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12040041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10437 VISTA KNOLL BLVD CONTRACTOR:S&B CONSTRUCTION PERMIT NO: 12040041 OWNER'S NAME: RAMANATHAN KALYAN K AND LAKSHMI K 1294 CALDWELL Cr DATE ISSUED:04/062012 OWNER'S PHONE.: 4085291818 SUNNYVALE,CA 94087 PHONE.NO:(408)529.1818 ❑ LICENSED CONTRACTOR'S DECLARATION r r r (� 2_ _ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.B O O� �— MECH r RESIDENTIAL r COMMERCIAL r Contractor C_ Date Y : I hereby affirm that I IkIl"19111fluder,the provisions of Chapter 9' JOB DESCRIPTION:TEMP POWER POLE,100AMP (commencing with Section 7000)of Division 3o 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:$500 1 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:32613033.00 Occupancy Type: APPLICANT CERTIFICATIONL�— 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 slate 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 Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may acerae against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply ,J - I with all non-point source.regulatims per the Cupertino Municipal Code,Section 9.16Issued by: ��4'✓ Nit TGF2� Dale: . , Signature RF.-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 Low for one of inspection. the following two reasons: I,as owner of the properly,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). 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(1)should I stare 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 1 will permit is issued. maintain compliance wHit the C ertin0 Municipal Code,Chapter 9.12 and the Health&Sefe)y Code,Sectio 25505,25533,and 255,;x, 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 Owner r th rized jy T dy -, /-7 Compensation laws of Cali fomia. I f,after making this certificate of exemption,I Dale: 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. CONSTRUCTION LENDING AGENCY 1 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 properly for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may acerae against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I 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 . . . . . . . . : 32613033 .00 DATE ISSUED. . . . . . . : 04/06/2012 RECEIPT #. . . . . . . . . : BS000016482 REFERENCE ID # . . . : 12040041 SITE ADDRESS . . . . . : 10437 VISTA KNOLL BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAMANATHAN KALYAN K AND LAKSHM ADDRESS . . . . . . . . . . : 10437 VISTA KNOLL BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SABRIJA C KUCEVIC CONTRACTOR . . . . . . . : SABRIJA KUCEVIC LIC # 29043 COMPANY . . . . . . . . . . : S & B CONSTRUCTION ADDRESS 1294 CALDWELL CT CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087 TELEPHONE . . . . . . . . : (408) 529-1818 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41.00 0 . 00 41 . 00 0. 00 1BCBSC VALUATION 500.00 1.00 0.00 1. 00 0. 00 1BSEISMICR VALUATION 500 .00 0 .50 0. 00 0 . 50 0. 00 1EPERMITFE FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 1ERT<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 AMEX --------------- TOTAL RECEIPT 174.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10437 Vista Knoll Blvd DATE: 04/06/2012 TREVIEWED BY: Sean APN: BPI#: 'VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP14 USE: PERMIT TYPE: WORK 100 amp temporary electrical. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $44 TOTALS: $44.00 ,ll.•clr. I'lun Check Plumb, Plan Cherk Elec. Plan Cheek 1 0.0 1 hrs $0.00 'Vech. Pe,mil Fee. Phonh. I'crmii Ice: Elec. Permit Fee: IEPERMIT Ocher,l lerh. Insp. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $44.00 ddcch. In,,p. 14re: Plumb. hup. Fes Elcc.Insp. Fre..' NOTE: This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Rc.sohaion 11-053 EIX 711/11) FEE QTY/FEE MISC ITEMS 1'lun Check Fee. .Supp/. PC F •e PME Plan Check: $0.00 Percnii Fee: Shppl. lnap Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 C onsi vction Tax. Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes Q No $0.00 drlrnuced/'/inning Fees. Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE:F $174.50 Revised: 04/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 M I /� CUP777 ERTINO (408) -3228• FAX(408)777-3333•buildinGC8cu°ertino.or° (v' PLUMBING ❑MECHANICAL ELECTRICAL EJMISCMLANEOUS (o 4 3-4 V157Il 3L V h "PN OWNER NAME /,�A ) Q A_.-u PHONE E MAIL. SrAEET ADDRESS I�I ,V /^ CT[Y.SCATE,ZIP 1 e FAX �✓/ A 1 V /f'�/I awrA Cr NAME �,I�17 F) - l.(rYl�/ • 1 L ( �/U E �FC- �Vl/t�r�/W'�rIL.co TMEEr ADDRESS CIN,SLATE, ffi FAX ❑owNER ❑ owm-BuRDEit ❑ 0WNEIt AGkM ❑ WNTRAcmR ❑C0MfRAC10R AGENT' ❑ Amamwr ❑ENamER ❑ DEVELOPER ❑ reN CONTRACTOR NAME '1/� /�n�S/ V- `//ITi� LICENSE NUMBER 893/y� LICENSE TYPE Bus-I]Cp COMPANY NAME G `V E-MAD. FAX STREt7 ADDRESS QTY.STATE 717 PHONE ARCLDTEMENGINEER NAME LICENSE NUMBER BUS.LIC 0 COMPANY NAME' E.MAD. FAX STREET ADDRESS CITY,STATE IJP PHONE USE OF M-DUMEX ❑ MUCTFFAMD-Y PROTECLIN WDDL.WD ❑ YES PROTECT IN ❑YES ISTHEBLDGAN ❑ BUDDING: ❑COMMERQAL. TURBAN INTERFACE AREA O FLOOD ZONE NO EROB.FR HOM17 O DESCRumcam OF WORK ��- 1/ 'LC ®0 TOTAL VALUATION: 5 RECEIVED BY: By my signature below,I certify to each of the fallowing: I am the property Owner m anthorked agent to act oa rhe property awoer's behalf I have rad this application and the information I have provided is have rrd th miption of Wark and verify it is accurate. I agree to comply with all applicable local ardman=and stare lava relaxing m building oa 1=, tatives of Cupertino m enter the above-identified property for inspection pulposes. Signature of ApplianvAgmt -1 L Da c: Z SUPPLEN E14TAL TION REQUIRED OFFICE Use ONLY u OVER-THE-COUNTER d � ❑ exPREs Y u i ❑ STANDARD U ❑ LARGE 6 ❑ MAJOR A1EPMwcApp 2011.doc revised 06121/11