08100021 CITY OF CUPERTINO
BUILDIN�VISION PERMIT tC�l'�ITRA.CTQIt I1�I'k'QRMA.'CIf1�N
BUILDING ADDRESS: PERMIT NO.
10541 LARRY WAY BAY LIGHT ELECTRIC 08100021
OWNER'S NAME: PERMIT ISSUE DATE
RAMALINGAM 150 SARATOGA AVE UNIT 3*09 10/03/2008
NE; SANITARY NO. CONTROL NO.
(408) 234-1832
ARCHIECT'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00, LICENSED CONTRACTORS DECLARATION - Job Description
1 herebyot affirm dI am I e and e$Dn under orwours of Chapter 9(commencing p
R vidaSeedon7") TO'"m]oftoaBond nev r 'a cone. pmylkennin ELECTRICAL WIRING IN KIT, OUTLETS, SUBPANEL IN
m IUII forte and
�,�rat� Lkense Clan Lk.g GARAGE
F, Dam Con
CHrrECFS DECLARATION
[ 1 nJ m adult In,used as public mcords
Ie.
G Licensed Professumal
3 OWNER-BUILDER DECLARATION
1 hereby anirm that I am exempt from the Cortracmr's License Law for do
p o following mason.(Section](I3L5.Business and PmfesGum Calc:Any coq or many
<m�+ which mquims a permit to cnnwucs alcor,improve.dcmultsh.or minor any auucmm
uzi prim m its iscusnce.alsu res,dos the applicant for such Permit m file a signed statement
that he is licensed pussuanuo flue pmvisimu of ti,Contractm's License,Law(Chaptm9 Sq.Ft. Floor Area Valuation
x (commerming with Section 7000)of Division J of toe B uslness and Professions Cade)or $4500
y $ that M is eumpt therefrom and she basis for the alleged exemption.Any violation of
Section 1031.5 by any applicant for a Permit subjects that applicant m a civil penalty of �,p�I Number - Occupancy Type
not more was fin hundred dollao(taro). 316 0 2 019.17 Cl
❑1,as...of the proper",m my employeeswith wages as their sole compeesadm,
will do the walk.and she su mune isnot inteMed or offered but ask(Sec.70441.Business
and Profession Colic The Conmcmr's Lkeve Law does ml apply m an owner or Required Inspections
pm,mi,who build,or in,ova thcrem,and who does such work himselfortMugh his
awn employees,provided that such Improvements are not inuMed moRered fmsalo.If.
Wwaver,the building or improvement is sold within one yev of emairmth n.the owner.
Wilder will hen the Wrdea of proving deal W did not Wild or improve for purpose of
sale.).
❑I.as owner of she Pmperty.am exclusively conoaming with licensed convectors m
construct she Project(Sec.7044.Bost est anal Professions Cale:)The Coutrxwfs Li.
cane law does out apply man owner of Property who Wilds or Improves therenn.and.
who contracts for such pmjecu with a contractor(s)licensed pursuant an the Contracmr's '
License law.
❑Icon exempt under See .B k PC fm thus moon
Owner Date
WORKERS COMPENSATION DECLARATION
1 bcmby aR under pemhy of Perjury oro of the following declwtions:
haw aM will maintain•ore,Sam ofComem Code,
t for W performance
of the
on,r provided for mi Section 3700 or do labor Code,for the peaformanna a(the
went far which this permit is tanned.
❑I ban and will maintain Wurtrls Compensation lasur.n¢,W required by Sceian
3M of the Labe Code,for the performance of she wash for which Nis permit is isswA
my Wori Compeasatim insurance atria and Policy number art:
Carrier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This uxem need mthe connPlemd ilthe Permit is fmmse buMmddollau(1100)
ear less)
1 centifY tont in due Pafomvcc of the work for which this permi 'sued 1 rot
employ any person in any mann[ con he e 1 Imthew ma0oe
Um
of Cdifomis Dam_
Applicant
NOTICE TO APPLICANT:IL almr making this Ccrtifiew of Eam Plitt .you should
become subject to the Worker's Compensation provisions of toe Iabm you most
.J z fonhwim ImaidY with such imWISioes m this permit shall W dame ked
Z tiCONSTRUCTION LENDING AGENCY
[—t I herby aRum that them is a construNm lending agency for toe Performance of
a > the work,for which this permit is issued(See.3097.CN.C.)
