11120079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10406 TONITA WAY CONTRACTOR:CALIFORNIA HOME PERMIT NO: 11120079
BUILDERS&DESIGN
OWNER'S NAME: SIVAKUMAR DANDAPANI&MAHADEVAN UMA 1775 JUNCTION AVE DATE ISSUED: 12/13/2011
,R'S PHONE: 4083403826 SAN JOSE,CA 95112 PHONE NO:(408)392-8200
❑ LICENSED CONTRACTOR'S DECLARATION r r r
r• BUILDING PERMIT INFO: BLDG � ELECT PLUMB
License Class_ Lic.N��1�s� r r r1
MECH RESIDENTIAL COMMERCIAL
Contractor S-�r-*�o.n V_r`K Date_
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMP POWER POLE
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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. Sq.Ft Floor Area: Valuation:$600
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. AIN Number:35915043.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cu ' o against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may seem 1 sai City in consequence of the
granting of this permit. Additio y,th pplican nderstands and will comply /f �(
with all non-point source miens r th Municipal Code,Section Issued by: s Date:/-2-
9.18.
ate:/ li-
9.18.
Signature Date/L
RE-ROOFS:
OW ER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that 1 am exempt from the Contractor's License Lew for one of installed without first obtaining an inspection,I agree to remove all new materials for
Y P inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equfpme vices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by ay ea Air Quality Management District 1 will
permit is issued. maintain compliance ' the Cu rtin0 Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safe e,Sectio ,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Ow o ori /
Compensation laws of California. If,after making this certificate of exemption,I Date: 3
become subject to the Worker's Compensation provisions of the Labor Code,I must R�i
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
�ftnify and keep harmless the City of Cupertino against liabilities,judgments,
d expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
g mg of this permit.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18• Licensed Professional
Signature Date
• CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
'Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35915043 . 00
DATE ISSUED. . . . . . . : 12/13/2011
RECEIPT #. . . . . . . . . : BS000015557
REFERENCE ID # . . . : 11120079
SITE ADDRESS . . . . . : 10406 TONITA WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SIVAKUMAR DANDAPANI & MAHADEVA
ADDRESS . . . . . . . . . . : 10406 TONITA WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BAHRAM D DERIS
CONTRACTOR . . . . . . . : SIMON KREK LIC # 31282
COMPANY . . . . . . . . . . : CALIFORNIA HOME BUILDERS & DES
ADDRESS . . . . . . . . . . : 1775 JUNCTION AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 392-8200
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ---------
lADMIN HOURS 1 .00 41. 00 0. 00 41.00 0. 00
1BCBSC VALUATION 600 .00 1.00 0. 00 1.00 0.00
1BSEISMICR VALUATION 600 .00 0.50 0.00 0.50 0.00
1EPERMITFE FLAT RATE 1 .00 44 .00 0. 00 44 . 00 0 .00
IERT<200 UNITS 1 .00 44 . 00 0. 00 44 .00 0.00
1TRAVDOC FLAT RATE 1 .00 44. 00 0. 00 44 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 174 . 50 0. 00 174 .50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 174 .50 MC
---------------
TOTAL
-------------
TOTAL RECEIPT 174 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER .
•
/ / / 079
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
• CUPERTINO (408)777-3228• FAX(408)777-3333•buildine(G,cupertino.orG MISC
PLUMBING! MECHANICAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS `O`IO / \ O '\1 C,� PN
cx� AN .I
OWNER NAME S V\, +�`��v o^Ar \ PHONE M -3'YO-39
REET E-MAII.
STADDRESS I OO( ^; CITY, STATE,ZEP y� t O FAX
CONTACT NAME 1 IpM ,(� Je • PHONE / �O I ` ( �_1 oM{ 1 ^✓�
STREETADDRESS h \f 1 CITY,ST TE,bZIP ` FAX h tlrt
c �.r R�/2 //..� olL C:l� 3 Ail-' 101
13 OWNER 13OWNER-BUIDEA ll OWNER AGENT 11 CONTRACTOR —GJ,�CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME _,t d^ LICENSE NUMBER LICENSE TYPE BUS.LICA
CO NAME r•�` E-MAIL 1 L FAX
\ o :� 1 SM4� a� M'C IT F rN. s2o \
S ADORE CITY,STATE, 9 C. CfVPHO
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP - PHONE
USE OF SFD m DUPLEX [IMULTI-FAMILYPROTECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN El YES
-BUILDING: ❑COMMERt]AL URBAN INTERFACE AREA 11N0 Fl.OpD ZONE ❑No EICHLER HOME) ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: p C� RECEIVED BY:
By my signature below,I certify,to each of the following: I am grope caner or au 'ud agent to act on the perry owner's behalf. I have read this
application and the information I have provided is correct. ve read ork and verify it is accurate. I agree to comply with all applicable local
ordinances and same laws relating to building construe' . I rep vas of Cupertino to enter the above-identified property for inspection put�oses.
Signature ofApplica /Agent: Date:
SUP
PL d 0 TION ItEQUII2ED OFFICE USE ONLY
OVER-THECOUNTER
d
❑ EXPRESS
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_ ❑ STANDARD
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❑ MAJOR
MEPMucApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 10406 tonita way DATE: 12/13/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $600
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1REAP14
USE: PERMIT TYPE:
WORKinstall tem ower ole.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $44
TOTALS: $44.00
Ife,•h. PI'm Cheek Numb, Plan Check Elec.Plan Cheek 0.0 1 hrs $0.00
..Xfech. Permit Fee: Phrmh. Permit Fee: Elec.Permit Fee: IEPERMIT
• ?her dfe tr.hcsp. Other Plumb Insp. Li
Other Elec.Insp. 0.0 hrs $44.00
,1(vJr.Inep. Fre: Plumb, In"I", Fee: fs(ee.Inep. F'ee:
NOTE: This estlmale does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the Prelinina In ormadon available and are only an estimate. Contact the De t or addn 7 Infa
FEE ITEMS (Fee Resolution 11-053 Eff 711,']1) FEE QTY/FEE MISC ITEMS
Plan ('.'/recd'lee:
Sl.eppl. PC f ne
PME Plan Check: $0.00
Pc rntu Fcc:
Suppl. lisp Fee
PME Unit Fee: $44.00
PME Permit Fee: $44.00
C'oastructiun 7ir.r:
Administrative Fee: (ADMIN $41.00
Work Without Permit? 0 Yes (E) No $0.00
.4dVancer/Planning Fees:
Travel Documentation Fee: ITRA VDOC $44.00
Strong Motion Fee: IBSEiSM/CR $0.50 Select an Administrative Item
• Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $174.50 $0.00 TOTAL FEE: 1 $174.50
Revised: 12/04/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (7� Q '— L PERMIT# e5 0`7
OWNER'S NAME: s r^ V,,ArAc%r _ PHONE# O —
GENERAL CONTRACTOR: f\ Krc—rs 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 INSP WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON O VE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
a ate
Please check applicable subcont s andmp a the following information:
V SUBCONTRACTOR INESS 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
r/Co actor ignat Dat