10040002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 912 ROSE BLOSSOM DR CONTRACTOR:SANFORD ELECT PERMIT NO: 10040002
OWNER'S NAME: BALAJI VENKATACHARI
20888 PROSPECT RD DATE ISSUED:04/01/2010
SARATOGA,CA 95070 PHONE NO:(408)996-9797
JER'S PHONE: 6503355091
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG[_ ELECT F PLUMB
License Class C-10 pj Lic.# 64-33D1q MECH r— RESIDENTIAL f— COMMERCIAL
Contractor_, V A09 D H Date JOB DESCRIPTION:ELECTRICAL METER PANEL UPGRADE TO 200 AMPS
I hereby affirm that I am licensed under the provisions of Chapter 9 OVERHEAD
(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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$1200
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35906031.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agreecomply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,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,
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 applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section - Date: "
9.18. Issued''
Signature ^ 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, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
I,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 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.
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
permit is issued. maintain compliance with the 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,Sections 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 Owner or7 r=a
� Date: 4 I— IO
become subject to the Worker's Compensation provisions of the Labor Code,I must / 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
nify and keep harmless the City of Cupertino against liabilities,judgments,
,and 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 L Date --
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
5 ITEMS OF 5 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35906031 . 00
DATE ISSUED. . . . . . . : 04/01/2010
RECEIPT #. . . . . . . . . BS000010074
REFERENCE ID # 10040002
SITE ADDRESS . . . . . : 912 ROSE BLOSSOM DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BALAJI VENKATACHARI
ADDRESS 912 ROSEBLOSSOM DR
CITY/STATE/ZIP CUPERTINO CA, CA 95014-4216
RECEIVED FROM • • . FRANK SFNRANKIONLIC # 20090
CONTRACTOR . . . . . . .
COMPANY . . . . . . . . . . : SANFORD ELECT
ADDRESS . . . . . . . . . . : 20888 PROSPECT RD
CITY/STATE/ZIP • • . S4RTOG6,9CA 95070
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC - NEW-BAL
---- ----------
--------
---------- -------------
------ 0 . 00 1 . 0
0 . 00
1BCBSC VALUATION 1, 200 .00 1. 00
1BSEISMICR VALUATION 1, 200 . 00 0 .50 0 .00 40 . 00 0 . 00
1EPERMITFE FLAT RATE 1 .00 42 . 00
1 .00 42 . 00 0 . 00 42 . 00 0 . 00
1ERT<200 UNITS
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 -- 42 . 00 --- 0_0
TOTAL PERMIT
127 . 50 0 .00 127 . 50 0 . 00
METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER--
------------
---------------
CREDIT CARD 127. 50 DISCOVER
---------------
TOTAL RECEIPT 127 .50
4
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN #� .�- G � � � Date:
Building Address: Z
r�S6 Lo
S o m]
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes LJ No
LJ
HOA: (Exterior work only) Yes ❑ No If es, rovide letter from HOA
Owner's Name: _ Phone#: _
AL J i VF-/V� T/4C AR 6 �
Contractor: Phone: .7'�?7
S'pI --o R•D T LT-C( Fax:
Contractor License#: d:5Jk 33 d
Cu ertino Business License#: �
Contact: Phone: -¢t�Fs—�
TR�k-/U k L I O AJ 4 Fax: — >y
Residential Commercial
Job Description:
MPSI -e-
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 E0
' ❑
Valuation: Square Footage:
Z
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.builditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CInOF GENERAL BUILDING APPLICATION
CUPEt�TINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 s fl B
additional stucco application
1W Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
IEPERMITFEE Electrical Permit Fee E
IMPERMITFEE Mechanical Permit Fee
M
IPPERMITFEE Plumbing Permit Fee P
I ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
IPLMBLNCK 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
/ IBCBSC Cal Bldg Standards Commission Fee B ALL EPRMIT
1
1BSEISMICR Seismic Residential B
ES
I
IBSEISMICO Seismic Commercial B
ITRAVDOC Travel &Documentation B
IBUSLIC Business License B
5 of 5
M.Indoor Air Quality and Finishes
0
1 IAQ/Health pts y=yes
1.Use t_owlfdo-VOC Paint D
2.Use Low VOC,Water-Based Wood Finishes 2 IAWsalth pts y=yes 0
3.Use LDWND VOC Adhesives 3 IADJHealth pts yryes
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea 0
Formaldeh de 61AQ/Health pts y=yes
Y 0
6.Use E)�terior Grade PlyWood for Interior Uses 1 IAO/Heaith pts y=yes
4 IAOJHaltts es 0
7..Sea1 aetxi;3rd ter MDF — eh p = D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
� i o
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
0
2.Use f3aodly Renenrat Flooring Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl . 5 IAQ/Health pts y=yes
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y--yesD
Total oints Available: 140 130 57
Total Points Project Received:1 D D1 D
G:data/progslgreenbuiidingguidelinesln:modelerslgreenpointsfinal212Mprotecied-As
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: /2 PERMIT# i C�)Li
OWNER'S NAME: Fj ., PHONE#
GENERAL CONTRACTOR: jets'/aL BUSINESS LICENSE# (�
ADDRESS: �2DSE& ,y A ISTIu CITY/ZIPCODE:
*Our municipal code requi es all businesses wo king 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. /
I am not using any subcontractors: �/ 2 D
Slvnature 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