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09100010 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10276 E ESTATES DR CONTRACTOR:KELLAR CONST. PERMIT NO:09100010 OWNER'S NAME: RAVI NARULA 15240 MADRONE HILL RD DATE ISSUED: 10/02/2009 /NEB's PHONE: 4084994346 SARATOGA,CA 95070 PHONE NO:(408)867-9743 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION: SWIMMING POOL DEMO 1 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 Valuation:$4000 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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:36907024.00 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 Issued by: Date: Date: ��Z 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. 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 Date: ( Signature of Applicant: 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to 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 1 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 1 store or handle hazardous 1 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 the Health&Safety Code,Sections 25595,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by � A Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent• Date: 0 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,1 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 work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct.1 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 !mnify and keep harmless the City of Cupertino against liabilities,judgments, s,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. 'J� Signature -' =/ Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: SylviaM 4 ITEMS OF 4 COPY # : 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36907024 . 00 DATE ISSUED. . . . . . . : 10/BS00000009 RECEIPT #• " ' . 09100010 8817 REFERENCE ID # • • SITE ADDRESS 10276 E ESTATES DR SUBDIVISION . . . . . . CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . OWNER . . . . . . . . . . RAVI NARULE ADDRESS 10276 E ESTATES DR CITY/STATE/ZIP CUPERTINO, CA 95014-3305 RECEIVED FROM RAVI NARULA CONTRACTOR DONALD R. KELLAR LIC # 24365 COMPANY KELLAR CONST. ADDRESS 15240 MADRONE HILL RD CITY/STATE/ZIP SARATOGA, CA 95070 TELEPHONE (408) 867-9743 UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- FEE ID ----- ---------- 0 .00---------- 1 . 00 -------- ------------ 4, 000 . 00 1 . 00 0 . 00 0 .00 1BCBSC VALUATION 0 . 50 0 . 00 0 . 50 1BSEISMICR VALUATION 4, 000 . 00 0 . 00 114 . 00 0 .00 1. 00 114 . 00 0 . 00 490 . 00 0 .00 1BUSLIC FLAT RATE 0 . 00 490 . 00 1DEMOPRE SQUARE FEET ---------- 0 . 00 605 . 50 ---------- 0 .00 605 . 50 TOTAL PERMIT : AMOUNT REFERENCE NUMBER METHOD OF PAYMENT ---------- --- CREDIT CARD ---------605_50 master card TOTAL RECEIPT 605 .50 --------- VOICE ID DESCRIPTION DESCRIPTION -------------- VOICE ID ------------- 704 DEMO Community Development a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF :UPEkTINO Buildin De artment JOB ADDRESS: PERMIT #CA ��o�l� OWNER'S NAME: IQ W �u 4 LA PHONE # �Q�i -311V �b� GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the follow' information: LICENSE # SUBCONTRACTOR BUSINESS NAM 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 k-2 Date Owner/Contractor Signature CITY OF CITY OF CUPERTINO ELI DEMO GUPERTINO PERMIT APPLICATION FORM q tl APN# Date: L(� �9-01 - n24 0-0 Building Address: uA C� Vb( y tb2 �, cs ( e �� Mailing Address (if different from building address): Owner's Name: Phone: 9-PV1 N �utA dog -�iq 9- y 3+�-� Contractor: Phone : kA 0 16rio 699 1 Fax: Contractor License#: -101— 6 '1 Cupertino Business License#: ��3 Phone: Contact: Fax: Residential '� Sq Footage Commercial ❑ Sq Footage Job Description: u D-P�,-),�iV'v,, SW 1 rnrn+ Valuation: !A ti 00 Ot Project Size: Express E��tandard ❑ 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 1DEMORES Demo-Residential B ISFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFPOOL-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09