12070196 e
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23016 VOSS AVE CONTRACI'OR:SWAMI ARUN N PERMIT NO: 12070196
OW'NER'SNAME: SWAMI ARUNN 23016 VOSS AVE DATE ISSUED:07242012
OWNIiR'SPBONE: 4083380906 CUPERTINO.CA 95014 PDONENO:
❑ LICENSED CON\fRAC-fOR'S DECLARATION BUILDING PERMIT INFO: BLDG F- ELECT r PLUMB 1-
License Class Lie.N
AIECFI (- RESIDENTIAL r COMMERCIAL
Contractor Date
hereby affirn,that I am licensed under the provisions of Chapter 9 •1013 DESCRIPTION:ADD NEW GAS LINE,UPGRADE ELECTRICAL PANEL TO
(commencing with Section 7000)of Division 3 of the Business&Prof".sions 200
Code and that nn•license is in full force and effect. AbIPS
hereby affirn,under penally of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of die 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 die work for which this Sq. Ft Floor Aren: Valuation:$1500
permit is issued.
APPLICANT CERTIFICATION AI,N Number:34250018.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnity ryxp keep s hornless the City of Cupertino City
int onsequenceogmems, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City inconsequence of the
granting ofthis permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Sectio,
9.18.
Issued by: Date:��ZLi-( �--
Signature Date
�❑ OWNER-BIIILDER DECLARA'T'ION
RE-ROOF'S:
hereby affirm that 1 am exempt from the Contractor's License La%% fur one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 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 HAZARDOUSMATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California l lealth&Safely Code,Sections 25505.25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safely Code,Section 25532(x)should I store or handle hazardous material.
Additionally:should I use equipment or devices is hich emit hazardous air
permit is issued. contaminants as defined by the Buy Area Air Quality Management District I will
I certify that in the performance of Unc work for which this permit is issued,I shall maintain compliance wish the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Code,Sections 25505.25533,and 25534.
Compensation laws ol'California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must \Toa'�yl�or.nutho 'zed ngent:
forthwith comply with such provisions or this permit shall be deemed revoked. "`^ Date: -L-
A PPLICANT
LAPPLICANTCERTIFICATION CONSTRUCTION LENDING AGENCY
1 certily that I have read this application mid state that the above information is I hereby affirn,that there is a construction lending agency for the performance of work's
correct.I agree to comply with Lill city and county ordinances mid state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemmniN and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accme against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ,\RCI(ITFCI"S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature r Dural [,--c I1%-- Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:121 ADDRESS: 23016 voss ave. DATE: 07/24/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: $1,500
*PERMITTI'PE: Building Permit PLAN CHECK 7.1'PE: Alteration I Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERNIITTI'PE: 1RPGA
WORK add new gas line upgrade electrical panel to 200 amps
SCOPE
dlech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 1 0.0 hrs $0.00
Mich. Permit Fee: Plumb. Pennit Fee: I PPERAHT Elec. Pennit Fee: IEPERAIIT
Other,lfech.Insp. Other Plumb Insp. 0.0l II
hrs $45.00 Other Elec.Insp. 0.0 hrs $45.00
,Neck. Insp.Fee: Plumb. Map.Fee: Elco.Insp.Fee:
NOTE: This estinutte does not inchrrle fees clue to other Departments(i.e. Planning, Public Works. Fire,SanitarySemer District,School
District, etc.). These fees are based on the prelintinart information available and tire onb•an esrinuue. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 F_fl 7/1/1/I FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Plumbing
Supp]. PC Fee: (D Reg. Q OTE67 hrs $0.00 $67.00 IPGASR63 Piping, Gas<=4 Outlets
PME Plan Check: $0.00 F 200 amps Electrical
Permit Fee: $0.00 $45.00 /ERT<200 Services
Supp]. Insp. Fee:Q Reg. O OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $90.00
Consnvction Tar:
Administrative Fee: ]ADMIN $42.00 O
Work Without Permit? O Yes Q No $0.00 G
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRALI'DOC $45.00 Building or Structure
Strong,Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $178.50 $112.001 TOTAL FEE: $290.50
Revised: 07/01/2012
l -�"7 vl q (.,o
GENERAL PERMIT APPLICATION M E P
Em COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 w w I /� /�
CUPERTINO (408)777-3228• FAX(408)777-3333 • buildingr5cuoertino.orD '\v/' v\ /v�
PLUMBING /��❑MECFLANiCAL LECTRICAL []MISCELLANEOUS
PROTECT ADDRESS -110
` I V ,�l.F' A � � AFN4 �U /a—
OWNER NAME L uvN SW AJI `1 P ONE 0S-333-091o` E-, I1"As. OL1'vn Q 1VtG� ccf"
STREET ADDRESS ^ O / SS AVC
l I C-u P STATE 'i—OS�CJ C/"1 I Y O ' 4- FA.Y
CONTACT NAME '/ U VPHONE E-MAILII--
t?Unl fvjAr1� Lf a- - o`�o iS'Gs• avuKQ' r^aJ' cc,
STREET ADDRESS q Q I ZIP
V UJJ 'A V 0. 1'ATE Te j-COL-1 y/iU C A / 0 I FAX
❑OWNER OWNER-BUBDER ❑ OWNERAG ❑ CONTRACTOR ❑COMTUCTOR AGENT ❑ ARCHITECT ❑PNGINEEIt ❑ DEVELOPER ❑ TENANT
CONTRACTO NAME LICENSE NUMBER LICENSE TYPE BUS.LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CrTY,STATE,IIP PHONE
ARCHTTECTJPNONEER NAME LICENSE NUMBER BUS.LIC N
COMPANY NAME' E-MAIL FAX
STREET ADDRESS I CITY,STATE,ZIP PHONE
USE OF FD w DUPIFX ❑ MULTI-FAMR.Y PROJECT W WE-Ot.N'D ❑ YES PROTECT IN ❑ YES tS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN DrrERFACE AREA ❑ NO FLOOD ZONE ❑NO ELCHLERHOMEf ❑NO
DESCRIPTION OF WORK
I'.
CrAf LsNc Fulz Nrcw G f can --on is
2 , UPG AD' IC2oM mxr- 'r
2-00 S . V A (z 4 JQ
J( TOTAL VALUATION: I5-0
o RECE VED BY: Z '
By my signamrc below.I certify to each of the following: I am the property owner or authorized Wet to act an the property owner's behalf 1 have read this
application and the iaronnation I have provided is CO=CL I have read the Description of Work and verify it is accurate. 1 ag=,,w comply with all applicable local
ordinances and state laws relating• building cc suuction. I authorize representatives of Cupertino to enter the above-identiiicd pmper y for inspection pul¢oses.
Signature ofApplicanVAgene Date: t `f-, Lll2V I z—
SUPPLEMENTAL INFO&MfATION REQUIRED OFFICE USE ONLY
m t-1-0--v;;-THE-COUNTER
r
❑ EXPRESS
2
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
A,EP,4ferc4pp_2011.doc revised 06/21/11