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09120144 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10825 STEVENS CANYON RD CONTRACTOR:BROTHERS HOME PERMIT NO:09120144 IMPROVEMENT —,VNER'S NAME: CHAITANYA POTHIMENI 2510 DOUGLAS BLVD DATE ISSUED: 12/23/2009 ,-,WNER'S PHONE: 4085170543 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL0 COMMERCIAL CI License Class, C-17 Lic.# /0 q9 O REPLACE 28 WINDOWS A 10 PATIO DOORS LIKE FOR '� — LIKE Contractor Date —v— I hereby affirm that I am licensed under the provisions or 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:$25656 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 APN Number:34217075.00 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 ''r' - – J? ,. Z granting of this permit. Additiona/thelicant understands and will comply Issued byf '� Date:with all non-point source regu tiCupertino Municipal Code,Section 9.18. RE-ROOFS: �ianature _ 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 or 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 compensatior,, 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 unic' al Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 3 d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent- 7 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 CONSTRUCTION LENDING AGENCY 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 mu:•t 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 relatir g to building construction,and hereby authorize representatives of this city to enter -)n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION amnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 re ations r the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 7 lU�z,s s n �� Rio (�l D7 -effivio I _N 4:�D APPi+ f L z IN ACCOR[)A"4 -i NITN THE CITY OF CUPERTINO CODES AND ORDINANCES DATE__12 SIGNen, - �fications MUST This set of Pd spec be kept on the job at all times and it is unlawful t make any changes or alterations on same without written permission from the B ,,,duilding De artanent.City of Cupe�i �d specificationCity s Intl aLo...t'-- r,rt nr to vc _ SNALL NOT be,hei(Sions approval of the viola'""'`�t�;t�ate Law Ot 2nV City�lr,�lna'�r�>� L-�viv� C RIVED 1 2 3 2009 b i�� Q r Z,- 'lam 4r /� �� V c� T"fd -0W S Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: PERMIT # 7i,� .S�✓�r� rQ i2d. � 2 OWNER'S NAME: G PHONE # %'... U — '7-L GENERAL CONTRACTOR: # I am not using any subcontractors: tee ate Please check a licable subcontractors andco followin 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 Own / ontrac Signature Dat CITY OF C.UPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM 00 IZoI APN# -7 U 7.S nO Date: Building Address: 7�✓4 vh IPI Mailing Address (if different from building address): Are Hazardous Materials being used as part of tht; project? Yes ❑ No HOA: (Exterior work onW Yes ❑ No 9if yes, provide letter from HOA Owner's Name: Ch cin�� Phone#: Contracto Phone: + /�ra h r r � Fax: 67 z-- Contractor License#: (a 1990-7 Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: Q-flue'tM-oi C,- 2j� cN'� 1wt I C) 1--10r 4y, G,Xc CeIra - 4 i4j 114 hm . Building Permit Info: Bldg [� Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT,V-:3 �f r Valuation: j/ Square Footage: 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.builditgr�,-en.or Revised 07/14/09 CITY OF (:UPERTINO Cin 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 1WINREP Replacement windows/sliding glass B door (ea 3 windows) 1WINMEWSTR New Win3ow-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 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-st ind alone l 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5