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10100196CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10195 POTTERS HATCH CMN CONTRACTOR: RAGINENI RAMESH PERMIT NO: 10100196 OWNER'S NAME: CUPERTINO, CA 95014 PRONENO: ❑ CONTRACTOR'S DECLARATION I" I PLUMB pLICENSED BUILDING PERMIT INFO: BLDG([] ELECT License Class D I Lic. >t I IRS Q S-7 � ^ Contractor �" / 2 r 6' MECH � L_IRESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BASEMENT STRENGTHENING, FOUNDATION REPAIR BY (commencing with Section 7000) of Division 3 of the Business & Professions ADDINGADDING NEW RETAINING WALL Code and that my license is in full force and effect. %�/I ``'' 2/8/11-REV#I- REVISE RETAINING WALL(DEEPENKEY UNDER WALL 9" GG `( I hereby affirm under penalty of perjury one of the following two declarations: RAISE WALL TO 6)- REVgl ISSD 2./8/11 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: $20000 permit is issued. APPLICANT CERTIFICATION APN Number: 34235053.00 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature V Issued by: Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, 1 agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec. 7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10195 POTTERS HATCH CMN I CONTRACTOR: RAGINENI RAMESH PERMIT NO: 10 100 196 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # MECH r RESIDENTIAL F COMMERCIAL Contractor Date I hereby affirm that 1 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. 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date ❑ I� \� OWNER -BUILDER DECLARATION I hereby affirm that 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ML L 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. 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, l 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, l become subject to the Worker's Compensation provisions of the Labor Code, l 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 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 source regulations per the Cupertino Municipal Code, Section 9.18. ` l 1 t Signature a Date JOB DESCRIPTION: BASEMENT STRENGTHENING, FOUNDATION REPAIR BY ADDING NEW RETAINING WALL Sq. Ft Floor Area: I Valuation: $20000 APN Number: 34235053.00 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: Dane: 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 1 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized age: ' / Date: T CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO r-7 FEE ESTIMATOR - BUILDING DIVISION NOTE: These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (fee Resolution 09-051 E . 711110) ADDRESS: DATE: REVIEWED BY: fe,h. Permit Fee. APN: BP#: 'VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p 101',1L F1,00R _1RIA. PENTAMATION 1GENRES PERMIT TYPE: WORK SCOPE PME Plan Check: NOTE: These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (fee Resolution 09-051 E . 711110) ,finch. Pion Chu A T/�Nnh. Plan C. ii( r6 Do . Plan Check fe,h. Permit Fee. P:,rrnh Peamit fre: Ele(- Permit I ee f)rher A!;', il, Msp- Uis+:: . ,_. Otyro- r r_. r . In y, Foundation Repair IFOUNDREP4 uO_ h: , , ,.. L! . Inv" NOTE: These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $760.00 Foundation Repair IFOUNDREP4 Suppl. PC Fee: 0 Reg. © OT Elhrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee{') Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslrtiction .Tax Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Docr-nnentulion Fees:� Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.00 $760.00 TOTAL FEE: $763.00 Revised: 10/17/2010 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 EK. 7/1/10) ADDRESS: 10195 potters hatch commons DATE: 02/08/2011 REVIEWED BY: bobs. Xle(_h Permit Fee: APN: BP#: 'VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Phnnh. hup. I-ce. PENTAMATION 1GENRES PERMIT TYPE: WORK revise retaining wall SCOPE NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 EK. 7/1/10) A -le ch. Plun ('&.wk Phrmh. P4nr C"hcc% t 4'c. Plan Cite r'k Xle(_h Permit Fee: „-..`'. Pe;n2a lC(I. (,li C, i'ci-Yew l`c'.:-' 011wPAfech, f;.'p, " — 0"' - -, 0i., 1;�: 1.1v, E17— .Flick hmp Pee: Phnnh. hup. I-ce. Lic(. tnsp. Fc:e: NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 EK. 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (F) No $0.00 0 hours $126.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SuppL Insp. Fee10 Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consti-arction Tax Acoustical Fee: 0 Yes 0 No $0.00 Q 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Q Building or Structure i Travel Doc Fees: c Strone; Motion Fee: IBSEISMICR $1.00 0 # $0.00 Revision IREVRESREM Remodel Bldg; Stds Commission Fee: IBCBSC$1.00 SUBTOTALS: $2.00 $126.001 TOTAL FEE: $128.00 Revised: 01/15/2011