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11060029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10335 VIRGINIA SWAN PL CONTRACTOR:GENTLE JAMES PERMIT NO: 11060029 CONSTRUCTION OWNER'S NAME: SHENOY ARVIND P AND ANURADHA 2050 S BASCOM AVE DATE ISSUED:06/03/2011 lER'S PHONE: 4084648601 CAMPBELL,CA 95008 PHONE NO:(408)377-3502 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f- ELECT r- PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:ELECTRICAL PERMIT,ADDING CAN LIGHTS IN 4 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions BEDROOMS &KITCHEN,WORK STARTED WITHOUT PERMIT 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. 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 Sq.Ft Floor Area: Valuation:$3800 permit is issued. APPLICANT CERTIFICATION APN Number:31646010.00 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS RO AST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. J 6—� Issued by: / Date: Signature Date L.. OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for 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,I 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(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER v I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with 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 Health&Safety Code,Sections 25505,25533,and 25534. 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 Own"�autl��ri ed agent: b �'I forthwith comply with such provisions or this permit shall be deemed revoked. �/ — Dater CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and 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 -nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature ! Date j �/' Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31646010 . 00 DATE ISSUED. . . . . . . : 06/03/2011 RECEIPT #. . . . . . . . . : BS000013650 REFERENCE ID # . . . : 11060029 SITE ADDRESS . . . . . : 10335 VIRGINIA SWAN PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : SHENOY ARVIND P AND ANURADHA ADDRESS . . . . . . . . . . : 10335 VIRGINIA SWAN PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024 RECEIVED FROM . . . . : ARVIND SHENOV CONTRACTOR . . . . . . . : KIM KANG LIC # 32582 COMPANY . . . . . . . . . . : GENTLE JAMES CONSTRUCTION ADDRESS : 2050 S BASCOM AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 377-3502 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 800 . 00 1 . 00 0 .00 1 . 00 0 .00 1BREMFIXT NO. FIXTURES 1 . 00 126 . 00 0. 00 126 . 00 0 .00 1BSEISMICR VALUATION 3 , 800 . 00 0 .50 0 . 00 0 . 50 0 .00 1EPERMITFE FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 253 .50 0 . 00 253 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 253 . 50 Amex 584937 --------------- TOTAL RECEIPT 253 . 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 ADDRESS: 10335 Virginia Swan PI DATE: 06/03/2011 REVIEWED BY: jsg APN: BP#: '"VALUATION: 1$3,800 r PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP11 USE: p I PERMIT TYPE: WORK To Clear Code Enforcement Case: SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 1 # $63 TOTALS: $63.00 Elec.Plan Check 0.0Trs $0.00 Elec.Permit Fee: IEPERMIT -. Li Other Elec.Insp. L2-0j hrs $42.00 NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-05.1 IS' 7,1110) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes 0 No $105.00 Travel Documentation Fee: 1 TRA VDOC $42.00 Stronc Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg? Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $253.50 $0.00 TOTAL FEE: $253.50 Revised: 04/29/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION { �J 10300 TORRE AVENUE- CUPERTINO. CA 95014-3255 (408)777-3228 • FAX(408)777-3333 -building(McuDertino.org MISC CUPERTINO ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1(333-�_ V l R lI A/l04 Arm# n/� ) PHONEft/,,.,ij M l__4� 4501 E-MAIL � " CIT Y.STATE ZIP Q,.)Qom` 7 C�` -o FAX CONTACT NAME v',,1Vb ",L�'0 PHOIyTe46--dj 11 6�, _�%,6n/ E-MAIL /`' CA FA C LJ OWNER ❑ OWNER-aUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUNMER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WR.DLAND PROJECT IN rRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZO/NES ❑l Yes ❑ No DESCRIFITON OF WORK CN j �ti 4 �2��}g�� L'i TOTAL VALUATION: 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 I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent - Date: SUPPLEMENTAL INFORMATION REQUIRED — >4 - - _ - MEPMiscApp_2011.doc revised 03/16/11