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11080101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7454 DE LA FARGE DR CONTRACTOR:ALI'S CONSTRUCTION& PERMIT NO: 11080101 REMODELING OWNER'S NAME: VARSHNEYA ATUL AND RENU 681 E BROKAW RD DATE ISSUED:08/12/2011 BIER'S PHONE: 4087770693 SAN JOSE,CA 95112 PHONE NO:(408)898-6474 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class A Lic.# QoQEF 1--A MECH RESIDENTIAL COMMERCIAL Contractor /Ilt'S pjq SkdO IA Date 2- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SERVICE PANEL UPGRADE TO 200 AMPS (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:$800 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. APN Number:35926041.00 Occupancy Type: 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 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 accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source r ulations per the Cupertino Municipal Code,Section Issued bDate:/ C t 9.18. Signature Date O� 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) I,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 Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety C de,Sections 25505,25533,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 Ow r r autho rzedAe h ` Compensation laws of California. If,after making this certificate of exemption,I Date: 011 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 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 property for inspection purposes.(We)agree to save '-mnify 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 g.siting 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: TraciC COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35926041 . 00 DATE ISSUED. . . . . . . : 08/12/2011 RECEIPT #. . . . . . . . . BS000014421 REFERENCE ID # . . . : 11080101 SITE ADDRESS . . . . . : 7454 DE LA FARGE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VARSHNEYA ATUL AND RENU ADDRESS 7454 DE LA FARGE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : OMID MIRI CONTRACTOR ALI ZAMANI LIC # 28677 COMPANY ALI' S CONSTRUCTION & REMODELIN ADDRESS 681 E BROKAW RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE (408) 898-6474 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 800 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 800 . 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 V --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL GENERAL PERMIT APPLICATION MEP- CONIMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Isc (408)777-3228 • FAX (408)T77-3333• buildino(acuoertino.org IT a CUPERTINO ❑PLUMBING ❑NfF-CHANICAL /' ®ELECTRICAL ❑TNESCELLANEOUS PROJECT ADDRESS T ! �� t{� �,;1(S APN# OWNER NAME N/eLYSkv,,eya PHONE c--(OS) —O4 Vg\ E-MAM STREET ADDRESS V CITY, STATE,ZIP FAX CONTACT NAME J PHONE 468 )/��l —076E bfAII r�mi(�' STREET ADDRESS Q /' L {� CITY,STATE, ZIP SCIVk C)-Sr— Sr FAX ❑ OWNER ❑ -- OWNER-BUGENT ILDER ❑ OWNERAGENI v CONTRACTOR Qt`ONTRACTORA ❑ xARCHITECT ❑ENG➢vEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME js �N C ru i, LICENSE NUIV[BER 909 4 ? LICENSE TYPE BUS.LIC# COMPANY NAME FAX C 1` E-MAR 5 FAX STREET ADDRESS SY /� f1 CITY,STATE,ZIP C` ace PHONE 4(Lj)q(4 c—aq ARCHITECT/ENGINEER NAMED C 1J LICENSE NUMBER `] J BUS.LIC# COMPANY NAME' E-MAII. FAX STREET ADDRESS CITY,STATE,ZIP PHONE lisp-OF ❑SFD or DUPLEX ❑ MULTI-FA V(ILY PROJECT IN WII.DLANO ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ElNO EICHLER HOME? C1NO DESCRIPTION OF WORK d' ulo te`�Lr,&ra ` TOTAL VALUATION: g00 RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro erty owner's behalf. I have read this application and the information I have provided is corre . i ve read the Description of Work and verify it is accurate. I agree to co=I-;,vith all applicable local ordinances and state laws relating tc ng constru n:I th rize representatives of Cupertino to enter the above-identified property for inspection pu3poses. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFOR-NiATION REQUIRED OFFIC E ONLY OVER-THE-COUNTER ❑ EXPRESS Y U w ❑ STANDARD U Ic ❑ LARGE ❑ MAJOR 11 fPMIscAppj011.doc revised 06121/11 CITY OF CUPERTINO j ��l 6olo FEE ESTIMATOR-BUILDING DIVISION jA, jDDRESS: 7454 de la forge DATE: 08/12/2011 REVIEWED BY: bobs. PN: o4t-1 BP#: "VALUATION: $800 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK service upgrade to 200 amps SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 TOTALS: $44.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $44.00 NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 1.1-053 f f,� 7%1,"11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 FA PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: 1BCBSC $1.00 $41.00 1ADMIN SUBTOTALS: $133.501 $41.00 TOTAL FEE: $174.50 Revised: 07/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 711S-14 I>- La e PERMIT# Jl0 OWNER'S NAME: kjePHONE # q0,5 7-1F4--d6c( GENERAL CONTRACTOR IA BUSINESS LICENSE# `9094 3 ADDRESS: f,O$ Calz-� CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL UBCON RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I kk" , I am not using any subcontractors: _ g f Z i 2 o i j _ Signature Date Please check applicable subcontractors and complete the following information: V 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