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13050005 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10575 SAN LEANDRO AVE. CONTRACTOR:CRAIG A ROGERS PERMIT NO:13050005 OWNER'S NAME: REDDY VENUGOPAL AND GUNNA VISHAN 3914 WELLINGTON SQ DATE ISSUED:05/01/2013 OWNER'S PHONE: 4084109326 SAN JOSE,CA 95136 PHONE NO:(408)499-3354 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class Lie.# �JZ 1 �o�o- TEMPORARY POWER POLE Contraetkak L �-T Date��-1 I hereby affirm that I am licensed under the provisions of Chapterr99 (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 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:35705081.00 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 + A ALLED INSPEC IO indemnify and keep harmless the City of Cupertino against liabilities,judgments, l costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply I Date: with all n t so ice regulations per the Cupertino Municipal Code,Section 9.18. - RE-ROOFS: Signature Date Ail 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 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 asdeflnedbhthe Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ti 2 50 2,533f 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 CONSTR CTION 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 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 I /II ii I I I I I I GENERAL PERMIT APPLICATION O o MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 v / CUPI=RYINO (408):i.17-3 28 FAX(408)777-3333•building(c�cupertino.org MIS: ❑PLUUNMWIIG ❑M\ECHANICAL ELECTRICAL ❑MISCELLLLANEOUS PROJECT ADDRESS �^tv �� �ZN# �� OWNERNAME - r--�� Vl 1.V V��• P V�.r� V�-q LlQ E-MAIL �J 1 STREET S `V��� �� 1,�b FVO 11 � ' CONTACT NAME.r C� / ,(�©� PHONE -e���/' (JO �. E-MA1L STREETADDRBSS ��"(� (�•, iG• C Y,S A,T,E\ZIP L�(� `r Qc �j F•°��,y�/� ❑OWNER ❑.{OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR NTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT. CONTRACTOR N LI LICENSE TYPE i BUS.LIC# l I y^ COMP E-MAJL F f ?� G I Ott• `C STREET ADDRESS TAY, P 1'SII I , � AR p LICENSE NUMBER BUS.LIC# C ANY N V\ E MAII b CJ V ST RE SII l v1 'D,I 1 S_T+J1 �` USS'OF SFD II DUPLEX III❑ MULTI-FAMQ.Y PROJECT INWB,DLAND ❑ YES PROJECT IN YES IS THE BLDG AN ❑YES BUII.DING �I.❑GOMMEYtCIALj URBAN INTERFACE AREA ❑ NO FLOOD ZONE O EICHLERHOI NO DESK P'TIQN O WORD ! ILI III I •:I it I II TOTALY.. ATIO : By Ilm Iow„I certify t, ach of the following: I the property owner or authorized agent to act on the property owner's . I have read this y s,gnature be application and ,e Iinformat,on I h ro Wed is c ect. a read the Description of Work and verify it is accurate. I agree to c mply with all applicable local ordinanceslandstate laws relating b d g c,on. I au o epresentatives of Cupertino to enter the above-identifie property for inspection purposes. Signature ofAppli ianAgent: Date: SUP L NTAL INFO TION REQUIRED - ji li l: II lj,'SII IIIA II! II I I I. III III I I I I I i I 1 I III I III '.1 I I, II _ ;:III; I! MEPMiscApp_2011.doc revised 06/21/11 I I CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10575 SAN LEANDRO AVE DATE: 05/01/2013 REVIEWED BY: MELISSA APN: 357 05 081 BP#: *VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP1 i WORK TEMPORARY POWER.POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary. Power 1ERT<200 100 Amps $45 TOTALS: -- $45.00 "-NMI 11<:ch.Plcm Check Plumb.Pleat Check Elec.Plan Check 0.0 hrs $0.00 Meeh.Penuit Fee: Plumb.Permit Fec: Elec.Permit Fee: 1EPERMIT Other:Rech.Insp. Cliher Plumb Insp, Li Other Elec.Insp. 0.0 hrs $45.00 ,Rech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on therelindna information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution)1-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Checklce: Suppl. PC:.I ce PME Plan Check: $0.00 Permit.Fee: Suppl. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tax: F-1 Administrative Fee: 1ADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 AdvancedPlanning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $178.50 $0.00 $178.50 ` Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10 S�1 C-Pr V PERMIT41' U�5 v 0 V Z OWNER'S NAME: 0'kV AN- PHONE# ; GENERAL CONTRACTOR: e �.o BUSINESS LICENSE# `. ADDRESS: 'rp,,) CITY/ZIPCOD *Our municipal code requires all businesses korking in the city to have a City of Cupe„rtino business license. NO BUILDING FINAL OR FINALCCUPANCY INSPECTION(S) WILL BE :SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AlB ONTRAC RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Sign Da 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date