10100078 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:VENKAT PERMIT NO: 10100078
BUILDING ADDRESa 19`1 I4�AMHERST DR ZANGANATHAN
} :ER's NAME: VENKAT RANGANATHAN 19714 AMHERST DR DATE ISSUED: 10/11/2010
:�UPERTINO,CA 95014 PHONE NO:
hOWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION: REMOVE 300 SQ FT IN KITCHEN,REMOVF,CABINE"i'S,
I hereby affirm that I am licensed under the provisions of Chapter 9 NON-STRUCTURAL WALL ELECTRICAL EFFECTED BY DEMO
(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 Valuation:$4000
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:31628019.00 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 180 DAYS OF PERMIT ISSUANCE OR
to building constructim and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTIO
indemnity and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whicn may accrue against said City in consequence of the Issued by � �"'"-�--- Date: G 6
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 1
9.i 8. RE ROOFS:
Date_ All roofs shall be inspected prior to any roofing material being installed. if a roof is
tture
-- installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
9 OWNER-BUILDER DECLARATION Signature of Applicant: __Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons: _
with wages as their sole compensation,
1,as owner of the property,or my employees
will do the work.and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
1.as owner of the property,am exclusively contracting with licensed contractors to
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. 1 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
air as definedCompensation,as provided for by Section 3700 of the Labor Code,for the willcontaminants maintain compliance wi hytheManagement I
apertino Mun c palAir QvCode,(:hapter 9tstrict
12 and
pei-fcrmance of the work for which this permit is issued. the Health&Safety Code,Se tions 155 ,25533,and 25534.
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 Owner or authorized agent: _Date: 9L
�O
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 CONSTRUCTION LENDING AGENCY
Compensation laws of Califomia. If,after making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,I mu:t whereby
rk b fo�f wh h thisat hpermit is ere is a issued(Sec.309nstruction 7,Civ C)ng agenev for the pc rformanc.e of
forthwith comply with such provisions or this permit shall be deemed r� Lender's Name__ --------——
IAPPLICANT CERTIFICATION Lender's Address-------------
I
ddress!__ -- --- --
I certify that I have read this application and state that the above information is
^arrect I agree to comply with all city and county ordinances and state lava:.lrtirg
.uildmg construction,and hereby authorize representatives of this city to enter
,an tre above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
I indemnity and keep hamiless 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 urea as public records.
granting of this pe t.Additionall,,the applicant understands and will omply
with all non-pont rce r Mations per the Cupertino Mu7:2
tion Licensed Professional__-_
9.18. I
Signature__ __ DateL !r�
CITY OF C'UPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk; Lot :
APN . . . . . . . . . 316::8019 . 00
DATE ISSUED. . . . . . . : 10/:_1/2010
RECEIPT # . . . . . . . . . BS000011697
REFERENCE ID # . . . : 10100078
SITE ADDRESS 197:_4 AMHERST DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VEN:CAT RANGANATHAN
ADDRESS . . . . . . . . . . : 197L4 AMHERST DR
CITY/STATE/ZIP . . . : CUP:ERTINO, CA 95014
RECEIVED FROM . . . . : VENKATESAN RANGANAT
CONTRACTOR . . . . . . . : jIC # *OWNER*
COMPANY . . . . . . . . . . : VEN KAT RANGANATHAN
ADDRESS . . . . . . . . . . : 197L4 AMHERST DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AvIOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---
1BCBSC VALUATION 4 , 000 . 00 1 . 00 0 . 00 1 . 00 0 .00
1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1SUPPKFEE HOURS 1 .00 126 . 00 0 . 00 126 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127 . 50 0 . 00 127 . 50 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------
704 DEMO
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, aA 95014-3255
(408)777-3228- FAX(408)777-3333- biilding(cbcuoertino.org
CUPERTINO
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SIT ATC12ESS APN 'Z _Q I� BP#
OWNERNAME OW R AD 3 RESS
DESCRIPTION OF WORK:
SA 14LI
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by hw ing this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
- I understand a frequent practice of unlicensed )ersons is to have the property owner obtain an "Owner-
uilder'building permit that erroneously implies that ti-e property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully actin(i as an Owner-Builder and am aware of the limits of my
Insurance coverage for injuries to workers on my proporty.
understand building permits are not required o be signed by property owners unless they are responsible for
e construction and are not hiring a licensed Contractor to assume this responsibility.
�3._I understand as an"Owner-Builder" I am the rE sponsible party of record on the permit. I understand that I may
p ct myself from potential financial risk by hiring a I censed Contractor and having the permit filed in his or her
name instead of my own.
4. I understand Contractors are required by law t)be licensed and bonded in California and to list their license
ers on permits and contracts.
��. understand if I employ or otherwise engage z ny persons, other than California licensed Contractors, and the
otal value of my construction is at least five hundred dollars($500), including labor and materials, I may be
onsidered an"employee'under state and federal law.
. understand if I am considered an "employer" under state and federal law, I must register with the state and
ederal government,withhold payroll taxes, provide w)rkers'compensation disability insurance, and contribute to
unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject
e to serious financial risk.
understand under California Contractors' State License Law, an Owner-Builder who builds single-family
esldential structures cannot legally build them with ti-a intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
performed under contract with a licensed general bailding Contractor.
I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
y financial or personal injuries sustained by any su)sequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OivnerBuilderForm 2010.doc revised 04/14/10
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OCT 1 2010
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ROOM ADDITION AND REMODEL
> PATEL sTRuCTURAL ENGINEERS
. .
19714 AMHERST DRIVE, CUPERTINO, CA. 95014 461 PARK AVE /SAN JOSE CA95110
DEMOLITION PLAN
CITY OF CUPERTINO
a-M.
DEMO
CITY Of
CUPEIZTINO PERMIT APPLICATION FORM
APN# Date:
31( - 28 - 0lc1 ►o- 11 - 10
Building Address:
19714 A m 1l e s t �' Cc eW t,VLO C i4 5o I�-
Mailing Address (if different from building address):
Owner's Name: Phone:
Ve.vt_�O,t 408 - 802 - 9080
Contractor: Phone : 406_X75-0401
AIq N 1 Z C.0y)6tv.UC o�
Fax:
Contractor License #: ,B 910 2 2-el
Cupertino Business License#:
Contact: Phone:
Ve_vo, kaI t Rangaha 4NAAA— 406-802- 9060
Fax:
3 vo-S .F,
Residential ZK Sq Footage_ _ Zommercial ❑ Sq Footage
Job Description:
Remo ve ki t'c-1%e., CO-6; ,Lb %G�, no K -st_v'UcW 1s e�ect7ri c� e
Valuation: 4,00v 6 j 4e
Project Size: Express Standard ❑ Lar;e ❑ Major ❑ �T C
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee De icription Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
1DEMOPRES Pool Derr.o Residential B 1SFP00L-DEIVr
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09