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10050110 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10317 NORWICH AVE CONTRACTOR:A PLUS CONTRACTING PERMIT NO: 10050110 OWNER'S NAME: SHILPA&SATICH JOSHI 3 0 HANS WAY DATE ISSUED:05/11/2010 OWNER'S PHONE: 4083660766 SAN JOSE,CA 95133 PHONE NO:(877)929-5524 LICENSED CONTRACTOR'S DECLARATION J DB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class 4-341--yLic.# ��/—' � RUN A 3/4" GAS PIPE FORM THE GAS METER 55 FEET TO SUPPLY NEW GAS RANGE n) Contractor A 1'"!a-4 d�O' ' 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. 'q.Ft Floor Area: Valuation:$1400 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 i LPN Number:31629084.00 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 ssued b3+'` �? " �z__ Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. &aej_2.WVJ0,,y/ `� RE-ROOFS: Signature_ayw�y� 1:Z A' 1,I1 roofs shall be inspected prior to any roofing material being installed.If a roof is nstalled without first obtaining an inspection,I agree to remove all new materials for nspection. ❑ OWNER-BUILDER DECLARATION signature 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 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, 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 have 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 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 1 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 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. will 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 2 5534 09 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work'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 -non the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .emnify and keep harmless the City of Cupertino against liabilities,judgments, osts,and expenses which may accrue against said City in consequence of the I understand 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 Mu ' i1al Code,Section Licensed Professional 9.18. Signature e Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 CONTRACTOR/SUBCONTRACTOR LIST Fax: 408-777-3333 JOB ADDRESS: ' 7 OWNER'S NAME: �G PERMIT# GENERAL CONTRACTO PHONE# - c�► r_� ADDRESS: l ./ Gf/ BUSINESS LICENSE# �� ► P- , CITY/ZIPCODE: F"' Our municipal code bu requires all sinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. _ r I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS 1\AME 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 Owner/Contractor Signature Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: SylviaM 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31629084 . 00 DATE ISSUED. . . . . . . : 05/11/2010 RECEIPT #. . . . . . . . . : BS000010387 REFERENCE ID # 10050110 SITE ADDRESS 10317 rORWICH AVE SUBDIVISION . . . . . . CITY CUPERT]NO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SHILPA & SATICH JOSHI ADDRESS 10317 NORWICH AVE CITY/STATE/ZIP CUPERT:=NO CA, CA 95014-2445 RECEIVED FROM . . . . : EDWARD LULLINS MULLINS LIC # 25457 CONTRACTOR . . . . . . . COMPANY A PLUS CONTRACTING ADDRESS 383 HATS WAY CITY/STATE/ZIP . . . : SAN N JOS9,5524 95133 CA TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- -NEW BAL- ---------- ---------- ---------- ------- ---------- ------------- 1. 00 0 . 00 1 . 00 0 . 0 1BCBSC VALUATION 1, 400 :00 63 . 00 0 . 00 63 . 00 0 . 00 1BPGAS OULETS 0 . 50 0 . 00 1BSEISMICR VALUATION 1,400 . 00 0 . 50 0 .00 42 .00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 ---- 148 . 50 0 . 00 42 . 00 - ----0_00 TOTAL PERMIT :_48 . 50 0 .00 METHOD OF PAYMENT AMOUNTREFERENCE-NUMBER-- ------------ --------------- - CREDIT CARD 148 . 50 VESA --------------- TOTAL RECEIPT 148 . 50 4� CITY OF CU PERTINO CUPEI,TINO GENERAL BUILDING PERMIT APPLICATION FORM � IIU APN# ` uc o�, /' (5 C) Date: Building Address: (- Mailing A dr ss (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No , If yes, provide letter from HOA Owner's N e: / t5O 5 �^ Phone#: 566--o Contractor Phone: Fax: &log- Contractor License#: Cupertino Business License#: " Contact: " Phone: �'? 7;2,F��all Fax: Ora Residential Commercial ❑ Job Description: "3 t `fO S upp/y he W A; rG'�'� Building Permit Info: Bldg ❑ Elect ❑ Plumb a Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B —3 Valuation: Square Footage: Project Size: Express tandard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of tht; Green Building/LEED Checklist& attach it to the application or if applicable, inc�ude in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEt�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Appli rations (up to 400 sD B additional sh cco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Windov-structural shear B wall/masoM (includes plan ck fee) 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M j 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT / TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Corr.mercial B / 1 TRAVDOC Travel &Do mmentation B 1BUSLIC Business Lic,-nse B 5 of 5