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10100017 CITY OF CUPERTINO BUILDING PERMIT BUILDIF'G ADDR'SS: 20708 GARDEN CREST CT CONTRACTOR-+Be--+G43E PERMIT NO: 10100017 £RtvI[NED OWNER'S NAME: SATYANARAYANA VEMPATIDATE ISSUED: 10/01/2010 NER'S PHONE: 4085073339 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOII DESCRIPTION: RESIDENTIAL COMMERCIAL License Class II Lic.# �j,2> ) 1 0 REPLACE 14 WINDOWS AND 1 PATIO DOOR Contractor (a'`(,l0 d Date 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:$7000 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 AP11 Number:36230053.00 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 construction,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 INSPECTION. 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. �1ite' with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. RE-ROOFS: Signature Date n to- All roofs shall be inspected prior to any roofing material being installed.If a roof is instilled without first obtaining an inspection,I agree to remove all new materials for insl ection. L7 OWNER-BUILDER DECLARATION Sig rature 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 hive 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 ma ntain 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 ma serial. 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. wil maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ON ner or authorized agent: Date:` 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 he reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wo:k'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 unon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, ..s,and expenses which may accrue against said City in consequence of the I uj derstand 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 Lic.-nsed Professional 9.18. Signature Date ci —t> 06 (b PcAt-y deer t -3 o o o Cb i;0 JUA.RAA o I i(JN I NW- J1 , jtobuidwvl',aLu id, (1a4 buiplinq aq) -A. JI(Allim aillp",UO i4eu)04 it 4melu" th weld p 1�A,SIU 1 eG 14 VIN OAN91S IV() id(l N:VIH(` i Al Ni tj IN Q 5� In 2 �"cJ 802 PW 3 ob 2 7 c� 3 d� 7 N ts. a C , 1 00 e6 c Soh ("1,j azOP f")G z'7,Oh t1` '-er 1 in i dc�vl vc r)d .2-rl)l7C')S CSardencrest (-'blu! Cuperlino, CA 95014 �Vlnciov� Dear 'St'idev-i ".1'r-ITIDW!, I I I.. - f! tN:5 10J.'t"t d,� ioi i,) 'l-lal pcj;-ic, vvl-,dov�s � 0, )I (; J 101— cl!I Lit ha,, Qrjo in the qli �s �)Fldl mW 1 all he replacc,cl F --w won ijt m(- sarne r-rl c �d� it uist. bt� e,� 04 he Same, , I , I cis YOU, t, Marilis fIll ir ouiont ,vindo -,,ts it id 1 c1 IVs I I c. :_lit i.i r i i t y �,Jl a r-i a gi, S, 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: PERMIT# OWNER'S NAME: i PHONE# GENERAL CONTRACTOR: h BUSINESS LICENSE # ADDRESS:/ 0 Peca14 QV >-36 1 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS?ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �_ --� Signnatat I am not using any subcontractor . --- `" ure Date 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 (2 Owner/Contractor Signature Date CITY OF CU PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$7,000 PERMIT TYPE: Building Permit PLAN CI[ECK TYPE: Addition PRIMARY SFD or Duplex � ��`�� PENTAMATION 1GENRES USE: F 1 t}t�1�.,d fi t,�(. PERMIT TYPE: WORK SCOPE 1'?,na t/Wt A 1.let' ti;a7 t h°cit h71"j Fc t)ri'rc3 tf-sh. Itrs;=> E).r •,"'rtr rr`rr � NOTE. Thesefees are based on thepreliminary information availa,ile and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7111,110,I FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 15 # Window/Sliding Glass Door Suppl. PC Fee: (F) Reg. 0 OT F601 hrs $0.00 $506.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee{') Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ��tlttS(1'11t'IiCt;x 1 c7a" Acoustical Fee: 0 Yes (F) No $0.00 0 Work Without Permit? 0 Yes (F) No $0.00 Plamain� $0.00 Select a Non-Residential t Building or Structure 0 jt'tr`ic' }C7C7?ilii'J71C�i`7CtF7 1'Ct',S: Strong Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.70 $506.00 TOTAL FEE: $507.70 Revised: 9/29/2010 CITY OF CUPHRTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Loft: APN . . . . . . . . : 36230053 . 00 DATE ISSUED. . . . . . . : 10/01/ 2010 RECEIPT # . . . . . . . . . : BSOOOOL1624 REFERENCE ID # . . . 101000L7 SITE ADDRESS . . . . . : 20708 -ARDEN CREST CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SATYANARAYANA VEMPATI ADDRESS . . . . . . . . . . : 20708 3ARDEN CREST CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SREEDEJI VEMPTI CONTRACTOR . . . . . . . : TBD - 'PO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - 'PO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 . 00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 7, 000 . 00 0. 70 0 . 00 0 .70 0. 00 1WINREP EACH 8 15 . 00 536 . 00 0 .00 506 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 507 .70 0 . 00 507 .70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 507 .70 3567 --------------- TOTAL RECEIPT 507. 70 �--- CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERK ET APPLICATION FORM APN # Date: 3C�a 30 053.01_" Building Address: 2O o &v,-de ix G-, L4�-�- Mailing Address (if different from building address): Are Hazardous Materials being used as part of this prc ject? Yes No HOA: (Exterior work only) Yes ® No ❑ If es, rovide letter from HOA Owner's Name: Phone#: Contractor: Phone: t Fax: Contractor License#: 10 Cupertino Business License#: Contact:.- Phone: J e s LA5 Q ` , ✓�rig Fax: S`cv " � - -7 Zesidential Commercial ❑ Job Description: Building Permit Info: Bldg 3 Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U=-A ❑ IUIII B, IV-HT, V-B Y Valuation- Square Footage: '7000 , 0 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: - . or help, contact Build it Green at www.builditgreen.or �1 Revised 07/14/09 ' 3