13040174 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18985 BARNHART AVE CONTRACTOR:ALI'S CONSTRUCTION& PERMIT NO:13040174
REMODELING
OWNER'S NAME: PRASHANT TOMAR 681 E BROKAW RD DATE ISSUED:04/24/2013
OWNER'S PHONE: 4085837288 SAN JOSE,CA 95112 PHONE NO:(408)898-6474
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
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License Class Lie.# INSTALL TEMP POWER
Contractor ate
I hereby affirm that I am licensed under the provisions of 'hapter
(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:$500
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:37509029.00 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 0 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 DA OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, `J
costs,and expenses which may accrue against said City in consequence of the Z7
Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all.non-points ur a regulations per the Cupertino Municipal Code,Sectiork
9.18.
RE-ROOFS:
Signature Date AP144 11'12 All roofs shall be inspected prior to any roofing material being installed.If a roof is
1/ installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ O E BUILDER DECLARATION
Signature of Applicant:. Date:
I hereby affirm 4t/a,exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
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 25 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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 CONSTRUCT ENDING AGENCY
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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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify 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 regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18..
Signature Date
VIII I
of
GENERAL PERMIT APPLICATION E P
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COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
-. 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 "
(4d8)777-3228•FAX(408)777-3333•building(&cupertino.org
misc
CrJPERTINO
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CONTRACTOR NAME "�e LICENSE NUMBER 0 LICENSE TYPE BUS'.LIC#
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BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK '.
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By my slgnattite below,II,certify.10 each of the following: I am the property owner or authorized agent to a o property owner's behalf. I have read.this
appltcatlon andi! a tmformatton I have Prov' a is correct. I have read the Description of Work and verify it is urate. I agree to com ly,with all applicable local, I!
ordmances'and State laws relating to bull nstruotion. I authorize representatives of Cupertino to enter the above-ide Tied prop for inspection purposes:.
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Signature of,Aplieant/Agent Date:
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18985 BARNHART AVE DATE: 04/24/2013 REVIEWED BY: MENDEZ
APN: BP#: "VALUATION: $500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duple PENTAMATION 1 REAP14
USE: p PERMIT TYPE: A
WORK install tem ower
SCOPE
a
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P/rrrrrb.Plan Check Elec.Plan Check 0.0 hrs
M ech.Plan Check $0.00
Rech. Permit Fee Plumb.Per~mit 1Tee: Elec.Permit Fee: IEPERMIT
C)tha;r Alech.Insp, Other Plumb Insp. Other Elec.Insp. L.0 hrs $45.00
ilech.
Insp. Fee: Plumb. Lrslr.Fee: glee.Insp.Fee:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the relimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7fi /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl.PC Fee: Q Reg. ® OT FO-701hrs $0.00 $45.00 /ERT<200 Temporary Power
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. Q OT 0.0 hrs $0.00
PME Unit Fee:_ $0.00
PME Permit Fee: $45.00
Construction Tax.
Administrative Fee: IADMIN $42.00
Work Without Permit? B Yes 0 No $0.00
Advanced Planning Fee_ $0.00 Select a Non-Residential
Travel Documentation Fee: ITR,4VDOC $45.00 Building or Structure. ®�
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
f $178.50
$133.50 $45.00
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Revised: 04/01/2013