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10090045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1015 KENMORE CT CONTRACTOR:VINOD VARMA PERMIT NO: 10090045 OWNER'S NAME: VINOD VARMA 1015 KENMORE CT DATE ISSUED:09/08/2010 NER'S PHONE: 4087251902 CUPERTINO CA,CA 950144120 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r License Class Lic.# MECH r RESIDENTIAL r- COMMERCIAL Contractor Date lOB DESCRIPTION:UPGRADING THE MAIN ELECTRICAL PANEL TO 200AMP 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. ;iq.Ft Floor Area: Valuation:$500 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 CPN Number:36215035.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building constriction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: 9.18. Signature Date 5 RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorizyd agent- Compensation laws of California. If,after making this certificate of exemption,I "— (�+ — Date: �V 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. e� CONSTRUCTION LENDING AGENCY CAI) I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address unnn the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. p Licensed Professional Signature 0 � Date CITY OF C'UPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: DATE: REVIEWED BY71�$5�007 APN: BP#: `VALUATION: xPERMIT TYPE: Electrical Permit PLAT CHECK TYPE: Alteration/Addition/ Repair PRIMARY 101 Ill, PENTAMATION 1 REAP 14 USE: SFD or Duplex 1 1 C)C1tt Mitt ,1 PERMIT TYPE: WORK SCOPE APPLIANCE I P FEE ID QTY UNITS BP FEES Temporary ower 1 ERT<200 100 Amps $42 TOTALS: $42.00 77� Lt'c lr Y:Qr{ I.cLh" 111ulmh I'llm( fih<, Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT L0111 cr Pi; tr r) t,��� Other Elec.Insp. 0.0 hrs $42.00 NOTE: These fees are based on the relimina in ormation available and are only an estimate. o. Contact the De t or addn'l in EFEEITEMS (Fee Resolution 09-051 Eff Z�1/1.0) FEE QTY/FEE MISC ITEMS ee - F= PME Plan Check: $0.00 Permit f >c SuppT. Iri.sp F'e'e PME Unit Fee: EJ$42.00 PME Permit Fee: ?.00 C'onstr•trCfion ,acoustical Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item strolr, Bldg Stds Commission Fee: IBCBSC 911.00 SUBTOTALS:- $1'e7.00 $0.00 TOTAL FEE-.1 $127.00 Revised: 9/01/2010 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36215035. 00 DATE ISSUED. . . . . . . : 09/08/2010 RECEIPT #. . . . . . . . . BS000011400 REFERENCE ID # . . . : 10090045 SITE ADDRESS . . . . . : 1015 KENMORE CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUFERTINO IMPACT AREA . . . . . . OWNER VINOD VARMA ADDRESS 1015 KENMORE CT CITY/STATE/ZIP . . . : CUFERTINO CA, CA 95014-4120 RECEIVED FROM . . . . : VINOD VARMA CONTRACTOR ANIBAL VARGAS LIC # 31804 COMPANY . . . . . . . . . . : VAF.GAS CONSTRUCTION ADDRESS 664 RED ROME LN CITY/STATE/ZIP . . . : BRENTWOOD, CA 94513 TELEPHONE (925) 437-9468 FEE ID UNIT QUANTITY 7,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 500. 00 1.00 0 .00 1. 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 127 .00 0.00 127. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 .00 MC --------------- TOTAL RECEIPT 127 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, �A 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•bAding(a)Cuoertino.ora 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: SITE ADSDRESSO�E C C 'CPN C B ?Ga OWNER NAMEV.1 Pia V OWNER AD[iRESSsc,me- Q� DESCRIPTION OF WORK: V -Y� 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 hav'ng 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 01=INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) V-`/ ` 1. 1 understand a frequent practice of unlicensed p,:rsons is to have the property owner obtain an "Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and.material personally. I, as an Owner-Builder, may be held liable a-id 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 acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. V-'v" 2. 1 understand building permits are not required tc be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contracto-to assume this responsibility. V,'%/ , 3. 1 understand as an "Owner-Builder" I am the res:)onsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. V-V• 4. 1 understand Contractors are required by law to :)e licensed and bonded in California and to list their license numbers on permits and contracts. V-V,5. 