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13060224 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7965 WOODLARK WAY CONTRACTOR:TALENT DECIDE INC PERMIT NO:13060224 OWNER'S NAME: SREEDHAR VAIDYANATHAN 218 HARDING AVE DATE ISSUED:06/27/2013 OWNER'S PHONE: 6509967460 LOS GATOS,CA 95030 PHONE NO:(408)306-3968 4 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL11 License Class le Lic.# Ad�•-f l INSTALL TEMPORARY POWER POLE(100AMP) Contractors Date. f-� I hereby affirm 4fiat 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. Sq.Ft Floor Area: Valuation:$600 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:36203023.00 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 WITEIIN 180 DA S 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 O AST 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 Issu b Date 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 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 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 GENERAL PERMIT APPLICATION V � EP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 misc (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org �. ciw up>=11thwa EI PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �y/ APN# OWNER NAME' 7[' ,'` PHONEl�j /s E-MAIL BtiJ W" "� L��e�Z) STREET ADDRESS j CITY, STATE,ZIP FAX CONTACT NAME ® ` E-MAIL �+ PHO STREET DRESS CITY,STATE,ZIP FAX ayr'• �:.- 9�3 �(1 ❑OWNER ❑ OWNER-BUQ.DER, ❑ OWNERAGENT /L3 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT . CONTRACTORNAME LICENSENUMBER LICENSE�YPE BUS.LIC# I s-r (f COMPANY N E-MAIL FAX STREET ADDRESS I' yy CITY,STATE,ZIP PHONE Ci Y ARCHITECT/$NGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME I'I E-MAIL FAX STREET ADDRESS.;I: j CITY,STATE,ZIP PHONE USE OF ❑SFD of DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN OYES - BUJLDING ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? Cy,NO I - DESCRIPTION OF,V�ORI� '1 (dL-G / �Q {' jl t jlti� l l i � I jI111111 one= ' I� TOTI; I 11 I ,�L�AtTUATro '' - By iqy signature Ibelow'II certify tp each of the following: I am the property owner or authorized agent to act s half. I have re - applicahoJ�aiid the informatiola L have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply'with all applicable local. ordvtances and state laws relating to bwlding cons ction. I authorize representatives of Cupertino to enter the above-idd ii ied property for inspection purposes.,: 'Signature of Ap�Iltcant/Agent Date: ;SUPPLEMENT INFORMA RE UIRED r I I, :u. I Ea" I l' 'I II MEPMiscApp_2011.doc revised 06/21111 I iI� ' 11 iil ' ll I ' CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7965 WOODLARK WAY DATE: 06/27/2013 REVIEWED BY: MELISSA APN: 362 03 023 BP#: "VALUATION: $600 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP14 USE: p PERMIT TYPE: WORK I INSTALL TEMPORARY POWER POLE 100AMP SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $45 TOTALS: 1 $45.00 N� Mech.Plan(.'heck Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00 ,L1ech.Permit Fee: Phtmh.Permit Fee: Elec.Permit Fee: lEPERMIT Other hlec�h.Inst. " I Other Plumb Insp. F] I Other Elea Insp. 0.0 hrs $45.00 1�ech.Inst.Fee: Plumb. Insp.fee: flee.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 prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: tStgq)l. P(,Fee PME Plan Check: $0.00 Permit Fee: Su/�pl. .Ir�s�Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Co nstruction .Tx . Administrative Fee: 1ADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 Advanced Plarming Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 _ $178.50 $0.00 ;t SOT ` $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: 7,.5� PERMIT'# 3O6 0` OWNER'S NAME: .S'e2lc— PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE ADDRESS: >-t J CITY/ZIPCODE:- Ao *Our municipal code requires all businesses working in the city to have a City of.Cupertino.business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A:;CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Sign ture Date 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/Contr "or Signature Sate