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12040133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10620 STOKES AVE CONTRACTOR:ROCK SOLID BUILDERS PERMIT NO: 12040133 OWNER'S NAME: KOMMA MALLIKAR3UNA R AND CHANDULA B PO BOX 20265 DATE ISSUED:04252012 OWNER'S PHONE: 4082211620 SAN JOSE,CA 95160 PHONE NO:(408)997-762$ ❑ LICENSED CONTRACTOR'S �DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class t Lic.kyI� 1 CICP (/ l� C;� _l �at /' . __ � MECH r RESIDENTIAL r COMMERCIAL r Contractor`�0 1� `I &1l 10-( e A hereby affirm that 1 am licensed under the provisions of Chapler 9 JOB DESCRIPTION:REMOVE AND REPLACE ELEVEN(I I)WINDOWS (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valualion:$4700 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:3264900400 Occupancy Type: APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with 8 hall non-point source ulatims per the Cup no Municipal Code,Section 9 �� / nrG� 144 Issued by:, N H Date: !V-6R31 Signature Datey ❑ OWNER-RUILDF-R DLCLARATION RE-ROOFS: All roofs shall be inspected prior to any rooting material beng installed.If a roof is I hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the fallowing two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,mid the strucmrc is not intended or offered for sale(Sce.7044, Signature of Applicant: Dale: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penally of perjury one of the following three declarations: HAZARDOUS NIATERIAI S DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. 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 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 _ Compensation laws of California. If,after making this certificate of exemption,I Owner or eulhoFiud a enC become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the perfomhance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 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 ollhis permit.Additionally,the applicant understands and will comply ARCIIITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32649004 .00 DATE ISSUED. . . . . . . : 04/25/2012 RECEIPT #. . . . . . . . . : BS000016621 REFERENCE ID # . . . : 12040133 SITE ADDRESS . . . . . : 10620 STOKES AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KOMMA MALLIKARJUNA R AND CHAND ADDRESS . . . . . . . . . . : 10620 STOKES AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAY HAMMEN CONTRACTOR . . . . . . . : JAY G. HAMMEN LIC # 29304 COMPANY . . . . . . . . . . : ROCK SOLID BUILDERS ADDRESS . . . . . . . . . . : PO BOX 20265 CITY/STATE/ZIP . . . : SAN JOSE, CA 95160 TELEPHONE . . . . . . . . : (408) 997-7625 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4,700.00 1 . 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 4,700. 00 0. 50 0. 00 0 .50 0.00 1WINREP EACH 8 11. 00 522.00 0.00 522 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 523.50 0.00 523 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 523 .50 #2082 --------------- TOTAL RECEIPT 523 . 50 Zen Lt (j 3 3 . CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 950143255 (408)77/3228• FAX(408)777-3333•buildinD(fcupertino.OrD CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION -y}�ALTERATION/TI ❑ REVISION/DEFERRED (..OIUGINALPMUZT# PRprEcrADOREss rll�IV60O 5 /1 l� APNa 37 ( I 00 OWHFR NAME �JYI .� VI.I PftooB a� ,;� �'�,f�E-MAD. kwma, STREET ADDRESS S VI �Y7 Y(/� O G/7 FAX CONTACT NAME PBONE F.ALIII. c' G STRIETADDRFSS CfIY,STATE, z@ FAX ❑owNEr ❑ OWNER-auL DER ❑ OWNFAAOENT La CONIAACI9R ❑cONTRAcroR�A�G,F/rr ❑ ARCM= ❑ENGD�I ❑ DEVELOPER ❑ TENANT CONTRALTO S 1 LICENSE NUMBER//37 I `.b LICENSE TYPE EUs.L'C p 6 COMPANY NAME J(J E-MAQ.�Ar��//TD , .• FAX STREET ADDRESS �1 T arY.STATES,MP �4I�.