The URL can be used to link to this page

11030136CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10385 STERN AVE I CONTRACTOR: ALI'S CONSTRUCTION & MODELING I PERMIT NO: 11030136 I OWNER'S NAME: PRAKASH NAYAK O` R'S PHONE: 4082420318 ❑ LICENSED CONTRACTOR'S DECLARATION License Class R Lic. # "IOq 4/ ContractorA56 A&Date C to I hereby affirm that I am licensed under the rovisions 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. 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. Q. Z APPLICANT CERTIFICATION / J 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 permit. Additionally, the applicant understands and will comply with all non -point ou�ce regulations per the Cupertino Municipal Code, Section 9.18. Signature Date /' 01 / / n I hereby affirm i4rat 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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. 1 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 ind--nify and keep harmless the City of Cupertino against liabilities, judgments, C( id expenses which may accrue against said City in consequence of the grac,..ng 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 681 E BROKAW RD SAN JOSE, CA 95112 DATE ISSUED: 03/29/2011 PHONE NO: (408) 898-6474 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH T_ RESIDENTIAL 1— COMMERCIAL JOB DESCRIPTION: INSTALL TEMP POWER POLE Sq. Ft Floor Area: I Valuation: $250 APN Number: 37510056.00 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: y Z 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. Owne authorized agent: /]n ,/ Date:—I+r'�-�-- ZG�- t I I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Aork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37510056.00 DATE ISSUED.......: 03/29/2011 RECEIPT #.........: BS000013024 REFERENCE ID # ...: 11030136 SITE ADDRESS .....: 10385 STERN AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: PRAKASH NAYAK ADDRESS ..........: 10385 STERN AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ALI'S CONST & REMOD CONTRACTOR .......: ALI ZAMANI LIC # 28677 COMPANY ..........: ALI'S CONSTRUCTION & REMODELIN ADDRESS ..........: 681 E BROKAW RD CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408) 898-6474 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 250.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 250.00 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 ---------- 127.50 ---------- 0.00 ---------- 127.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 127.50 --------------- 127.50 REFERENCE NUMBER -------------------- #5507 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC (408) 777-3228 • FAX (408) 777-3333 • buildingCc)cupertino.org F-1 PLUMBING ❑ MECHANICAL ELECTRICAL ❑ MISCELLANEOUS PROJECTADDRESS 3 95� w Ve—, APN# L_�'� G (J �� 6 v V OWNER NAMEflj�Ko, Na -Y o, I` 2k P © >— (f i EMAIL STREET ADDRESS/0h,^ 5 CITY, STATE, ZIP C Lt * FAX CONTACT NAME� t �� E MAII�� STREET ADDRESS /� �C j CITY, STATE, ZIP F X yQ Vt ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑( ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANTt CONTRACTOR NAME S �i15 rmc r0 LICENSE NUMBER O `f33 LICENSE TYPE BUS. LIC # COMPANY NAME n �— E-MAIL "JJ ` © `�Ct) FAX STREET ADDRESS CITY, STATE, ZIP /� ce ` PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK Q TOTAL VALUATION: 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 provide 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 bui in onstruction. I authorize representatives of Cupertino to enter the above -i ntified operty for inspection purposes. C / Signature of Applicant/Al � Date' EN INFORMATION REQUIRED .,0FFI,E USE ONLY a .OVER-THE-COUNTER Q EXPRESS D STANDARD- ❑.LARGE M"Rf . MEPMiscApp_2011. doc revised 03/16/11 �1 !�� , loo , CL yt7 � CITY OF CUPERTINO 1�l1 FEE ESTIMATOR -BUILDING DIVISION APPLIANCE / EQUIP TYPE 10385 stern ave. DATE: 03/29/2011 REVIEWED BY: bobs. PA,ADDRESS: APN: BP#: "VALUATION: $250 '°PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP14 PERMIT TYPE: WORK install temp power pole SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $42 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR NOTE. These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (! ee Resolution 09-051 /?ff.' 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? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldgy Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 01/15/2011 CUPERTINO CONT"CTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: to 5, 5 i�r4A- A ve__- PERMIT # OWNER'S NAME:FI"e- CkVQ PHONE # O C� GENERAL CONTRACTOR: AU le V L04 ADDRESS: BUSINESS LICENSE # CITY/ZIPCODE: a *Our municipal code requires all businesses working in the city to have a City of Cupertino�usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ignature Date Please check applicable subcontractors a d mplete the following information: Signature Aq / Z //// 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 Signature Aq / Z //// Date