08060025Y�1t �c
f5!
CITY OF CUPERTINO
BUILDING DIVISION . PERMIT
CONTRAGT(OINFORMATI®N'
ax, .,y,.s:'pr.... .:+S;a.��. �ma.,••n �*c. ��as,�^a
BUIIN A 0 FSS:
11o2�b PALOS VERDES CT
ADAMS BROTHERS CONSTRUCTION
PERMIT NO.
08060025
OWNER'S NAME:
PERMIT ISSUE DATE
SRIKAUTH GOPOLAU
10100 TORRE AVE
06/04/2008
NE:
SANITARY NO. CONTROL NO.
(408) 564-5207
ARCHRECffFNGINEER:
_
BUILDING PERMIT INFO
BLDG EIECi PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
CSCiIP
Job Description
1 bunny a(etm does 1 w licsmcd under provisions of Chapter 9 (c«nmencing
with Section 7") of Division J of the Business and Professions Code, and my license u
PANEL UPGRADE
in full force and effccL c e
Linc Class L. A
DOW «—CannuW
—�
ARCHITECTS DECLa ATION
I understand my plata shall be used an Wblic records
-
Licensed Pmfsssionsl
OWNER-BUIIDER DECLARATION
I herehy .M. thin Am .empt from the Contractors License Law for the
i following moon. (section 70] 1.5, Business and Profession Cade: Any city ase county
which requima A Permit to atmmcs. alto. improve. demolish, Al .*, any A recture
; prior W its issuance, aw requites the applicant forwch permit to Ole a signed statement
• mat he is licensed ro me of the Canuacmra Uame law (Chapter 9
Sq. Ft. Floor Area
Valuation
purwam provi:ism
Suction ]000) of Division 3 or me Business And Professions Cods) or
2 2 0 O
(c«nmencing with
. that he is exempt thud" and the basis for the alleged exemption. Any violation of
35621031
OCCU
Occupancy Type
Section 7031.5 by any applicant fora permit subjecu the applicant to a civil penalty ofNumber
nosm«e than five hundred dollars(g500}
❑ Luowner property,«my employes with wagerer
cW.Bu Wn,
Required Inspections
le'v.le
. andor offend Tarsale (sec. toad. Business
b omen
will do mcwom and the he
Con License do
Code: Th CanuActors Licca law duces not apply to an owncr
And Pry,wW
nwork ltimulfar Waugh his
W And who is
«imposach
enywymes,
psis
are
such improwmanta,re not intaMed eered for
Own imp,
awn employcu, provided
th' owns-
the Wilding or improvement u mid avoter.
pr
thin oro year of completion.
,
Wildeohowever.
o provfor
Wilda will haw Je burdrn of proving that k did not build a improve for puryose of
.mJ.
1, As Manor of the pcurl AM emdusivelY,onnandng with licensed c nuxnars us
cuutmct the project (Sec. 1044, Business and Profmsimu Code:) The ContraMrs U.
chose Law docs not apply to an owner of pmperty who builds or improves thereon. and.
who anuaus for such p.jem with A cowncWrts) licensed pursuam An me Convauora
Littme Law.
❑ 1 Am '...in vada Sec , B A P C for this mason
owncr Date
WORKER'S COMPENSATION DECLARATION
i hereby affUm uM r penalty of perjury oro of the fallowing tr ler one
1 nem and will maintain • CerdfinW of Conscm w self -insure (or Workers Campers -
.tion, An pmvidhd for by Section 3700 of the labor Code, for the performance of one
were fee which this permit is i.ued.
I have and will maimain Workers Comp'matian Insurance, ss required by section
IN"00 of the Lnor Code. for site Performance of the uncle for which Jus permit is issued.
My Workers Compen.tion ntwran¢ artier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(ITu sealm need not An completed lithe permit Is foram, hundred dollars (5100)
or less-)
I certify, that in the performance of rah work for which this Permit abroad, 1 shall not
employ any pecan in any ��yy99^^ncyp u tgyc�pme wbject W the Warken' Compensation
Laws of CaHemi^ Date 1(" J X57_
Applican, tJJ (��-�--
NOTICE fO APPLICANT: If, after making this Ccriificae Of Eaemptom, you sbauld
bcrome Achim to the Workers conexh.tion provisions of m, lab« Ceds, you most
'
foMwids comply with such provisions to mu permit shat In domed revoked.
i CONSTRUCTION LENDINGAGENCY
1 herebyich thi WI mere is for the Performance of
' LftLe work for which this permit is issued (Sec. J09]. Civ. C.)
s ed (Sec. 7. Civ. C.)
Name
Lenders
Lander: Address
•
1 1 certify that 1 have read this Application and sou that the show information in
cartes 1 agree W compry with All city and aunty ordinances and a= laws relating W
Wilding nonunion, and hereby authoarz mpreuntauws of this city W enter upon the
oncd inspection
shove-mnnudgments.co fond
purp
indemnify
(We) agree to save. and kap harmless the City of Cupertino agumt
cx which
j coating ca penseswhich may in any w,Yaarm against said City
sunce
; I
inof the
of the granting Sosis permit
A APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 6_ Zh
SOURCEREGULATIONS.
