11050203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10334 PALO VISTA RD CONTRACTOR: PERMIT NO: 11050203
OWNER'S NAME: KUMAR SANGAREDDI Y►�'�( DATE ISSUED:05/25/2011
O`' 'R'S PHONE: 4088886327 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
y� u�I Z� MECH F RESIDENTIAL� COMMERCIAL�
Contractor �� /uafAy 0er;cbate ZSIt I
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ELECT PANEL UPGRADE TO 200AMP
(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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1600
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35702053.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DA S FROML T CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section t1 / ("; .� l
9.18. Issued by: Date:
Signature Date
L OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,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
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of cork's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building constriction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
.and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ing of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333 •building(acupertino.orcl misc
CUPERTINO
PLUMBING ❑MECHANICALELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APNoA
I i .
E-MAIL
OWNER NAME ' c.'fie— J. �W J � u mo� c (,i mom
STREET ADDRESS -3,
FAX
CONTACT NAME PHONE
STREET ADDRESSi > t-✓ , 1 ik Y LA✓C 3 L!� CITY,STTE,
ZII' FAX
FA
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR 1-1CONTRACTOR AGENT `❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEA
n ✓� LI=EN LICE TYPF� BUS.LIC N
_ 3
COMPANY NAME Fu 4c �-Ierfl-.C- E ^ ` v� i_ / FAX
STREET ADDRESS /D f 4�. '?I C=,CTIY.ST-AtTE ZIP / PHON E+ 7W_ :7 1 00
ARCHRECT/ENGINEERNAME G( 1_1
ICENSE NUMBER (� BUS.LIC lk7v 7 I
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes Cl No FLOOD zoNE ❑ Yes ❑ No
DESCRIPTION OF WORKI UU ci/ 7 to V•c ufg
� l
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 I have read the Descriptind verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building truction. I authorize rep _ uper[i to enter the above�� tified pr petty for inspection purposes.
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATIO D
.
MEPJLfucApp_2011.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10334 pato vista DATE: 05/25/2011 REVIEWED BY:
APN: BP#: "VALUATION: 1$1,600
PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PENTAMATION 1 REAP2
USE: P
PRIMARY SFD or Duplex ERMIT TYPE:
WORK 200 amp service panel change out
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 200 Amps $42
TOTALS: $42.00
Elec.Plan Check 0.0 1 hrs $0.00
Elec.Permit Fee: IEPERMIT
LiOther Elea Insp. 0.0 hrs $42.00
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff' 7,1/10)_ FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $42.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $127.50 $0.00 TOTAL FEE': F $127.50
Revised: 04/29/2011
CITY OF CUPERTINO
5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35702053 . 00
DATE ISSUED. . . . . . . : 05/25/2011
RECEIPT #. . . . . . . . . : BS000013564
REFERENCE ID # . . . : 11050203
SITE ADDRESS . . . . . : 10334 PALO VISTA RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KUMAR SANGAREDDI
ADDRESS . . . . . . . . . . : 10334 PALO VISTA RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AARON E MURPHY
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 600.00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 1, 600.00 0.50 0. 00 0 .50 0. 00
lEPERMITFE FLAT RATE 1.00 42 . 00 0. 00 42 .00 0. 00
1ERT<200 UNITS 1.00 42 . 00 0. 00 42 .00 0. 00
1TRAVDOC FLAT RATE 1 .00 42 . 00 0. 00 42 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 127.50 0. 00 127.50 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
Building Department
City Of Cupertino
ELI] 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: ) 3 3 Vilkk PERMIT# I L� o
OWNER'S NAME: K/~ 5 Gi4 / { PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY PECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC R� RS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 5 57//
I am not using any subcontractors:
Signature D to
Please check applicable subcontractors and complete the following information:
&/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical Ulf 1�v/ �(cc ,
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