1 understand if I employ or otherwise engage anti persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an"employer' under state and federal law. V�" 6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide worcers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. VIV 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the ntent 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 is performed under contract with a licensed general buil Jing Contractor. V V d8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subs,:quent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBui[derForm 2010.doc revised 04114/10 V-V• 9. 1 understand I may obtain more information regardirg my obligations ascan "employer"from the Internal Revenue Service, the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www.(:slb.ca.gov for more!information about licensed contractors. V.v'10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. v-V'11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. V-v X12. 1 agree to notify the issuer of this form immediately of any additions, deTletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by designed to protect the public. If you contract with someone who does not have a license, the Contractors' States License Board may be unable to assist you with any financial loss you may sustain as a rest It of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for yon to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of tl-eir workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: S1 10 --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of whicl- I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: M ,� Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner 'or the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the croperty owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 1010.doc revised 04/14/10 "Inddws �:lil '1 r 0 IL 1 Energy pt Y=YB 0 2 Energy Y--yes es t !h _ o 2 Energy pts y--yes 0 2.Install Low HeatTransmissionGlazing 1 Energy pt y=yes J.Beating Ventilation and Air Conditioning 0 1 004 —m*on+� ' _ 2 =nergy pts Y--yes • 0 2.Install Ductwork within Conditioned Space 3 =nergy pts Y--yes 0 3.Vent Range Hood to the Outside 1 AQ/Health pt Y=yes 0 4.Glean all Ducts Before2 AQ/HeaJth pts ts y=yes 0 5.Install Solar Attic Fan 2 Energy pts yeses 0 6.Install Attic Ventilation Systems 1 Energy pt Y--yes 0 7.Install Whole House Fan 4 Energy pts Y--yes B.Install Sealed Combustion Units 0 a.Furnaces 3 IAOJHealth pts y--yes ' 0 b.Water Heaters 31AQ/Health pts y=yes 9.Replace Wall-Mounted FJectric and Gas Heaters with 0 Through-the-Wall Heat Pumps Energy pts y=yes 0 10.Install 13 SEER1 EER or higher AC with a TXV Energy pts Y=yeS 0 11 11.Install AC with Non-HCFC Refrigerants 2 Resource pts yeses ' 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts Y--Yes0 13.Retrofit Wood Burning Fireplaces 0 a.Install EPA certified wood stovesinserts i IAQ/Health pt y=yes 0 b. Install/ 1 Energy pt Y=Yes Replace Dampers 0 c.Install Airtight Doors t Energy pt yeses 0 14.Install Zoned,Hydropic Radiant Heating 3 Energy pts y=ye5 0 15,Install High Efficiency Filter 4 IAQ/Health pts Y--yes 51AQJHeaith is es D 16.Install Heat Recovery Ventilation Unit(H RV) p Y=Y 0 17.Install Separate Garage Exhaust Fan3 IAQ/Health pts y--yes K-Renewable Energy and Roofing 0 1.Pre-Plumb for Solar Water Heating 4 Energy pts Y--yes 0 2.install SDIar Water Heating System 10 Energy pts y=yes 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes D 4.Install Photovoltaic(PV)System 0 (1.2 kw=6 points,2.4 kw=12 points,3.8 kw=18 points) Up to 1 B Energy pts 0 6.,sledSSfe80fJwoeungMaterials. 1 Resource pt y=yes pts y=yes Energy p0 7.Install Radiant Barrier 3 i L.Natural Heating and Cooling 0 1.Incorporate Passive SDlar Heating 5 Energy pts y=YeS 0 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts Mes 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts Y--yes t 0 0 J CITY OF CUPERTINO CITY Of CvPEKINO GENERAL BUILDING PERMIT APPLICATION FORM APN # i �, r Date: 9 I g �./ Building Address: (0 IS KEn1M��2E CT r CUPEPTJa �5or� 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 L7 �.f es, rovide letter from HOA Owner's Name: v T N O� VA r MA Phone#: Lf©S +z 5 1 g 0 2 (H Contractor: Phone: 9 2 L{`3 `�9 6 S Co Co/�sTRI�C,T '4 Fax: Contractor License#: 5$ G Cu ertino Business License#: Phone: 4 0� .- 23 0 10 2 C c Contact: V�4O3) VAR MA Fax: Residential Commercial Job Description: i -tuc. V►�l°�`� U� Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): occupannncy Type: 1-A, 1-B ❑ HMI/V-A ❑ LVIE B,-IV-HT, V-B E 12 --T Valuation: Square Footage: Project Size: Ex cess andasd ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green B ' ding/LEED Checca sst& attach it to the application or if applic able, include in plan set & the sheet x. oints Achieved: For help, contact Build it Green at www.buildit een.or Revised 07/14/09