Re-roofsDate
/
G"`%—
Sgm�iure of A4ppli,anJConpacWr
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will me applicant or future building occupant some or handle ha.rdous materia
As defineino d by the CupertMumcipal Cade. Chains, 9. 12. and the Health and Safety
code, section 25533(.)7
❑Yes ,qNa
All roofs shall be inspected prior to any roofing material being installed.
Win thea Tuan, o, future Wilding aau t a.
g eAn
Quality vias which
If a roof is installed without first obtainingan inspection, I agree to remove
P gr
Julpp
us ase contaminants u Jefincd by Ne Bay Arta Air Quality Maosgcmcm
co Ail
all new materials for inspection.
Dista.?
District?
❑Yes 16N.
I bars read the havardswmm,aslsmqui,emew under ChapAn&95 ofthe CAlifor.
his Health& Safety Ceds.Secti«u 35565.25533 um 25534.1 undenund mnirde building
does hes currently haw • Leman ran it u my mapoosihility to notify the occupant of Me
rc�¢mcns which most h�,=issuance ofa cemB„m of a,apAncy.G�
Signature of Applicant Date
All roof coverings to be Class or better
dw'ne/�«wmoannd agent Date'
•
•
U�U0oO.S
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
(9? 0 18
APN # 3 I l O 3
Date: Z
Building Address:
Mailing Address (if different from building address):
Owner's Name:
Phone #:
Cp7--x'11q
Contractor: !aJAIm S (p3 (� C -`S
Phone:�t2� -2 p
U �4p y�
_
Contractor License #:
Cupertino Business License
Contact:
Phone: Olb -2-1-0
Fax: Dib- �(7 -52-o',
Residential Commercial ❑ c� �-,pc���(�
Y
1_
Job Description: \ O A-� � A 5 V S� � 1UR `- 1 k 4;-Qj�-
c�U\�-.s�.p
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A,II-B❑ 11,111,V -A ❑ 1], III, 1V.V-B Q-
2.—
Valuation: Square Footage:
Project Size: Standard are ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED 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 -...... �•: d'-9'= --
CITY OF
• CUPEkTINO
r
L
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1 FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1 FLAGPOL>20
Flagpole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1 FOUNDREP
Foundation Repair
B
1 PILECAST
Pile Foundation Cast in place concrete
B
1PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete)
B
3 of 5
; N-
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE 0
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1 RETSTN
Standard (up to 50 R)
B
I RETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSPI0
Special Design, over 10' high (up to
50')
B
1RETCRB<
Gravity/Crib Wall, 0-1O'high (up to
50 ft)
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 R)
B
SIDING
1 SIDEST/BK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>1 OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
I SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
11
CITY OF
• CUPEkTINO
r
L
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
r
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ca 8 windows)
B
1WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee
B
1 EPERMITFEE
Electrical Permit Fee
E
IMPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMBLNCK
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
1BSEISMICR
Seismic Residential
B
IBSEISMICO
Seismic Commercial
B
(
1TRAVDOC
Travel & Documentation
B
IBUSLIC
Business License
B
•
5 of 5
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT
Sec: Twp: Rng: Sub: B1k:-Lot':
APN ........: 35621031.00
DATE ISSUED.......: 06/04/2008
RECEIPT #.........: BS000004990
REFERENCE ID # ...: 08060025
SITE ADDRESS .....: 11256 PALOS VERDES CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------
CHECK
TOTAL RECEIPT :
•
AMOUNT REFERENCE NUMBER
-- --------------------
82.08 #125
---------------
82.08
OWNER ............:
SRIKAUTH GOPOLAU
.ADDRESS ..........:
11256 PALOS VERDES
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-4721
RECEIVED FROM ....:
ADAMS BROTHERS CONS
CONTRACTOR .......:
STEVE ADAMS LIC # 22207
COMPANY ..........:
ADAMS BROTHERS CONSTRUCTION
ADDRESS ..........:
10100 TORRE AVE
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
TELEPHONE ........:
(408) 564-5207
•
FEE ID
---------
UNIT QUANTITY
-------------------
AMOUNT PD -TO -DT THIS
REC
NEW BAL
1BSEISMICR
VALUATION 2,200.00
------------------------------
0.50 0.00
0.50
----------
0.00
1EPERMITFE
FLAT RATE 1.00
40.79 0.00
40.79
0.00
ITRAVDOC
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
-----------
CHECK
TOTAL RECEIPT :
•
AMOUNT REFERENCE NUMBER
-- --------------------
82.08 #125
---------------
82.08
CITY OF
SCUPERTINO
•
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
(o.d" C l--
PERMIT #
0;--06. d 0, .-
O R'S NAME: „ o o
PHONE # _
GENERAL CONTRACTOR: ; o
FAX #
I am not using any subcontractors:%w^ tl�
Signature
Please check applicable subcontractors and complete the following information:
%.. ✓ic c/ Qfi
Date
Owner/ Contractor Signature
Date
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