The URL can be used to link to this page

11040159 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22641 ALCALDE RD CONTRACTOR: PERMIT NO:11040159 OWNER'S NAME: VIJAY K ERANTI DATE ISSUED:04/22/2011 OWNER'S PHONE: 4083941019 PHONE NO: T. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# C� MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affir that am li nse un ceder the provisions of Cha to 9 JOB DESCRIPTION:TEMP POWER POLE (commencing with Section 7000)of Division 3 of the Business&P ofessions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$500 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. APN Number:34229036.00 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 AYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DA M LAST CALLED INSPECTION. 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- nt source regulations per the Cupertino Municipal Code,Section Issued by: Ll f Zc v Date: 9.18. Signature Y Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs 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 I hereby affirm that I am exempt from the Contractor's License Law for one of 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) I,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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I 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(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino 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&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's n or authorized anent: Compensation laws of California. If,after making this certificate of exemption,I f Dat become subject to the Worker's Compensation provisions of the Labor Code,I must ZaL 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, --ts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION .ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. ,a all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO ` ok FEE ESTIMATOR-BUILDING DIVISIOl , ADDRESS: '�p� �Q DATE: 04/22/2011 REVIEWED BY: gs APN: 34 0-D--9 o3t, I BP#: "VALUATION: j$500 "PERMIT TYPE: Electrical Permit I PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: p I PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $42 TOTALS: I I ( $42.00 II I I Elec.Plan Check [-0--0 I hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elec.Insp. Ld hrs I $42.00 NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 09-051 1'/f.' T-l,]0) FEE QTY/FEE I MISC ITEMS I PME Plan Check: $0.00 I F-] PME Unit Fee: $42.00 PME Permit Fee: $42.00 n Work Without Permit? ® Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld)Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: I $127.50 Revised: 04/01/2011 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34229036 .00 DATE ISSUED. . . . . . . : 04/22/2011 RECEIPT #. . . . . . . . . : BS000013266 REFERENCE ID # • • . : 11040159 SITE ADDRESS . . . . . : 22641 ALCALDE RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VIJAY K ERANTI ADDRESS . . . . . . . . . . : 22641 ALCALDE RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RADENKO LOSIC 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 500. 00 1.00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 500 . 00 0 .50 0 .00 0 . 50 0 .00 1BUSLIC FLAT RATE 1 . 00 115 . 00 0 .00 115 . 00 0.00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 IERT<200 UNITS 1. 00 42 .00 0.00 42. 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 242 .50 0 . 00 242 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 242 .50 012204 --------------- TOTAL RECEIPT 242 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER GENERAL PERMIT APPLICATION MEN COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION \� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinad)..cuoertino.ora yy misc ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �� r f J APN# ��f 0 OWNER NAM —' PHONE EMAIL -7 � STREET ADDRESS I CITY,STATE,ZIP p I FAX CONTACT NAME PHONE /n )r 3 E-MAIL STREET ADDRESS I CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 1 P 2 53 8� LICENSE TYPE D BUS.LIC# COMPANY NAME E_MAII. FAX STREET ADDRESS 2 /1 CITY.STATE.ZIP � ��Q� I PHONE ARCHTTECTIENGINEER NAME V / / I LICENSE NUMBER BUS.LIC# COMPANYNAME I E-MAIL FAX STREET ADDRESS I CITY,STATE,ZIP I PHONE USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE; ❑ Commercial SAN INTERFACE AREA ❑ Yes \-,W No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK r - T M Pc%z) ! TOTALVALUATIO( By my signature below,I certify tc 0'-he following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h ve ovided is Correct have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to Iding construction. I authorize representatives of Cupertino to enter the abov-id tified p perty fyr inspection purposes. Signature of Applicant(Agent: Date: / UPPLEMENTAL INFORMATION REQUIRED _ - ter -- �+1F�TlItSlllFi,'^- ��i.��O�}'-�` t � _ MEPMiscApp 2011.doc revised 03/16/11