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11070074 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 828 KIM ST CONTRACTOR:NEKO ELECTRIC PERMIT NO: 11070074 OWNER'S NAME: SRIRAM RAGHUNATHAN 22430 CUPERTINO RD DATE ISSUED:07/12/2011 -)W=PHONE: 4087251030 CUPERTINO, CA 95014 PHONE NO:(408)446-4141 LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# �� -7 -7 i�� F , � MECH RESIDENTIAL COMMERCIAL Contractor A'1, Date, 7NEW� JOB DESCRIPTION: INSTALL NEW FAN IN MASTER SUITE I hereby affir'm that" - ru I am licensed under the provisions of Chapter 9 (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:$250 I have and will maintain Worker's Compensation Insurance,as provided for b Section 3700 of the Labor Code,for the performance of the work for whi this APN Number:35919041.00 Occupancy"Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT MIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 D ROM LAST CA LED INSPECTION. 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 peen ona , licant understands and will comply Issued by: Date: with all non- i source regulations per the rtino Municipal Code,Section 9.18. (( RE-ROOFS: Sign ure a Date 7 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. _J OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance wi uper m cipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,Sections 25505,25533,an 5534. r� Section 3700 of the Labor Code,for the performance of the work for which this Z I permit is issued. Owner or authorized agent: Date: �� 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,[ CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 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 'emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 2 'e vk.V" < PERMIT# OWNER'S NAME: AA 440 HONE # K d 2 G GENERAL CONTRACTOR: e-1�0 C- If, 2- BUSINESS LICENSE# ADDRESS: Z`Z GL u '.T,;nr 7 CITY/ZIPCODE: C- I ,' I kIVI - *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ignature 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 Owner/Contractor Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 35919041 . 00 DATE ISSUED. . . . . . . : 07/12/2011 RECEIPT # . . . . . . . . 1 : BS000014024 REFERENCE ID # . . . : 11070074 SITE ADDRESS . . . . . : 828 KIM ST SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SRIRAM RAGHUNATHAN ADDRESS . . . . . . . . . . : 828 KIM ST CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : M. MESABANI CONTRACTOR . . . . . . . : ALI PAKNAHAL LIC # 31642 COMPANY . . . . . . . . . . : NEKO ELECTRIC ADDRESS . . . . . . . . . . : 22430 CUPERTINO RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 446-4141 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 250 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMFIXT NO. FIXTURES 1 . 00 65 . 00 0 . 00 65 . 00 0 . 00 1BSEISMICR VALUATION 250 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 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 195 . 50 0 . 00 195 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 195 . 50 visa --------------- TOTAL RECEIPT 195 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MDDRESS: 828 kim st. DATE: 07/12/2011 REVIEWED BY: bobs. PN: I BP#: 'VALUATION: $250 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP11 USE: p PERMIT TYPE: WORK install new fan. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 1 # $65 TOTALS: $65.00 L -T Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elea Insp. 0.0 hrs 1 $44.00 NOTE: These ees are based on the reliminar in ormation available and are onl an estimate. Contact the De t or addh7 info, FEE ITEMS (f'ee Resolution]1-05 1 ff %7."11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $65.00 PME Permit Fee: $44.00 F71 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 ]ADMIN SUBTOTALS: $154.501 $41.00 TOTAL FEE: $195.50 Revised: 07/04/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinq(c�cupertino.orq misc CUPERTINO 0034 ❑PLUMBING ❑MECHANICALrr�� ❑ELECTRICAL MISCELLANEOUS PROJECT ADDRESS �`r" Lut lI�•� "��\-1 APN# G OWNER NAME STREET ADDRESS J /' \ �1 CITY, STATE,ZIP fi ( vA Q FAX 2 � CONTACT NAME I- /j (� /1,n� PHONE` !,v 3 STREET ADDRESS I 3 0L + JCC 1 �' + yr CITY,STATE, ZIP �` - r/1� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (/ .//1 1 /} LICENSE NUMBER LICENSE TYPE BUS.LIC# -7q3 ' 7qa ' COMPANY NAME I 1 r� `�s� -� E-MAIL FAX STREET ADDRESS 2 t��Ct k. /� T1 �ti' Q CITY,STATE,ZIP U`Y 1 Lj PHONE E ARCHITECTIENGINEER NAME L/ICENSE NUMBER BUS.LIC# �+ COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILYPROJECT 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 VALUATION: 2'S�? 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 property owner's behalf. I have read this application and the information I have provided is correct. haver the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi ction. I authorize representatry u ertino to enter the above-identified property for inspection putposes. Signature of Applicant/Agent: L-''~- --7 Date: —1 2-- i r SL OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS U w ❑ STANDARD U ❑ LARGE ❑ MAJOR MEPM scApp_2011.doc revised 06/21111