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10030104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10535 ORANGE TREE LN CONTRACTOR:RICHIE BOBCAT& PERMIT NO: 10030104 HAULING ' 396 PATCH AVE DATE ISSUED:03/17/2010 'NER'S NAME: KRISHNAPILLAI K VELAYUDHAPILLAI SAN JOSE,CA 95128 PHONE NO:(408)529-2531 OWNER'S PHONE: 4082039719 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class l'— Lic.# -1'/9 3 J..D MECH[_ RESIDENTIAL r COMMERCIAL Contractor � �=K Date '3—1 —t —i u JOB DESCRIPTION:POOL F1LL(500SQ) 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. Sq.Ft Floor Area: Valuation:$6500 1 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 APN Number:31634012.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply ��'7 Date with all non-point source regulations per the Cupertino Municipal Code,Section Issued byi. �C 9.18. ` -nature 1� Date -3 RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is 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 inspection. the following two reasons: Date: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Owor authorized agent: Date: 'S — "� — t 4 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION 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 city to enter Lender's Address the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31634012 . 00 DATE ISSUED. . . . . . . : 03/17/2010 RECEIPT #. . . . . . . . . BS000009969 REFERENCE ID # 10030104 SITE ADDRESS . . . . . : 10535 ORANGE TREE LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KRISHNAPILLAI K VELAYUDHAPILL ADDRESS . 10535 ORANGE TREE LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2014 RECEIVED FROM . . . . : RICHIE BOBCAT AND H CONTRACTOR RICHARD MAES LIC # 31554 COMPANY . . . . . . . . . . : RICHIE BOBCAT & HAULING ADDRESS 396 PATCH AVE CITY/STATE/ZIP SAN JOSE, CA 95128 TELEPHONE (408) 529-2531 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 500 .00 0 .70 0 .00 0 .70 0. 00 1DEMOPRE SQUARE FEET 500 .00 490 . 00 0 .00 490 . 00 ---- - - ---------- ---------- ---------- TOTAL PERMIT 491.70 0 . 00 491 .70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 491. 70 VISA --------------- TOTAL RECEIPT 491 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- - 704 DEMO CITY OF CUPERTINO �p W DEMO CITY Of CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: k C>6 0 Mailing Address (if different from building address): Owner's Name: Phone: ek 1 9 1 �le 1411 A,3 Phone G 3 Contractor: Fax: Contractor License q 3 Cu ertino Business License #: Contact: Phone: 2- <5 3 1 Fax: t q SIG 0 c kel Residential Sq Footage Commercial ❑ Sq Footage Job Description: Valuation: Project Size: Express Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type IDEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEMI ALL PERMIT IBCBSC Cal Bldg Standards B TYPES Commission Fee IBSEISMICRE Seismic Residential B Revised 01/07/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: i. v. PERMIT# ► 535 -zo3 - �►-, 1(., ; PHONE# OWNER'S NAME: ,r nK ,1l' `"S" ° �� BUSINESS LICENSE# GENERAL CONTRACTOR: ,ct-,i e S CITY/ZIPCODE: ADDRESS: *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) HAVE OBTAINED AHCITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTOR BUSINESS LICENSE. I am not using any subcontractors: Signature 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature