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11080093. I I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10431 PLUM TREE LN I CONTRA AL R: RIGHT A WAY I PERMIT NO: 11080093 I OWNER'S NAME: CHINNANANCHI MURUGANANTHAM 110450 CORTE DE MADRID DATE ISSUED: 08/12/2011 !.R'S PHONE: 4087188569 I CUPERTINO, CA 95014 PHONE NO: (408) 466-7156 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor (� Date I hereby affirm that I am licensed unc er the provisions of Chapter (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 declaratioilil ]I I have and will maintain a certificate of consent to self -insure for Worker's \Y 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 of this Additio ly, the applicant understands and will comply with all non -p nt s rce r ul ti s per the Cupertino Munic'pal Code, Sec ion 9.18. Signature � Date G OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, 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 construct the project (Sec.7044, Business & Professions Code). I 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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Compensation laws of California. If, after making this certificate of exemption, I 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. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save it nify and keep harmless the City of Cupertino against liabilities, judgments, c nd 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG 1— ELECT F PLUMB I— MECH I- RESIDENTIAL r- COMMERCIAL JOB DESCRIPTION: PANEL UPGRADE 200AMP Sq. Ft Floor Area: I Valuation: $1500 APN Number: 31633117.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by '��'�� ..��"....-- Date:S_ RE-ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633117.00 DATE ISSUED.......: 08/12/2011 RECEIPT #......... BS000014410 REFERENCE ID # ...: 11080093 SITE ADDRESS 10431 PLUM TREE LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER CHINNANANCHI MURUGANANTHAM ADDRESS 10431 PLUM TREE LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM RIGHT A WAY ELECTRI CONTRACTOR ROLLAND RIIVES LIC # 32109 COMPANY RIGHT A WAY ELECTRICAL ADDRESS 10450 CORTE DE MADRID CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE (408) 466-7156 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ------ THIS REC NEW BAL ---------- lADMIN ------------- HOURS ---------- 1.00 ---------- 41.00 0.00 41.00 0.00 1BCBSC VALUATION 2,000.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 2,000.00 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 ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 174.50 --------------- 174.50 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- #157 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CUPERTINO GENERAL PERMIT APPLICATION - COMMUNI T Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (J08) 777-3333 • buildino(c")cuoertino.or C-0ojh4 p( -H ( ❑PLLniBTiVG ❑bIECHAN,gc L t ELECTRICAL ❑ MIS CELLANEOT MEP J PROJECT ADDRESS a � APN # OWNER NAME ^ " \ PHO _ AL �Cj L E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME �\` ^^ PHONE E-MAIL STREET ADDRESS J r L�V�■��1 (c` ( 4"t STATE, ZIP t FAX ElOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT❑ ENGINEER❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` CENSE NUMBERq l LICENSE TYPE BUS. LIC COMPANY NAME 1 l 4 Q n E MAR� \ / } FAX STREET ADDRESS L _ CITY, STATE, ZIP j' PHONE .� LI` % 6—?/ ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME ' E LIAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SE OF [I SFO or DUPLEX ❑ MULTI-FAMIl.Y PROJECT IN WILDLAND C1 YES URBAN INTERFACE AREA C] NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO B=ING: ❑ CONDAE"RCIAL DESCRIPTION OF WORK TOTAL VALUATION: RECEIVED BY: By my signature below, I ce: tify t eac he following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this d it is I agree to comply with all applicable local application and the information I e pr 'ded i correct.,.I ve read the Description OfFork verify accurate. a thorize representatives to enter the above -identified property for inspection pu.�oses. ordinances and state laws relatin ng con truction: /Cupleno Signature of Applicant/Agent:tLn k Date: S PLENIENTAL IN70RMAATI N REQ D OFFICE ONLY 'USE ER -THE -COUNTER G ❑ EXPRESS V ❑ STANDARD U ❑ LARGE ❑ MAJOR 1,EPMscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10431 plumtree In. DATE: 08/12/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: $1,500 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD or Duplex PERMIT TYPE: WORK service upgrade to 200 amps SCOPE APPLIANCE / EQUIP TYPE FEE ID �••» �• QTY/FEE QTY UNITS BP FEES Services 1 ERT<200 $0.00 1 Amps $44 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 i Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 TOTALS: Commission Fee: 1BCBSC $1.00 Effidg,ds SUBTOTALS: $44.00 $41.00 TOTAL FEE -,T Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 10.0 1 hrs $44.00 ._ . _ _ � _ -l.. iho vont far addn'L info. NOTE: These fees are vasea on inepreurrartury oa vi FEE ITEMS (lee Resolution 1].-053 Bff. ' 1. 'I I) i.wasvis �.�•��•� FEE �••» �• QTY/FEE - - MISC ITEMS xa _: PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 i Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee $41.00 (ADMIN Commission Fee: 1BCBSC $1.00 Effidg,ds SUBTOTALS: $133.50 $41.00 TOTAL FEE -,T $174.50 RCvibuu. ViiV`nw CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ��j wry OWNER'S NAME: t- LL PERMIT # 9 �/ PHONE # �So GENERAL CONTRACTOR: BUSINESS LICENSE # BUSINESS LICENSE # ADDRESS: r CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a t-�ity of Lupertnno business ucr„nr. NO BUILDING FINAL OR FINAL OQVUPANCYrSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL ON TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ` % n l'� ( C I am not using any subcontractors: j -Y"` Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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