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10120078 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10122 BRET AVE CONTRACTOR:ALPS CONSTRUCTION& PERMIT NO: 10120078 REMODELING OWNER'S NAME: VIVEK KARNATAKI&DEEPTI NAIK 681 E BROKAW RD DATE ISSUED: 12/14/2010 OWNER'S PHONE: 4086674018 SAN JOSE,CA 95112 PHONE NO:(408)898-6474 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lie.# © TEMP POWER Contractor ate �L Cfl I hereby affirm that I 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. Sq.Ft Floor Area: Valuation:$120 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 APN Number:37511040.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 '� ERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter D INSPECT upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY J indemnify and keep harmless the City of Cupertino against liabilities,judgments, AY costs,and expenses which may accrue against said City in consequence of the Issue Date. /�/ granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Sectio 9.18. / RE-RO S: Signature Date 1 C� All roofs shall be inspected prior to any roofing ma 'al being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWN UILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 a I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUC LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10122 bret ave. DATE: 12/14/2010 REVIEWED BY: bobs. APN: BP#: `VALUATION: $120 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 REAP 14 USE: SFD or Duplex 1Lc���r'� ,�,,. -� PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $42 TOTALS: $42.00 ttc<h Tk ter f,,.r�, P?r� ,,,�.k Elec.Plan Check 0.0 hrs $0.00 I'� Fc,,, Elec.Permit Fee: ]EPERMIT LiOther Elec.Insp. 0.0 hrs $42.00 1h"rn-list), F,,_, ha ,t, 1=,';r 1'o- NOTE. These ees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolutio»09-051 Elf 71,10) FEE QTY/FEE MISC ITEMS Plum Check /°-(v. sitppf P(,'Fec' PME Plan Check: $0.00 1,crini! Fflc. PME Unit Fee: $42.00 PME Permit Fee: $42.00 t,OtI,Sf7'1tC`ftUYl �1C1:�" Work Without Permit? 0 Yes 0 No $0.00 r�/Lltdl"Tltttr l`i'i',g: Travel Documentation Fee: ITRAVDOC $42.00 Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEe* : 127.50 Re7 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 37511040 . 00 DATE ISSUED. . . . . . . : 12/14/2010 RECEIPT #. . . . . . . . - : BS000012229 REFERENCE ID # . . . : 10120078 SITE ADDRESS 10122 BRET AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VIVEK KARNATAKI & DEEPTI NAIK ADDRESS 681 E BROKAW RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MEHRDAD ZAMANI 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 120 .00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 120 . 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 AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 .50 visa --------------- TOTAL RECEIPT 127. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO TEMPORARY PERMIT CUPEkTINO PERMIT APPLICATION FORM lCDL2, �� APN # Date: i ezf Original Permit# Building Address: +0 -�4 Owner's Name: /<�a Phone #:G �' \�� 1 ` O 6� \© 1 v k t e�kc �►V � Contractor: Phone 0 )�, C® Yl Arr� kc I� —0 0 ( S Fax#: 0� - Contact: Phone#: 14L 1 Zeman 1 Contractor License #: C � q 3 3 Cupertino Business License #: Job Description: 7imf ?,5\Wel- Valuation (cost of project): O Type of Construction: O Project Size• Over the Counter Quantity Fee ID Fee Description Fee Group Permit Type 1TEMPPMT Temporary Permit Good B 1TEMPPMT (Flat Fee) for 30 days —Commercial only. 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 01/07/09