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11010033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7848 ROBINDELL WAY CONTRACTOR:ADAMS BROTHERS PERMIT NO: 11010033 CONSTRUCTION OWNER'S NAME: ANANDI SUGEER&SHANKAR SHENOI 10100 TORRE AVE DATE ISSUED:01/06/2011 ( :R'S PHONE: 4085170885 CUPERTINO,CA 95014 PHONE NO:(408)5645207 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT I— PLUMB� License Class Lic.# �� MECH r— RESIDENTIAL r COMMERCIAL Contractor ,:k �YnC S Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT IN EXISTING INTERIOR HALLWAY (commencing with Section 7000)of Division 3 of the Business&Professions Code and that m license is in full force and effect. FURANCE CLOSET,PANEL UPGRADE FROM 125 AMP TO Y 200AMP,4'GAS LINE EXTENSION AT KITCHEN 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 whic permit is issued. Sq.Ft Floor Area: Valuation:$11700 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36219030.00 Occupancy Type: 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 regulat. ns per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date Issued b �� -� Signature Y'`�� Date:� �r LJ 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,I 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). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 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 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. 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 Ow a thorize gent: forthwith comply with such provisions or this permit shall be deemed revoked. _ Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby a correct.I agree to comply with all city and county ordinances and state laws relating 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 ,lemnify and keep harmless the City of Cupertino against liabilities,judgments, sts,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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36219030 .00 DATE ISSUED. . . . . . . : 01/06/2011 RECEIPT #. . . . . . . . . BS000012408 REFERENCE ID # . . . : 11010033 SITE ADDRESS 7848 ROBINDELL WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER ANANDI SUGEER & SHANKAR SHENOI ADDRESS . . . . . . . . . . : 7848 ROBINDELL WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM ADAMS BROTHERS CONS CONTRACTOR . . . . . . . : STEVE ADAMS LIC # 22207 COMPANY ADAMS BROTHERS CONSTRUCTION ADDRESS 10100 TORRE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 564-5207 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- - 1BCBSC VALUATION 11, 700 . 00 1 . 00 0 .00 1. 00 0 . 00 1BSEISMICR VALUATION 11, 700. 00 1.17 0 . 00 1.17 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 1MFR=<100 UNITS 1. 00 126 . 00 0 .00 126 . 00 0 .00 1MPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 . 00 1PGASRES OUTLETS 1. 00 63 .00 0 . 00 63 . 00 0 .00 1PPERMITFE FLAT RATE 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 401.17 0 . 00 401. 17 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK ----- -- CHECK 401.17 #255 --------------- TOTAL RECEIPT 401 .17 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------ 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7848 robindell way DATE: 01/06/2011 REVIEWED BY: APN: I BP#: *VALUATION: 1$11,700 R*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: I PERMIT TYPE: WORK replace existing furnace at hall way closet add new gas line at kitchen local upgrade electric panel to SCOPE 200 amps. Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT fther Mech.Insp. 0.0 hrs $42.00 Other Plumb Insp. 0.0 hrs $42.00 Other Elec.Insp. 0.0 hrs $42.00 0. Itis/). Fc, t'fzold). h Fc tslec.I sf�. t�x NOTE. Theseees are based on the preliminaryin ormation available and are onlyan estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resohrtion 09-051 Ef. 7%1/10) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl.PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $126.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 = # Plumbing Permit Fee: $0.00 $63.00 1PGASRES Piping,Gas<=4 Outlets Suppl. Insp.Feer Reg. 0 OT 0.0 hrs $0.00 200 amps Electrical PME Unit Fee: $0.00 $42.00 IERT<200 Services PME Permit Fee: $126.00 Construction 7tLV Acoustical Fee: 0 Yes No $0.00 0 Work Without Permit? 0 Yes No $0.00 E) Planning_Fee: $0.00 0 Travel Documentation Fee: I TRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $1.17 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $170.17 $231.00 TOTAL FEE: $401.17 Revised: 12/07/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t v PERMIT# /Q OWNER'S NAME: PHONE# Lj o Z p-- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: p 22 CITY/ZIPCODE: Gu pes-r0 *Our municipal code requires all businesses working in the city to have a City of Cuperti o business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPE TION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL C TRACTO S HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature bate Please check applicable subcontractors and complete the following information: V 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 Owner/Contractor Signature Date _ CITY OF I I CITY OF CUPERTINO GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part"is project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No l If yes, provide letter from HOA If Residential is house an Eichler? Yes ❑ No If yes, needs planning approval. Owner's N e: Phone#: Co tractor: Phone: S rJ Fax: 510 Contractor License#: ��,.� t4 Lt Cupertino Business License#: Contact: Phone: Fax/e-mail: Residential Commercial Job Description: , 9-uc-%'J 4 L.Q_— (-t'a- �2,YV4a.&J�- yl� �9—X V5 O- f-v C W A-c� G� OTA , - � L+ A- wt- QA lf-�4 LA Building Permit Info: Bldg Elect Plumb Mech Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IVIII B, IV-HT, V-B Ej-. Valuati ^ 40 Square Footage: Project Size: Counter E]--Ex ress ❑ Standard ❑ Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 12/06/10