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10030083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20087 LAS ONDAS CT CONTRACTOR:RENAISSANCE BUILDERS PERMIT NO: 10030083 OWNER'S NAME: RAKESH PATEL 945 BERRYESSA RD,#2 DATE ISSUED:03/15/2010 NER'S PHONE: 4083662624 SAN JOSE,CA 95133 PHONE NO:(408)720-1100 ❑ LICENSED CONTRACTOR'S DECLARATION f—� - .—, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ? Lic.# '� ��l "'V MECH F RESIDENTIAL F COMMERCIAL r Tf', Contractor Z� v � '✓! Date JOB DESCRIPTION:REPLACING 3 VELUX SKYLIGHT LIKE 4 LIKE CHANGE I hereby affirm that I am licensed under the provisions of apter 9 FROM (commencing with Section 7000)of Division 3 of the Business&Professions MANUAL TO ELECTRIC**SEE NOTES** Code and that my license is in full force and effect. 1 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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$4000 permit is issued. APPLICANT CERTIFICATION APN Number:36930031.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. _�-• --%' Issued by: �)_-7 Date: Signature7( ___Date �� OWNER-BUILDER DECLARATION RE-ROOFS: 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: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. 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 I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,255p,-and 25534. 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 Owner authorized agen - forthwith comply with such provisions or this permit shall be deemed revoked. r Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save ir'-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g..-..ging of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 2 I understand my plans shall be used as public records. Signature_ -� J Date J Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36930031 . 00 DATE ISSUED. . . . . . . : 03/15/2010 RECEIPT # . . . . . . . . . : BS000009940 REFERENCE ID # . . . : 10030083 SITE ADDRESS . . . . . : 20087 LAS ONDAS CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RAKESH PATEL ADDRESS . . . . . . . . . . : 20087 LAS ONDAS CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3106 RECEIVED FROM . . . . : RENAISSANCE BUILDER CONTRACTOR . . . . . . . : THOMAS ROMAK LIC # 24655 COMPANY . . . . . . . . . . : RENAISSANCE BUILDERS ADDRESS . . . . . . . . . . : 945 BERRYESSA RD, #2 CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (408) 720-1100 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMMISC FLAT RATE 1 . 00 126 . 00 0 . 00 126 . 00 0. 00 1BSEISMICR VALUATION 4, 000 . 00 0 .50 0 . 00 0 .50 0. 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 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 325 .50 0 . 00 325 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 325 .50 #7896 --------------- TOTAL RECEIPT 325. 50 CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# % � Date: Building Address: 00 DWTAS 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 If yes, provide letter from HOA Owner's Name: Phone#: ,r Contractor: Phone: c4 o t P--kv.->6 • ,c,� ` Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential YJ Commercial ❑ Job Description: Building Permit Info: ' ' Bldg ❑ Elect L.--` Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ©� Valuation: - ,� Square Footage: 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 CITY OF GENERAL BUILDING APPLICATION CUPEkTINO 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 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) I EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK 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 f 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES ( 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B I TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5 Community Development 10300 Torre Avenue M Cupertino CA 95014 Telephone(408)777-3228 C1TY OF Fax(408)777-3333 ';UPE�TIN0 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: tore Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner for Signature at