12010014BUILDING ADDRESS: 859 BETTE AVE
CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR: CAMPBELL FAMILYI PERMIT NO: 12010014
ELECTRIC INC
OWNER'S NAME: RAJ ABHYANKER 1352 GOLDEN LEAF CT I DATE ISSUED: 01/03/2012 I
c
'R'S PHONE: 4083983126
13
LICENSED CONTRACTOR'S DECLARATION
License Class LIC Lic. # b I(A, F,`1
Contractor Date t
I hereby affirm th �io,
under the provisions of Chapter 9
(commencing 000) of Division 3 of the Business &Professions
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.
TRACY, CA 95377
PHONE NO: (209) 814-3874
BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB'
MECH F RESIDENTIAL COMMERCIAL f—
JOB DESCRIPTION: INSTALL ELECTRICAL VEHICLE STATION AT GARAGE
LOCAL
I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 -point source regulations per thgCapertino Municipal Code, Section
9.18. ��
Signature Date ( 2
�. OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
�-a-mnify and keep harmless the City of Cupertino against liabilities, judgments,
, and expenses which may accrue against said City in consequence of the
&.—sting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
APN Number: 36927044.00
Valuation: $1200
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
i
Issued by: Date f� —
RE -ROOFS:
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
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or autho ' ge .
Date: I Z
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
3 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36927044.00
DATE ISSUED.......: 01/03/2012
RECEIPT #.........: BS000015649
REFERENCE ID # ...: 12010014
SITE ADDRESS .....: 859 BETTE AVE
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER RAJ ABHYANKER
ADDRESS ..........: 859 BETTE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: JERAMEE P CAMPBELL
CONTRACTOR .......: TEMPLE CAMPBELL LIC # 32988
COMPANY ..........: CAMPBELL FAMILY ELECTRIC INC
ADDRESS ..........: 352 GOLDEN LEAF CT
CITY/STATE/ZIP ...: TRACY, CA 95377
TELEPHONE ........: (209) 814-3874
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
1,200.00
----------
1.00
----------
0.00
----------
1.00
0.00
1BSEISMICR VALUATION
1,200.00
0.50
0.00
0.50
0.00
1CHRGSTA UNITS
1.00
100.00
0.00
100.00
0.00
----------
TOTAL PERMIT
----------
101.50
----------
0.00
----------
101.50
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
203.00
---------------
203.00
VOICE ID
DESCRIPTION
--------
301
----------------------------
ROUGH
PLUMBING
304
ROUGH
ELECTRICAL
505
FINAL
ELECTRICAL
508
FINAL
MECHANICAL
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
303 ROUGH MECHANICAL
313 ROOF NAIL
507 FINAL PLUMBING
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingaa cupertino.org
PROJECT ADD SS�`APN # �\
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OWNER NAMEONE1-4 E-MAIL
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STREET
STREET ADDRESSCI ,STATE, ZIP TFAX
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CONTACT NAME
PHONE
E-MAII
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ADDRESS
CITY, STATE, ZIP
FAX
�STRREEET
OWNER ❑ OWNER-BOII.DER ❑ OWNERAGENT ❑ CONTRACrOR ❑ CONTRACrORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME L
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
-Tet- 1t
COMP NAME rJ I- L! / C �[<
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FAX
STREET ADDRESS �^
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CITY, STATE, ZIP
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ONE
2 �G� �t� �c
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 21"ISFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ Yes ❑ NO
sTRucTURE. 2-
ElSOLAR PANELS L� ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION:
DESCRIPTION OF WORK
.► V C vc- v C7 1 �.
By my signature below, I certify to each of the 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 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil onstructiom au o ' e representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: C z Date: % 3/11
REQUIRED
PVApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
(�'
1�� FF.F. F.CTIMAT0R — RITII.nING DIVISION
ka,ADDRESS:
859 bette ave.
DATE: 01/03/2012
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: $1,200
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
PENTAMATION SOLAR -RES
PERMIT TYPE:
WORK
install e.v. station at garage local.
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, rare, sanitarysewer utstrict, scnoot
n:_4 Tl.t...nn 1 n_ 016. nrnti snru infnrM"dAn onidtnhtn nMd Orn n"k nn aetilnata Cantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 L f ' L 11Z
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$100.00
Alternative Energy System
ICHRGSTA EV Charging Station
Suppl. PC Fee: (j)Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1 1
E)
Work Without Permit? Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong /Motion Fee:
IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$100.00
TOTAL FEE:
$101.50
Revised: 12/04/2011
"UPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: ec,gp}
4 e A ve
PERMIT #
OWNER'S NAME: ,;
fair,h ti k e v
PHONE -2 �A 3`'may
GENERAL CONTRACTOR:
OweAi let+. ;
BUSINESS LICENSE #
ADDRESS: 3S2 ij.en
Pc C+ Fi f CA
CITY/ZIPCODE: ` 5 1
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTOR VE OBTAINED
BUSINESS LICENSE.
I am not using any subcontractors:
� at
Please check applicable subcontrac nd complete the following information:
A CITY OF CUPERTINO
\ 3 )21-1-L
ate
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
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job : ite during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The, stamping of this plan and specifications SHALL NOT
F -n )Id to permit or to be an approval of the violation
of ary provisions of any City Ordinance or State Law.
_
PE- �1'✓IIT NO. _-
Caw'"z