GQ Lender's Name
z Lender's Addmes
U Q 1 cenifY that I haw rend his application and sum thas the&how information I.
Ia PMMOL 1 All m comply with N city and county on inanas and state lam relabel to
O U Wilding construction.tad hereby authorize representatives of this city to anter upon toe
0. above-mentioned pmpcny for impection purposes.
(We)agree(o saw,indemnify and kap harmless the City of Cupertino slashed
ticn liabilities,judgments.cow and expenses which may In any say Accme against said City
U z in conscgmnee of the granting of this Permit.
r-t APPLICANT UNDERSTANDS AND WILL COMPLYWITH,y� ON�P Issued by: DateSOURCE REGULATIONS.
Re-roofs
Signvure of Appllam/Conuremr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuoua building mcuPant nom M handle havrdaw mamrid
u dcrned by th Cupenim Mu ''pal Cade.Chapmr 9.12.and the Health and Safety
Coate,tenons 25532(a)7
❑Yon All roofs shall be inspected prior to any roofing material being installed.
No
Will use.,pit.(or comm tiding occupant use cquipmant or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.t hsouomon air camumiruou defloctithylbellayAnsAirQualiftyManagennem all new materials for inspection.
District? 11p(
❑Yes No
t7511
ad thehvardmua man= uWmcnuuoder Chapaub.95afthe Califor.
notctYCWe,Scenesu 25.505. JJam125534.1undnnvb thvifth Wilding
Joeyhave a Ivan at i,/n Y nspomiMlisY b ratify Jc oaupan(of
mqu' kh mac W IpP o f a ter.cenir a ur,caro er Signature of Applicant Date
JA 4a
Ownerisad e( Dam
All roof coverings to be Class'%¢,'or better
CITY OF CUPERTINO
e 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31602019 . 00
DATE ISSUED. . . . . . . : 10/03/2008 -
RECEIPT # . . . . . . . . . : BS000006276
REFERENCE ID # . . . : 08100021
SITE ADDRESS . . . . . : 10541 LARRY WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. RAMALINGAM
ADDRESS . . . . . . . . . . : 10541 LARRY WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2034
RECEIVED FROM . . . . : BAY LIGHTING ELECT
CONTRACTOR . . . . . . . : RIMO JIZEH LIC # 29308
COMPANY . . . . . . . . . . : BAY LIGHT ELECTRIC
ADDRESS . . . . . . . . . . : 150 SARATOGA AVE UNIT 309
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051
TELEPHONE . . . . . . . . : (408) 234-1832
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00
1BREMFIXT NO. FIXTURES 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1BREMRECEP NO. OUTLETS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1BSEISMICR VALUATION 4, 500 . 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 213 .49 0 . 00 213 . 49 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 213 .49 master card
---------------
TOTAL RECEIPT 213 .49
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Hwy Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS:/0 I n 1! wQY f ^950 l� PERMIT ������ -2�j
OWNER'S NAME: /�T /J^� PIJONE #
GENERAL CONTRA OR: IF*4,X # (, /9
IV-
I am not using any subcontractors: IIA MA
Si tyre Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical 1 G
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
ALI
Owner/dontractor SiFatdxe Date
y
Sum CITY OF CUPERTINO
: . OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
p� Ibdaz I
APN # Date: /1 P /O
Cp DZ 019��v
Building Address: to ( y wa) ;�& � ,50
Mailing Address (if different from buil/ding address):
Owner's
c�
Owner's Name: lY1a /) Phone#
Contractor:r
�• ' Phone:
Fax:
Contractor License#:
Cupertino Business Lice se#: ✓�
Contac�Qn � Phone:
L
YV, UJ4' Fax: ,IQU 1 bel — I�_l4
Residential Commercial
Job Description: _
C/eca 6�i ca I W-tmA> Q kec M ca
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B II/III/V-A ❑ II/IIl B, IV-HT, V-B 0�
Valuation Square Footage:
Project Size: Express ❑ Standard Large ❑ 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 www.builditgreen.org
Revised 7/01/08
Q� J CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 16ENRES or
1GENCOM
1BBOILERI 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 sys over 100,000 Btu/h
1 BBOILER3 Install ation/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 ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH 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)
1 PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeti ng B •