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10090148CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7750 CARRIAGE CIR I CONTRACTOR: OWNER'S NAME: MAY SHARMA 'ER'S PHONE: 4083906229 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 49 (F aO4J=N I t Contractor Q�- I� Date ~ k 10 - ?Q t Q 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. 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. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 4-1 - (( /a - 33t V v OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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. APPLICANT CERTIFICATION 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 -unify and keep harmless the City of Cupertino against liabilities, judgments, , and expenses which may accrue against said City in consequence of the grunting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date ERMIT NO: 10090148 ' I DATE ISSUED: 09/16/2010 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ELECTRICAL RESIDENTIAL SERVICE CHANGE 100-200 AMP NO LOAD CHANGE. ZINSCO TO SQUARE D Sq. Ft Floor Area: I Valuation: $3000 APN Number: 35906052.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. �% - Issued by: 4, = ; '_�- Date: ,/ RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner agent_ Date: 1 A (0' V CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35906052.00 DATE ISSUED.......: 09/16/2010 RECEIPT #.........: BE000011474 REFERENCE ID # ...: 1C090148 SITE ADDRESS .....: 7750 CARRIAGE CIR SUBDIVISION ...... CITY CL PERTINO IMPACT AREA ...... OWNER A�AY SHARMA ADDRESS ..........: 7750 CARRIAGE CIR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: S'T'EPHEN GORDY CONTRACTOR .......: TED - TO BE DETERMINED LIC # 00096 COMPANY TE,D - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 3,000.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 3,000.00 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 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CITY OF CUPERTINO 1 1 FF.F. F.4TIMATOR -- BUILDING DIVISION [a ADDRESS: DATE: REVIEWED BY: UNITS APN: BP#: "VALUATION: 1$3,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex 7 C17r 11: ILl: PENTAMATION 1 REAP2 USE: F1 O(M AJ PERMIT TYPE: WORK PME Unit Fee: $42.00 SCOPE $42.00 APPLIANCE / EQUIP TYPE FEE ID ..h. I'/crrt Cltct f�l�rr,� 'z- QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1 ERT<200 Other Elea Insp. 0.0 hrs $42.00 100 Amps $42 Pet -Intl Fcc.' Suppi" Illsp FCe PME Unit Fee: $42.00 PME Permit Fee: $42.00 (_CJ)2:SJf'1fC'IiOt1 lrl:c ,'it'DUS/7Ci % hE'I'fi'i1- I'E'c>: Work Without Permit? 0 Yes 0 No K00 TOTALS: Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: TGl.va1;m;nan, ;nfnrmatinn availahle and are only an estimate. Contact the Dept for addn'1 info. llVlti• L/{GJG GGJ uiG UNJcu vis rirc ..rr••w•rw. .•. ..•••..---.•- FEE ITEMS (Fee Resoh;tion 09-051 Ef'. 717%101 lft-�� ,'t. Plrzri Ch':( �icrh ..h. I'/crrt Cltct f�l�rr,� 'z- Elec. Plan Check 0.0 hrs $0.00 1ft>� 1> Po mit 1"'c Elec. Permit Fee: IEPERMIT slip /. I'(' Fee t�,;;,�, t''t=,th t�,�rEl Other Elea Insp. 0.0 hrs $42.00 PME Plan Check: !"10'' hl") kcv TGl.va1;m;nan, ;nfnrmatinn availahle and are only an estimate. Contact the Dept for addn'1 info. llVlti• L/{GJG GGJ uiG UNJcu vis rirc ..rr••w•rw. .•. ..•••..---.•- FEE ITEMS (Fee Resoh;tion 09-051 Ef'. 717%101 ^•--------- FEE ------ --- - ---- QTY/FEE MISC ITEMS Plan Check I"ce: slip /. I'(' Fee PME Plan Check: $0.00 Pet -Intl Fcc.' Suppi" Illsp FCe PME Unit Fee: $42.00 PME Permit Fee: $42.00 (_CJ)2:SJf'1fC'IiOt1 lrl:c ,'it'DUS/7Ci % hE'I'fi'i1- I'E'c>: Work Without Permit? 0 Yes 0 No K00 Travel Documentation Fee: ITRAVDOC $,e 2.00 Strong Motion Fee: $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 91.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 9/14/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST O oAr>R.tR-C Ac Cu G C ��.. PERMIT JOB ADDRESS1. I S 2Z OWNER'S NAME: hrVzNA PHONE # GENERALCONTRACTOI CITY/ZIPCODE BUSINESS NSE # �� C4. S1i� ADDRESS. S3 *Our municipal code requires all businesses working in she city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) CTORS HAVE OBTAINED ADCITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT BUSINESS LICENSE. 9RF7I . l � -1010 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complc to the following information: Date Owner / Contractor Signature CM OF CUPS T1NO CITY OF C'UPERTINO GENERAL BUILDING PEPMT ADPL=[CATION FORM APN # ��1i _ (- Date: r %� Building Address: 7 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 [��If -es, provide letter from HOA Own 's Name: sq-��qq 1`\ Phone #: .z Contractor: S ��Z Fax: Phone: �� • 2� S 4 2 7 Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Residential 25 Commercial ❑ Job Description: R -e -—t IA> /OrD G `Z l N y c v -Cz� sCii L.Ar�2 E i� Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: _ 7 1-A, 1-B ❑ E/= -A ❑ II/VI B, IV -HT, V-13 Valuation: Square Footage: �K Project Size: Express taIldard ❑ Large [] Major ❑ Green Building: Please complete relevant portion of the Green BuildingfLEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. 'oints Achieved: j For help, contact Build it Green at www.builditZreen.or- Revised 07/14/09 i