart thus five hundred dollars(SSW).
❑I,uawner of die posperty,mmy mplayw with wgesu Heir ole eompewdon,
sol Prafrsdow Cdran e Contractor's Licanse dans Law not app y as an owner of Required Inspections
property who builds G Im posses Nerenn,and w ho does such wart himself w through his
own mplayms,provided that inch improvements are trot mtedd or offered forsala R.
however.the Wilding or imposumenl is into within au year of mmplation.the owner
builder will Tuve the humid of proving that he did rot build in Improve for purpose of
sakJ.
❑1.u owner of Ne Property w exclusively malMint with licaued mnmanon an
construct the pmjm(See.7044,Budnesa and Professions Cada:)The Cwmaetor's U.
cause Law does not apply an an owner of property who Wilds or improves thersw,and,
who contracts for such pmjeeu with a can racsor(s)licensed punwnt in Ne Committees
License Law.
❑I am exempt under See ,B B P C for this mason
Owner Dato
WORKER'S COMPENSATION DECLARATION
I hereby affirm udcr penalty of perjury ane of the fallowing declandoG:
I have and will maintain a Cardinale of Covent an self-iumrt far winter'sCompact.
on,as provided for by Season 1700 of the labor Code.far W peRormanon of the
wart for which this permit is issued.
0 1 hese and will maintain Worker's Compensation In xam m,as,required by Session
3700 of the labor Cade,for the performance of the work for which this permit is luucl.
My Waringampepusoo Inse� Gas/p0�fit mbar �
carrierCERTIFICATE.
sal/k CAhNO OI
CERTIFI COMPENSATION
TIONIEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thh and.and not W completed Ume,permh Is foram hundred downs(SI00)
or len)
1 cartify that in the part...of the work for which this permit is Issued.l her not
employ any person in say mwnerm as to become nbjma to the Winlans Cnmpenudw
laws of California.Dam
Appucwl
NOTICE TO APPLICANT.If,after misting Nie Certificate of Exemption,you should
become Subject in the Warher's Compensation provisions of the Labor Code,you mail
vOO forthwith comply with seen provisions or this MMiuhall W deemed revoked.
.Zs .yCONSTRUCTION LENDING AGENCY
y.
(—t Ibertby affirm that there is a comueWn lendingagemy fns da;performance of
C'> the work fur which this permit is issued f!1m.3097,Civ.C.)
f21 Lender's Name
z lender's Adtlm..
U O I awry dost 1 have read this application and ststo Nu No shove infomumw is
Iy^ cancan.l agree an comply with all city and county oNiw¢es and mm lawn missing an
5 Wilding consmuNon,and hereby suNadu mpreenmivG of Nu City to enter upon Ne
W ahow-mendaned property for inspection purposes
G (We)agme to Save,indemnify and keep harmlm the City of Cupertino gaiml
Cj liabilities,judgments.eau and expenses which may in my way scene gLmst said City
U in consegunnce of the trmtlnt of this permit.
^" APPLICANT UNDERSTANDS AND WIL OMPLY WITH ALL N-POINT Issued by: Date
SOURCE ATION i ' ^
va Re-roofs
Signuurt icansCan Date
H Us MATERIALS DISCLOSURE Type of Roof
R yUse Cupmt n forum Wal Co e.Chapter
x9.12.Mille Health
material
u deOnd io Cite Cupertino Municipal Code.Chapter 9.11 and the NcaiN and Safety
Code.Se y.255324)? e
❑rexAll roofs shall be inspected prior to any roofing material being installed.
W111Cite applicant ar future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
't harardnus air commminams as defined by the Bay Area Air Quality Management all new materials for inspection.
R `
QYG
I have read the han.dWl mucrialamquimmenuunMr Chapter6.95 of the Cdifor.
.H.10 h SafetyCadm Sodom 25505,x5533 m125534.1 udenmad Neuf Ne Wilding
Joev net currcndy have a mrunL d u It is my maxnexhility to notify the ma m,n the
mgOmaha hkhmun ' rte Wuancaofa Cemrmw.f Oc O Signature of Applicant Date
] All roof coverings to be Class"B"or better
Owner ar wt .gent Date'
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
NIP
APN# (nq 23 1
Y0,) Date:
Building Address:
v cA ISo / y
Mailing Address (if different from building address):
Owner's Name: Phone#:
257 -- 67 27
Contractor: 1 ,L Phone:
w! , I Dw le 1, � !'CC.Ir�`� 6 `l'b — Oo8'Z
Fax: 1H10
Contractor License #: 5 Cl ' _ C O
Cupertino Business License#: I q7
• Contact: 1 1 " ✓ I Phone: / i� o�\ . L� 0 O o
'\ L D� r�'' q)" J
Residential Commercial Fax: l`Z
Job Description:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, I1FR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N ?--
Valuation: Square Footage:
2 �—o v �—
Project Size: Standard ['t1--L are ❑ Major ❑
•
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
IBBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h •
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ca boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P •
(per hour
1MEETINGIHR Application Meeting B
Q CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
0
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1 CHIMIVEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
IFENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
IMODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3of5
{ CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION .
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone &Brick Veneer B
(interior/exterior) •
17S-IEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>IOSF Skylight greater than 10sfor B
structural
17STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
4of5
r - CITY OF CUPERTINO
CUPEfr,TINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
lEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1TRAVDOC Travel &Documentation B .
IBUSLIC Business License B
•
5 of 5
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # : . 1
Sec: Twp,: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36928037 . 00
DATE ISSUED. . . . . . . : 01/11/2008
RECEIPT #. . . . . . . . . : BS000003670
REFERENCE ID # . . . : 08010067
SITE ADDRESS . . . . . : 10383 S BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANIL KUMAR
ADDRESS . . . . . . . . . . : 10383 S BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3169
RECEIVED FROM . . . . : WILLOW GLEN ELECTRI
CONTRACTOR . . . . . . . : LONDRE, MARK T LIC # 15897
COMPANY . . . . . . . . . . : WILLOW GLEN ELECTRIC INC
ADDRESS . . . . . . . . . . : 1085 WARREN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 289-9725
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 500. 00 0 .50 0. 00 0. 50 0. 00
1ELECINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00
1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 204 .46 0. 00 204 .46 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 204 .46 # 12349
---------------
TOTAL RECEIPT 204 .46 .
Community Development
' 10300 Torre Avenue
SO
Cupertino C A 95014
Telephone(408)777-3228
CIN OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/033 s 3C �a ooG�
OWNER'S NAME: W we
GENERAL CONTRACTOR: O F #
I am not using any subcontractors: I 0
S' a Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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
Sheet Rock
Tile
Owner/Contractor Signature Date