10040046 CITY OF CUPERTINO 13UILDINGP PERBE MIT ERMINED PERMIT NO:10040046
CONTRACTOR.TBDo
BUILDING ADDRESS: 11598 RAINTREE SPRING IT DATE ISSUED:04/07/2010
OWNER'S NAME: RAGHUVARAN NARAYANAN PHONE NO:
ER'S PHONE: 4084823402
[] LICENSED S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB
CON
TRACTOR'
License Class Lic.#
_e22_`,U 6 MECH r RESIDENTIAL COMMERCIAL
Date
Contractor 'n � ��am-licenscd
�- �1�-- JOB DESCRIPTION:REPLACE WINDOWS LIKE FOR LIEK NON STRUCTURABEDROOM TO MEET EGRESS;BAY CITY WINDOWS PD FOR BUS
I hereby affirm that Iprovisions of Chapter 9 LIC
it license tions n full force and effect.fthe Business&
Code and that Professions
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. provided for by Valuation:$11800
1 have and will maintain Worker's Compensation Insurance,as p
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:
permit is issued. Occupancy Type: ,
APPLICANT CERTIFICATION
APN Number:36654044.00
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 IS NOT STARTED
to building construction,and hereby faouthro authorize
renresepurposes s(We)agree to saveof this city to r PENT EXPIRES IF WORK
upon the above mentioned property WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
ence of the
costs,and expenses which may accrue againsl cant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the app �7
with all non-point source regulations per the Cupertino Municipal Code,Section Date: /L t)
9.18. Issued by: '
Date u_�—
Signature
OWNER-BUILDER DECLARATION
RE_ROOFS-
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 All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, inspection. Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
1,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
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 oft e
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505 Chapter and g 12 and4the Health&maintain
provided for by compliance with the Cupertin should Intoe oal rhandlehazardous material.
performance of the work for which this permit is issued. Safety Code,Section 25532(a)
I have and will maintain Worker's Compensation Insurance,as p
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 Chapter 9.12 and the
ll
contaminants h defined by the Bay Area Air Quality Management District I w�
permit is issued.
I certify that in the performance of the work for which this permit
o` issued,I maintain
Safety Code,Sections 25505,25533,andal Code,25534.
not employ any person in any manner so as to becomes
Compensation laws of California. If,after making this certificate of exemption,l Own auth zed agent:
become subject to the Worker's Compensation provisions of the Labor Code,1 must
��5 � - Date: —
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
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 yty to saveenter
upon the above mentioned property for inspection purposes.(We)agreeLender's Address
unify and keep harmless the City of Cupertino against liabilities,judgments,
t said City in consequence of the
and expenses which may accrue again applicant understands and will comply ARCHITECT'S DECLARATION
granting of this permit.Additionally,the app
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
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CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 4 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36654044 . 00
DATE ISSUED. . . . . . . 04/07/2010
RECEIPT #• • " ' . 10040046
23
REFERENCE ID # • •
SITE ADDRESS 11598 RAINTREE SPRING CT
SUBDIVISION • • . . CUPERTINO
CITY . . . . . . . . . . . .
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . RAGHUVARAN NARAYANAN
ADDRESS 11598 RAINTREE CT 95014-5123
CITY/STATE/ZIP . . . : CUPERTINO CA, C
RECEIVED FROM BAY CITY WINDOWS
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP
TELEPHONE . . . . . . . .
UNIT QUANTITY AMOUNT PD-TO-DT -THIS REC- --NEW BAL
FEE ID 0 . 00
---------- _ ------0 . 00 1 . 00
-------- --------- 11, 800 .00 1 . 00 1 .20 0 . 00
1BCBSC VALUATION 1 20 0 . 00 0 . 00
11, 800 .00 0 .00 760 . 00
1BSEISMICR VALUATION 2 .00 760 . 00 _________-
----------
1WINREP EACH 8 ---------- ---------- 762 .20 0 . 00
762 .20 0 .00
TOTAL PERMIT
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# _ Date:
Building Address:
1 < 12 a. �rr r✓+
Mailing Address (if different from buil ng address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work on Yes ❑ No ❑ If yes, provide letter from HOA
Owner's Name: Phone#:
y 2 - 34vZ
Contractor:
Pe(96)o-S S-5 6 vt�
Fax: 3 -I
Contrac or Lice se#: $Z2 S 9 6
Cupertino Business License#:
Phone:
Contact:
Residential Commercial
Job Description: p`fuC e VU S � ''kk-C 1`'r 'e- Y)o
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑
Valuation: Square Footage:
l t.�
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:
For help, contact Build it Green at www.budditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
IW NMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK 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
1BSEISMICR Seismic Residential
B
1BSEES
ISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
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# U�
OWNER'S NAME: R PHONE#
GENERAL CONTRACTOR: B�, �,,.,' BUSINESS L CENSE#
ADDRESS: 302xo c CITY/ZIPCODE: -Ce 4
*Our municipal code requires all businesses 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: r g Y11�T7 /O
Signature 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
Owner/Contractor Signature Date