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10110078 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20087 LAS ONDAS CT CONTRACTOR:AAA ELECTRIC PERMIT NO: 10110078 OWNER'S NAME: RAKESH PATEL 3249 STEVENS CREEK BLVD DATE ISSUED: 11/12/2010 NER'S PHONE: SAN JOSE,CA 95117 PHONE NO:(408)557-8899 ❑ LICENSED CONTRACTOR'S DECLARATION,- JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL I PANEL UPGRADE TO 200 AMP License Class ' Lic.# Contractor � Date 2 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:$2000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36930031.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180APERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAV$FROM7LACALLEDINSPECT N. 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 Issued by Date: with all non-point source re ions per the Cupertino Municipal Code,Se tion - 9.18. j /� RE-ROOFS: Signature Date V 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. OWNER-BUILDER DECLARATION y 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) I,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/s�tore or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipme k devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay re �r Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu rti ipal Code,Chapter 9. and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 3 53 nd 25534. " Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: G l 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 CONSTRUCTION LENDING AGENCY 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 '-demnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may a G e against said City in consequence of the I understand my plans shall be used as public records. branting of this p it dition ly,thea nt�nderstands and wte,cSe I om y with all non-poi sou a ons per th Cupertino Municipal C ion Licensed Professional 9.18. ' p Signature Date Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: ✓ PHONE # -- - GENERAL CONTRACTOR: Z z 10J BUSINESS LICENSE# ADDRESS: �� - 5 i L -ice' CZ--6i1 CITY/ZIPCODE: Z �- *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANC I ECTION(S) WILL BE SCHEDULE • UNTIL THE GENERAL CONTRACTOR AND ALL SUBC T •H VE OBTAINED A CITY- CU ERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36930031 . 00 DATE ISSUED. . . . . . . : 11/12/2010 RECEIPT # . . . . . . . . . : BS000011988 REFERENCE ID # 10110078 SITE ADDRESS . . . . . : 20087 LAS ONDAS CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER RAKESH PATEL ADDRESS 20087 LAS ONDAS CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3106 RECEIVED FROM . . . . : AAA ELECTRIC CONTRACTOR . . . . . . . : WILLIS TANG LIC # 27828 COMPANY AAA ELECTRIC ADDRESS 3249 STEVENS CREEK BLVD CITY/STATE/ZIP . . . : SAN JOSE, CA 95117 TELEPHONE . . . . . . . . : (408) 557-8899 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 000 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 2, 000 .00 0 .50 0 .00 0 . 50 0. 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 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 241. 50 0 .00 241 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 241.50 VISA --------------- TOTAL RECEIPT 241.50 a-t-i CITY OF CUPERTINO C17Y 0'F CUFF TING GENERAL BUILDING PERMIT APPLICATION FORM ccq APN # Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No �ffyes,provide letter from HOA Owner's Name: -� Phone* � Contractor: /V/4 -� ,, _ t Phone t,� �_"�� - Contractor License t i:�- f OC Cupertino Business License#( Contact: U j ( Phone: Fax: esidential Commercial r Job D escription:,.�---- �- �' / ; C Building Permit Info: Bldg ❑ Elect 11' Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U/=-A ❑ II/III B. IV-HT, 'V-B Valuation: Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ 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. ",)ints Achieved: �- ir help, contact Build it Green at www.builditgreen.oriz Revised 07/14/09 3