11050293 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10134 S TANTAU AVE CONTRACTOR:G R ELECTRIC PERMIT NO: 11050293
OWNER'S NAME: RAMAN MUMMIDIVARAPU 855 WYMAN WAY APT 3 DATE ISSUED:05/31/2011
OWNER'S PHONE: 4086556677 SAN JOSE,CA 95133 PHONE NO:(408)660-7126
L_ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT F PLUMB
License Class L'(O Lic.# n S 3 2"6
MECH F RESIDENTIAL COMMERCIAL
Contractor ,t1le LTy,(Date J 3 i
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SERVICE UPGRADE TO 200AMPS
(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.
APPLICANT CERTIFICATION APN Number:37507038.00 Occupancy Type:
I certify that 1 have read this application and state that the above in tion 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 DAYS FROM LAST 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
9.18. Issued by: .__.. __ Date:' �� 1
Signature Date
r 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.
I,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)
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
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 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(x)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
permit is issued. 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
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 Own r or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I mus[ Date:
forthwith comply with such provisions or this permit shall be deemed revoked. 0
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work'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 construction,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,
c,,-',,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ng of this permit.Additionally,the applicant understands and will comply
w....all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature Dale Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37507038. 00
DATE ISSUED. . . . . . . : 05/31/2011
RECEIPT #. . . . . . . . . BS000013607
REFERENCE ID # . . . : 11050293
SITE ADDRESS 10134 S TANTAU AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAMAN MUMMIDIVARAPU
ADDRESS . . . . . . . . . . : 10134 S TANTAU AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOHN CARRANZA
CONTRACTOR . . . . . . . : GREGORIO RAMIREZ LIC # 29252
COMPANY . . . . . . . . . . : G R ELECTRIC
ADDRESS . . . . . . . . . . : 855 WYMAN WAY APT 3
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 660-7126
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 0 .50 39.00 0. 00 39 .00 0. 00
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
1EPERMITFE 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 166.50 0. 00 166.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 166 .50
---------------
TOTAL RECEIPT 166 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333 -building(a cupertino.org misc
CUPERTINO
❑PLUMBING ❑MECHANICAL 5KELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS j� �4 Av1 TA v vk� APN# '�5
OWNER NAME E-MAIL
71
STREET ADDRESS �-rCITY,STATE, TPI rA rsw FAX
CONTACT NAME J �A 1 L �p 'tv PHO E-MAIL
STREErADRES ,, a �` �✓ Com, SATE 1 71 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ju CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME r K) LICENSE NUMBER �/ LICENSE TYPF/` /y,, BUS.LIC H
COMPANY NAME ]/ �j�'4 E-MAIL FAX
STREET ADDRESS i LA—?QW!'"4; C ATE t PH 4
ARCH TECP/ENGINEER NAME LICENSE NUMBER �J BUS.LIC r�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
SE OF 19 SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT rN
-MUS : ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
AL9 c CID, �-
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 ail applicable local
ordinances and state laws relating too/building construction. I authorize representatives of Cupertino to enter the above-ide tifiejd perry for inspection purposes.
Signature of Applicant/Agent: 111k - Date: t
SUPPLEMENT ORMATION REQUIRED
� SFia : max
A1fEPMIsc.4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10134 s.tantau ave. DATE: 05/31/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$1,600
'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP2
USE: -7PERMIT TYPE: 19
WORK service upgarde too 200 amps.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $42
TOTALS: 1 $42.00
Elec.Plan Check 0.0 hrs $0.00
Elec.Permit Fee: IEPERMIT
LLJI Other Elec.Insp. 0.0 hrs 1 $42.00
NOTE. Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 09-051 F.,ff 7/1,10) FEE QTY/FEE MISC ITEMS
%i
PME Plan Check: $0.00
PME Unit Fee: $42.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes G No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Stroniz Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 HMIN
SUBTOTALS: $127.50 $39.00 TOTAL FEE: $166.50
Revised: 04/29/2011