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10070145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 IMPERAIL AVE CONTRACTOR:BAY LIGHT ELECTRIC PERMIT NO: 10070145 OWNER'S NAME: RAGHU DEVARAKONDA 150 SARATOGA AVE UNIT 309 DATE ISSUED:07/21/2010 ER'S PHONE: 4082184277 SANTA CLARA,CA 95051 PHONE NO:(408)234-1832 LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ' Lic.# /9► MECH RESIDENTIAL COMMERCIAL Contractor ��6I Y .C�Qj,! G'�eGl�h C Date 0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE ELECTRICAL MAIN PANEL TO 200AMP (commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES** 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 providedAr by Sq.Ft Floor Area: Valuation:$1850 Section 3700 of the Labor Code,for the performance of the work for wc t permit is issued. APN Number:35719052.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above informatio S correct.I agree to comply with all city and county ordinances and state la relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the a licant understands and will comply with all no oint source regulati n er th Cupertino Municipal Code,Section 9.18. Issued by: Dater 2�—fid Signature t Date / �v ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER ru I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with t Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sec ons 25505,25533,and 25534. 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 O er or autho ' g o, Q become subject to the Worker's Compensation provisions of the Labor Code,I must Date: (��J forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address uify and keep harmless the City of Cupertino against liabilities,judgments, end expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 4 ITEMS OF 5 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1):: Lot: APN . . . . . . . . : 35'719052 . 00 DATE ISSUED. . . . . . . : 07,'21/2010 RECEIPT #. . . . . . . . . : BS000010922 REFERENCE ID # . . . : 10070145 SITE ADDRESS . . . . . : 10:300 IMPERAIL AVE SUBDIVISION . . . . . . CITY CU:?ERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RA(3HU DEVARAKONDA ADDRESS 10:300 IMPERAIL AVE CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014 RECEIVED FROM . . . . : RIMO JIZEH CONTRACTOR RIMO JIZEH LIC # 29308 COMPANY . . . . . . . . . . : BA-t LIGHT ELECTRIC ADDRESS . . . . . . . . . . : 15 ) SARATOGA AVE UNIT 309 CITY/STATE/ZIP . . . : SA]JTA CLARA, CA 95051 TELEPHONE . . . . . . . . : (4 )8) 234-1832 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 850 . 00 1 . 00 0. 00 1. 00 0 . 00 1ECT<200 UNITS 1. 00 42 .00 0 . 00 42 . 00 0 . 00 1EPERMITFE FLAT RATE 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 CITY OF CUPERTINO RECEIPT NUMBER: BS000010922 RECEIVED BY: PATG PAYOR: RIMO JIZEH TODAY'S DATE: 07/21/10 REGISTER DATE: 07/21/10 TIME: 09 : 14 5 1BCBSC 10070145 $1 . 00 1ECT<200 10070145 $42 .00 lEPERMITFE 10070145 $42 . 00 1TRAVDOC 10070145 $42 . 00 BUSINESS LICENSE TAX RENW-#2930£4 $114 . 00 ---------------- TOTAL DUE: $241 .00 CREDIT CARD: $241 .00 REF NUM: VISA TENDERED CHANGE $241 . 00 $. 00 s � y CITY OF C,UPERTINO CITY OF CUPEI�T1NO GENERAL, BUILDING PERMIT APPLICATION FORM APN # Date: Building Address: 0 300 M?,,e(-;a I C4 qsa lir 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 92( If yes, provWe letter from HOA Owner's Name: 'J PhonekAAWl 0 U T Contractor: Phone: j�J J �_ I p� 1 ,010 t Fax: 0 Contractor License#: f a 3� y (5h,— Cl�'� i Cupertino Business License#: Contact: (406 ) ) 7� _ I �� �h�one: Residential J Commercial Job Description: (� Q � �e CA I M J-t ea�kelj A a Building Permit Info: ' Bldg ❑ Elect lid/ Plumb ❑ Mech ❑ Type of Construction(Usage Class): /0 Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ©� Q .�. Valuation: q cool p Square Footage: Project Size: Express ❑ Standard W Laz e [] Major ❑ Green Building: Please complete relevant portion cf the Green Bu' ding/LEED Checklist& attach it to the application or if applicable., include in plan set& the sheet index. 'oints Achieved: 1 For help, contact Build it Green at www.builditgre m.or Revised 07/14/09 i