The URL can be used to link to this page

11090137 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1104 ELMSFORD DR CONTRACTOR:CALIFORNIA HOME PERMIT NO: 11090137 BUILDERS&DESIGN OWNER'S NAME: KRISHNA ARVIND 1775 JUNCTION AVE DATE ISSUED:09/20/2011 ER'S PHONE: 4082525128 SAN JOSE,CA 95112 PHONE NO:(408)392-8200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# g p ,�� ` MECH T_ RESIDENTIAL� COMMERCIAL Contractori A AQ A c _Date O 1 I hereby affirm that I am licensed under the provisions of Chapter 9 1. JOB DESCRIPTION:TEMPORARY POWER POLE (commencing with Section 7000)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. Sq.Ft Floor Area: Valuation:$700 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 APN Number:36206003.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize represen Ives of this city to enter upon the above mentioned property for inspecti ses. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of ert' against liabi ties,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may acc agai said City in c quence of the granting of this permit. Addi ally,t ppl' t and ands and will comply with all non-point sourc gula' I Municipal Code,Section Issued b 1--- Date: 9.18. Signatur Date RE-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 Law for one of inspection. the following two reasons: I,as owner of the property,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. I 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(a)should I store 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 B ea Air Quality Management District I will maintain compliance with u in Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Cod ection 5059 25533,and 25534. I 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 or ized Compensation laws of California. If,after making this certificate of exemption,I Date: / 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 I hereby affirm that there is a construction lending agency for the performance of cork'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 property for inspection purposes.(We)agree to save 'emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ;,and expenses which may accrue against said City in consequence of the ,...ating 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 . . . . . . . . : 36206003 . 00 DATE ISSUED. . . . . . . : 09/20/2011 RECEIPT #. . . . . . . . . : BS000014800 REFERENCE ID # . . . : 11090137 SITE ADDRESS . . . . . : 1104 ELMSFORD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KRISHNA ARVIND ADDRESS . . . . . . . . . . : 1104 ELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : KRISHNA ARVIND CONTRACTOR . . . . . . . : SIMON KREK LIC # 31282 COMPANY . . . . . . . . . . : CALIFORNIA HOME BUILDERS & DES ADDRESS . . . . . . . . . . : 1775 JUNCTION AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 392-8200 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 700 . 00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 700 . 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 ----------------- --------------- -------------------- CHECK 174 .50 #1265 --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER C9 0(57 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CIfPERTtNO (408)777-3228• FAX(408)777-3333• building(aDcupertino.org misc ❑PLUMBING ❑MECHANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS I'I O M r Q D �� APN# l / 1 O 0,!5 OWNER NAME 1'<R 1 S+I N A 7c.1 a V i N PHONE� E-MAIL k A R v l N (0 i-Yj STREET ADDRESS b D t,3 Pia j2 KWC)O D CITY, STATE,ZIP e U Pf-P', I N O fk7( L*pS :j 0 G-q5 mit CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT C� ONTR/+CTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME R 1 `_, LICENSE NUMB LICENSE TYPE BUS.LIC# L Z COMPANY NAME "C1�-} "1'I i �{C>YY � �:i l I�e.Y E-MAIL FAX STREET ADDRESS �f 1 u�Ct�csx -At-,e CITY,STATE,ZIP PHONE L C\C) ARCHITECT/ENGINEER NAME LICENSE NUMBER N U'_ J Lr I D BUS.LIC# �4 COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE c"� C C , 2^ -76R n USE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATIO : RECEIVED BY: By my signature el certify to each of the following: I am the er or thorized agent to act on the property owner's behalf. I ave read this application and the information I have provided��correct., read th es doofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building coo' upertino to enter the above-id tified prop for inspection putposes. Signature of Applicant/Agent: Date: ST-T PP ORMATI REQUIRED OFFICE USE ONLY VER-THE-COUNTER a ❑ EXPRESS Y U T ❑ STANDARD U ❑ LARGE a ❑ MAJOR AEPMscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1104 elmsford dr. DATE: 09/20/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: 1$700 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK temp power pole SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $44 TOTALS: $44.00 T7T Elee.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT LiOther Elea Insp. El hrs 1 $44.00 NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the Dept-for addn7 info. FEE ITEMS (Fee Resolution 11-053 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item 131daStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: 1 $174.50 Revised: 09/02/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# ` OWNER'S NAME: r I 1 PHONE# GENERAL CONTRAC OR: BUSINESS LICENSE# 3 ADDRESS: 00 CITY/ZIPCODE: *Our municipa code requires all businesses working in the city to have a City of Cupertino 1754siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 wner ontractor Signature Date