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10110194 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21$40 TERRACE DR CONTRACTOR:HOLDER INC DBA ABLE PERMIT NO: 10 110 194 GLASS Ow ,ER'S NAME: RAM KALYANASUNDARAM 1129 RICHARD AVE DATE ISSUED: 11/30/2010 OWNER'S PHONE: 4084464282 SANTA CLARA,CA 95050 PHONE NO:(408)496-9960 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r— � C-16 90 91� License Class B 7 Lic.# MECH r— RESIDENTIAL r— COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE ELEVEN(I I)WINDOWS&TWO(2)PATIO (commencing with Section 7000)of Division 3 of the Business&Professions DOORS& Code and that my license is in full force and effect. TWO(2)GLASS PANES AOVE FRONT ENTRY DOOR; NON-STRUCTURAL 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. Sq.Ft Floor Area: Valuation:$9485 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35625002.00 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 regulations per the Cupertino Municipal Code,Section 9.10 180 DAYS FROM LAST CALLED INSPECTION. Si .ure Date (Ou-/O Issued by: ' Da ❑ 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) 1,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: 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. 1 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 provisions or this permit shall be deemed revoked. Owner or rized agent: p y p p Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is cc 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 tc ling 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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21840 terrace dr. DATE: 11/30/2010 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$9,485 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY 7 �, E x', PENTAMATION USE: SFD or Duplex �,� �,rz �� PERMIT TYPE: 1GENRES WORK window replacement non structural 11 windows 2 patio doors 2 glass panes above front entry door. SCOPE !r:. i C, Li I 11!",ti M,P, c-<': r iii'r_ is j;. 1..,,c... 1,t''L rI t<<_:,L_. __j NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resohitiol109-051 Elf. 7%1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 EEI # Window/Sliding Glass Door Suppl. PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $506.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee10 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (E) No $0.00 Work Without Permit? 0 Yes 0 No $0.00 E) Planning L;ee: $0.00 Select a Non-Residential 0 Building or Structure I Strong Motion Fee: IBSEISMICR $0.95 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $1.95 $506.00 TOTAL FEE: 1 $507.95 Revised: 11/08/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35625002 . 00 DATE ISSUED. . . . . . . : 11/30/2010 RECEIPT #. . . . . . . . . : BS000012116 REFERENCE ID # 10110194 SITE ADDRESS . . . . . : 21840 TERRACE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RAM KALYANASUNDARAM ADDRESS . . . . . . . . . . : 21840 TERRACE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : R KALYANASUNDARAM CONTRACTOR . . . . . . . : HOLDER, ERIC LIC # 22037 COMPANY . . . . . . . . . . : HOLDER INC DBA ABLE GLASS ADDRESS . . . . . . . . . . : 1129 RICHARD AVE CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 496-9960 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 485. 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 9, 485. 00 0 .95 0. 00 0 . 95 0 . 00 1WINREP EACH 8 15. 00 506 .00 0 . 00 506 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 507. 95 0. 00 507. 95 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 507. 95 #667 --------------- TOTAL RECEIPT 507 .95 r fF r 9 •g� ter- c o sov K rt- CIS� o _ C U 7 PIN V1, cj ir- p �o ,v U � v >4 o x 0 p� > Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: p " g PERMIT# OWNER'S NAME: y,,, k, rte yr, PHONE# - 2-92— GENERAL LGENERAL CONTRACTOR: TNG 2 BUSINESS LICENSE# /1 ADDRESS: G 'p , CITY/ZIPCODES -AN7 (? 0A. Pd74 3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCWITRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 4PPN- 1 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 ,I. CITY OF CITPERTINO CITY OF • cUPE TING GENERAL BUILDING PERNUT APPLICATION FORM APN# p^ Date: Building Address: 7e 2ry 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 aZifyes, provide letter from HOA Owner's Name: Phone#: Yyl G, 11CSC:;V� Ct Lti 4O / - 2 k)- Contractor: .Contractor: yas Y96- 0 Fax: - 6 to Contractor License#: 6 90 Cupertino Business License#: ntact: Phone: o8) Fax: Residentiai-7 Commercial ❑ Job Description: e&f(A,(C- �� b INDaivf 4 ('2-) Ph- o -Acwt ( Z) G�r rr /V move 5Yvvt� ��.r�.� � C1 c✓1 Srty�, c�- 1 Building Permit Info: Bldg I Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-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. Points Achieved: For help, contact Build it Green at www-bu2ditgreen.oriz Revised 07/14/09