10020118 I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21085 RED FIR CT CONTRACTOR:SAVITHA AMARNATH PERMIT NO: 10020118
SAJAPURAM
OWNER'S NAME: SAVITHA AMARNATH SAJAPURAM 21085 RED FIR CT DATE ISSUED:02/22/2010
NER'S PHONE: 4089738251 CUPERTINO CA,CA 95014-4252 PHONE NO:
I� LICENSED CONTRACTOR'S DECLARATIONr-BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH F RESIDENTIAL F COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACING WINDOWS&PATIO DOOR WITH INSULATED
(commencing with Section 7000)of Division 3 of the Business&Professions LOW-E GLASS&VINYL FRAME
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3290
Section 3700 of the Labor Code,for the performance of the work for which this
pen-nit is issued.
APN Number:35905028.00 Occupancy Type:
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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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
9.18. Issued by: Date. 2��w
Signature Date
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,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,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 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.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
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 Own uthorize�a ent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 0— �2 10
forthwith comply with such provisions or this permit shall be deemed revoked.
T�_
—
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
i—ri the above mentioned property for inspection purposes.(We)agree to save Lender's Address
inify and keep harmless the City of Cupertino against liabilities,judgments,
,._s,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.
p Licensed Professional
Signature tN'�� Date O 22 ll�
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI- RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B11:: Lot :
APN . . . . . . . . : 35905028 . 00
DATE ISSUED. . . . . . . : 02,22/2010
RECEIPT #. . . . . . . . . BS000009796
REFERENCE ID # . . . : 10020118
SITE ADDRESS . . . . . : 21 )85 RED FIR CT
SUBDIVISION . . . . . .
CITY CU?ERT INO
IMPACT AREA . . . . . .
OWNER SKIITHA AMARNATH SAJAPURAM
ADDRESS 21 )85 RED FIR CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4252
RECEIVED FROM . . . . : SA:JITHA AMARNATH
CONTRACTOR LIC # *OWNER*
COMPANY SA'JITHA AMARNATH SAJAPURAM
ADDRESS . . . . . . . . . . : 21)85 RED FIR CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4252
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 3, 290 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 3, 290 .00 0 . 50 0 . 00 0 .50 0 . 00
1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 381.50 0 .00 381 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 381.50 #115
---------------
TOTAL RECEIPT 381. 50
c� 0
APf rW)VED
,4 IN AC(;ORI)AN( VVI TH THE CITY OF 0
CUPERTINO C(A) ,AND ORDINANCES I
DATE_
SIGNE@- r
This set of plans ar ri specifications MUSTjfAd�I1N�
bekepton the to ,at ill trines and it is
unlawful to make ar chariyes or alterations
�thout ., itte, permission from
the Ruilding Depart, ler t City of Cupertino.
The stampin of�thr5 pla,,and specifications X
SHALL NO brhei 1 tc permit or to be an Q�}T
k ITCH I`ly approval of tho v r i S(� �T
of ar'y City rnGe ur a . 2UOt�
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OWNER-BUILDEF. VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child)will perform:
A. All the work authorized by this permit
B. _ A portion of the wort.
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired t:) do:
A. _ All of the work
B. _ A portion of the wort: (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand flat I may be an employer (see reverse side). A
Certificate of Insurance covering workers' comp enation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erf ormed
.....................................................................................................................................................................................
I declare under penalty of perjury that the abo•.re is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature: ,J,JA Date: _0d I k C)
a\0pg (�1=1� l'i1� CSI C�P�R��ty� C!� � C
Job Address. t Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
DeRartment.
CITY OF CUPERTINO
CUPEf�TiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date: p ZA 2z`t 0
Building Address: x,10 gS- r-ip- C -f ��> ErzTl tit p Cry - Sat
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of thii project? Yes No
HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA
Owner's Name: Phone#:
SAv k T " A AMA R-MA T NC Wig) R4 3 g2S` I
Contractor: Phone:
Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential r4 Commercial
Job Description: ��ti��� ��u`'
(� 1��a L int Cn tis t N ho v\S
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIIUV-A ❑ IU111 B, IV-HT, V-B '3
Valuation: ^C, Square Footage:
290 —
Project Size: Express dard ❑ 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.bufldilgreen.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 A:)plications (up to 400 sf) B
additional stucco application
/ 1 WINREP Replacement windows/sliding glass B
I door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
I EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing;Permit Fee P
IELCPLNCK 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
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Zesidential B-
1BSEISMICO Seismic Zommercial B
I TRAVDOC Travel &, Documentation B
IBUSLIC BusinesF License B
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