13080007CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10218 PASADENA AVE CONTRACTOR: NEKO ELECTRIC PERMIT NO: 13080007
OWNER'S NAME: MADHUKAR & CHAYA GOVINDARAJU 122430 CUPERTINO RD I DATE ISSUED: 08/01/2013
OWNER'S PHONE: 4086911896
0' . LICENSED CONTRACTOR'S DECLARATION
License Class I/) Lie. #-8,,, 4 7 4 9 7
ContractorDate�L
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
o ce of the work for which this permit is issued.
I a and will maintain Worker's Compensation Insurance, as provided for by
ction 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. Additi all the applicant understands and will comply
with all non -
,p regulations per Cupertino Municipal Code, Sect
Signa '~ Date
1 ❑ 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 isnot intended or offered for sale (Sec.7044,
Business & Professions Code)
I, 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 provisions 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
9.18.
Signature.
Date
CUPERTINO, CA 95014 PHONE NO: (408) 446-4141
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL0
INSTALL (1) EV CHARGING STATION IN GARAGE AREA
Sq. Ft Floor Area: I Valuation: $350
I APN Number: 34718041.00 I Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS O T ISSUANCE OR
180DAY LAS LED INSPECTION.
Tfiv.at It 13
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:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 complianc tfi t upertrno um de, Chapter 9.12 and
the Health & Sal ode, Sections 25505, 25533, and 25534.
Owner ora thorized agent: ¢A.(i� ate: (� r
i
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
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ALTERNATIVE ENERGY PERMIT APPLICATION �QO
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^Q
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1\
(408) 777-3228 • FAX (408) 777-3333 • building5cuoertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT b CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME `: _ (J jA
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LICENSE NUMBER -93743
LICENSE TYPE r'
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COMPANY NAME
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CITY,STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE ❑ Yes ❑ No
❑ SOLAR PANELS
V ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:
DESCRIPTION OF WORK I
RECE BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the owner's b have r
application and the inform atio a provided is correct: a escription of Work and verify it is accurate. I agree to comply with a pp rcable local
ordinances and state laws ating to building construction. I authorize represents _ Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplican gent: L "" Date:
—MIPMMENTAL INFORMATION REQUIRED
_
OFFICE USE ONLY
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P VApp_201 1. doc revised 03116/11
CITY OF CUPERTINO
l T'i i`i T`i 4Z9r7M A T(1R — RT TIT .DING DIVISION
LaADDRESS:
10218 PASADENA AVE
DATE: 08/01/2013
REVIEWED BY: MELISSA
QTY/FEE
APN: 357 18 041
BP#:
*VALUATION:
$350
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
hrs
PENTAMATION SOLAR -RES
PERMIT TYPE: i
USE:
PME Plan Check:
$0.00
WORK
INSTALL N EV CHARGING STATION IN GARAGE AREA
$0.00
SCOPE
0.0
ILfech. Plan Check Plumb. Plan Check F_lec. Plan Check
yl,ch. Permit Fee: Plumb. Permit ree: Flec. Permit Fee:
Other ibferch. Insp. Other Plumb Insp. Other Elec. Ins",
Allech, Insp. fee: Plumb. Insp. Fee: Elec. Insp. Fee:
a.. IL n PL.. ;ma Puhli,- Wnrks_ Fira_ Sanitary Sewer Distriet. St
District, etc). These fees are based on the prelindna information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7111121
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 # Alternative Energy System
$106.00 1CHRGSTA EV Charging Station
Suppl. PC Fee: (E) Reg. ® OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conswuction Tax:
Adininl5trative .Fee:
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
I A
Travel Uocuinentation Fees:
Strong: Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
BldgLStds Commission Fee: IBCBSC
$1.00
$1.50 $106.00 _ ,... �. $107.50
Revised: 07/01/2013
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CUP went ILDffy„ ,; r. T �s.Np,
'` �iullding Dep C q. C; =R i 7
Thrs set of plans and s APPROVE"®
012013 lob site during con specifications MUST
Chan struction. It is unlawful kept at the
COMPLIANCE 9es or alterations on wful to crake an
ED FOR CODE ►Bfrom, without approval frosame, or to deviate Y
REVIEW fie m the
Reviewed BY be held two Stamping
Of this plan and Building official.
specifications SHALL be an pp ALL N0T
ardinanceoort3 violation
�,�M tate Law.
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DATE
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