13050157I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1048 WESTLYNN WAY I CONTRACTOR: SAMPATH CHERUKURU I PERMIT NO: 13050157 I
OWNER'S NAME: SAMPATH CHERUKURU
1048 WESTLYNN WAY I DATE ISSUED: 05/22/2013
OWNER'S PHONE: 4084109187 1 CUPERTINO, CA 95014 ' PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #,
Contractor Date
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.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the. City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become, subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such'progisions or this permit shall be deemed revoked.
APPLICANT' CERTIFICATION
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
indemnify, and keep, harmless the: City of Cupertino against liabilities, judgments,
costs; and expenses which may accrue against said City in consequence of the
granting of this permit' Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, -Section
918 % C I/' l
Date
JOB DESCRIPTION: RESIDENTIAL
UPGRADE & RELOCATE (E) 100 AMP PANEL TO 200 AMP.
REMOVE (E) INTERIOR FIREPLACE & BBQ. SHEETROCK
GARAGE & ADD CEILING JOISTS AS REQUIRED BY
CODE,
Sq. Ft Floor Area: I Valuation: $9000
APN Number: 35927001.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F CALLED INSPECTION.
Date: ZZ
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Date:
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sectiop 72055M556d 25534.
Owner or authorized agent: — Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
NOW 1V1P1i. FCTIIMATnR — RITTI,DING DIVISION
r
ADDRESS: 104$ WESTLYNN WAY
DATE: 05/22/2013
REVIEWED BY: MELISSA
APN: 359 27 001
BP #:
`'VALUATION: 1$9,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
Plan Check Fee:
PENTAMATION 1 REAP2
PERMIT TYPE:
USE:
Electrical
WORK
UPGRADE &:RELOCATE E 100 AMP PANEL TO 200 AMP. REMOVE E INTERIOR FIREPLACE
SCOPE I
& BBQ. SHEETROCK GARAGE & ADD CEILING JOISTS AS REQUIRED BY CODE
Xle.ch. Plan Check
1lech. Permit Fee:
Other Alech. Insp.
Atech. Insp. Fee:
Plumb, Plan Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee.
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $45.00
1:16c. Insp. Faze.
NOTE: This estimate does not inetudejees due to otner uepartments (be. running, ruuuc rrurics, moire, our -luiy oervei �soaiou, ua isvvc
info.
District etc ). These fees are based on the preffinWha
in ormadon available and are only
an estimate. Contact the Dept for addn'1
FEE ITEMS (Fee Resolution 11 -053 E . 7f� /1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
200
amps
Electrical
Suppl. PC Fee: Reg. Q OT
0.0
his
$0.00
$45.00
IBELEC200
Services
PME Plan Check:
$0.00
499
s.f.
Remodel, Other
Permit Fee:
$0.00
$467.00
1 1REAMESOTH
Supp1. Insp. Fee Q Reg. 0 O
0,0
hrs
$0.00
PME Unit Fee:
$0.00
:PME Permit Fee:
$45.00
Conso- fiction Trrr:
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Travel Documentation Fee: ITRAVDOC
$45.00
Building or Structure
Strom Motion Fee: IBSEISAIICR
$0.90
Select an Administrative Item. -
Bldg Stds Commission Fee: IBCBSC
$1.00
C
C
$133.90 $512.00 $645.90
Revised: 04/29/2013