10010087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10341 PRUNE TREE LN CONTRACTOR:MAHEH&URMILA PERMIT NO: 10010087
BHIDE
"OWNER'S NAME: MAHEH&URMILA BHIDE 10341 PRUNE TREE LN DATE ISSUED:01/20/2010
_OWNER'S PHONE: 4088076525 CUPERTINO CA, 95014-2022 HONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Lr COMMERCIAL
License Class Lic.# REPLACE WEATHERHEAD CONNECTORS,CONFIRM
PANEL IS
Contractor Date UP TO STANDARD WORK DONE BY PG&E
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:$100
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:31633038.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the +. zo.i O
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �A1',
Owner or authorized agent:_+-1,�' .� Date:011 RAI Ib,
permit is issued.
I 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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
-,on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
-mnify and keep harmless the City of Cupertino against liabilities,judgments,
..osts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature e Date D.i b B
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31633038 . 00
DATE ISSUED. . . . . . . : 01/20/2010
RECEIPT #. . . . . . . . . : BS000009591
REFERENCE ID # . . . : 10010087
SITE ADDRESS . . . . . : 10341 PRUNE TREE LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAHEH & URMILA BHIDE
ADDRESS . . . . . . . . . . : 10341 PRUNE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2022
RECEIVED FROM . . . . : MAHESH BHIDE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MAHEH & URMILA BHIDE
ADDRESS . . . . . . . . . . : 10341 PRUNE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2022
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -
1BCBSC VALUATION 100 . 00 1. 00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 100 . 00 0 . 50 0 .00 0 .50 0 . 00
lEPERMITFE 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 85 . 50 0 . 00 85 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 85 . 50 master card
---------------
TOTAL RECEIPT 85 . 50
= CITY OF CUPERTINO
CITOf
CUPEYTINO GENERAL BUILDING
PERMIT APPLICATION FORM
db1 ct IR
APN # co 33 0 Date: to /20 1
Building Address: :f C5 S 4J- P R O O F TREE LI-J • C L)P ER T 0 0 j CA- ,3501J
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No 2--
HOA:
(Exterior work onl Yes ❑ No [200 If yes, provide letter from HOA
Owner's Name: Phone#: �O S g.01 6 52 5
MAHEO ,�� v�� 8H T-7)
Contractor: Phone:
o W N E-K • Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential R'00 Commercial ❑
Job Description. Nr $j E.
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t r r,n -n e.) L s - ,e, s-L c--n a y
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Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B [—] II/III/V-A ❑ II/III B, IV-HT, V-B 1-2� .
Valuation: Square Footage:
0100 • OO
Project Size: Express ❑ Standard ❑ Large ❑ Ma'or ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buflditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CU PEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
r
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
5 of 5
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
tin-OF
7UPEVINO
Building Depart a nt
JOB ADDRESS: 0 3.4 i • PRO t4 E TREE LO , PERMIT #
C�PC�-r� 7.10
OWNER'S NAME: OAReS q ASD t)RrTLA lbl�tT'DE PHONE # o$ 90 :rG X25
GENERAL CONTRACTOR: 0)4 N GK FAX #
I am not using any subcontractors.
j %j!�C)C,
�,pb-1 120 I ±6
Da
Signature
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
11201 io
Date
Owner/Contractor Signature