(� l. PHONE QL ARCHIT'ECr/ENGINEER. /NAME ElCENSE NUMBER BUS ILC Y COMPANY HAMS E-MAD. FAX STREET ADDRESS CITY,STATE,W PHONE DESCRIPTION OF WORK. G1(.Cn 1 P/Yl kzWl I 01() E1057fN USE PROPOSED us CONSTR_71'PE fsTyRtrS USE TYPE OCC SQ-FT. VALUATION(5) E=G NEWFLOORS DEMD TOrAL AREA AREA AREA BATHROOM XITL7¢]Y REMODELAREA REMODELAREA RDtlODELAREA PORCHAREA DECKAREA ECTUPORCH AREA I GNNGE AREA: OETAC}r ATTACH 5 DWE.r.D1G7umm: HASECONO OISR YES SECOND STORY YES affiNO ADDI ❑NO ADD[RONT ONO FRE42MICATION OY6 F PROVmE COPY OF rsCnZRHGAN ❑❑NO RECEIVl7�/--�7/tT' TOTAL,VALUATION: FLANNINGAPPLI NO PLANNING APPROVAL LETTER ffiCH78R SOMEt t///'JOO By my signature below,I certify tD each of the fonowhW I am rhe ptooerty Owner or aehotized anent m act on the prFpertyowner's behalf,Ibave read tb:s application and the mfo=atioa I have provided is correct I have read the Description of Work and verify it is acemate. [a&=to comply with an applicable local ordinances and Stam laws relating to building constraetoa I amhonze tatives of Capertmo to voter the above-i ed erty,for map==prapases. Sign., ofAppneaat/Agent Date: SUPPLEMENTAL INFO ON REQ PTANCBECRTYYE ROUMGSE" New SFD or Multilknily dwellings: Apply for demolition permit for OVER-TEE•Cordfm ❑ M=iNG PLAN ZMEW ; sig bmldmg(s). Demolition permit is required prior to issuance of building permit for new building. ❑ KSPRTVSS ❑ PLAMWC PLAN RzvvlEW _Commecial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PORLIC WORTS Form if any Hazardous Materials are being used as pmt of this project ❑ URGE ❑ PIBE bErr _Copy of Playing Approval Letter or Meeting with Planning prior to subTTritWofBuildiagPermit applimlion. ❑ nitron ❑ sAmrAmrsRwBaDLsrRLLr - ❑ ENVmoKMZNTAL FAITH. BldgApp_2 011.do c revised 06/21/71 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING.DIVISION ADDRESS: 10620 Stokes Ave DATE: 04/2512012 REVIEWED BY: Sean -A PN: BP#: "VALUATION: 1$4,700 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration ! Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK Remove and replace 11 windows. SCOPE • afrr•!e /'/✓n i'/;r.3 /'hunh. Plnrr r:hrrk Elm. Nor Portin Pte: I'hruvh, P:rniii Fee: 01"'. Poeta OiS�r.bltch. hi:!'. Oihtr PAnrrh/ny;, Utlrrr ha,%, lnxp. 1hs:h. hap, I-,, /7mab./Mtiu. FCCr- EIee. hr.•p. /h NOTE: This estimate does not includejees due to other Departments(i.e. Planning,Public{Yorks,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelindna in ormation available and are onip an estimate Contact the Dept for addn 7 info. FEE ITEMS (I-ec Resolution 11-053 liB: 7.-1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 11 1 # Window/Sliding Glass Door Suppl. PC Fee: (F) Reg. OT 0.0 hrs $0.00 $522.00 /7vhvREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feel@ Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (-ons/rurlion 7h1.. ,hhnirtisiralire Fee: Work Without Permit? Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Q Zirrecl Dncweewotion Fees: Building or Structure Strong Motion Fee: 1RSEISMICR $0.50 Select an Administrative Item Bldg Slds Commission Fee: IRCRSC $1.00 SUBTOTALS: $1.50 $522.00 TOTAL FEL. $523.50 Revised: 04/01/2012 slti� 01 APR 25 2012 °X BY:��1 Q`41 .�{4"V♦ �r M iNc f V COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO s APPROVED Is set of plans and specifications MUST be kept at the lob site during construction. It is unlawful to make any changes or alterations on same,or to deviate o therefrom,without approval from the Building Offclal. M Rig stamping of this plan and specifications SHALL NOT O O §p held to permit or to be an approval of the violation N csf any provisions of any City Ordinance or State Law. M BY �E,�1/✓ G/Z DATE a� PERMIT O ��� -Tv tiir/Z , N'h� r A 2 I G N :Ae peffj"a 30N dllQ OO3M3lA3b C a�oa s z "' FFICE COPY luew11080B+IPtlne ON11H dnD n(lrnq y � X� J -r,o Lit, Hb 151 CAN a5� Joar _ R:ECEIVED �x APR 25 2012 I I I i X s i } t r I i 7r�1 tij Y V Y � y I I LTJ•+� `VJ�'\� I