The URL can be used to link to this page

13090191 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21700 ALCAZAR AVE CONTRACTOR:ALI'S CONSTRUCTION& PERMIT NO:13090191 REMODELING OWNER'S NAME: AKHIL SAHAI 1011 S DE ANZA BLVD DATE ISSUED:09/24/2013 OWNER'S PHONE: 4082192196 SAN JOSE,CA 95129 PHONE NO:(408)898-6474 LICENSED CONTRACTOR'S DE,JCLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class 'ice Lic.# q q 1 33 i TEMPORARY POWER POLE Contractor �t L_�_ /0,1'�7 d 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. Sq.Ft Floor Area: Valuation:$250 A-4ection ave and will maintain Worker's Compensation Insurance,as provided for by 3700 of the Labor Code,for the performance of the work for which this APN Number:35719109.00 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 FR LLED 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 granting of this permit. Additionally,the applicant understands and will comply Issue '/i l / Date: Z with all non-point so c regulations per the Cupertino Municipal Code Section �,e® 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. ❑ OWN�R-BUILDER DECLARATION L/ 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 an I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 1150f`25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Z 1* 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 CONSTRUCT N ENDING 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 v N` GENERAL PERMIT APPLICATION � MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(E)cuDertino.ora. MISC ❑PLUMBING ` ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRES.°if i � ^O A` C� AN c- I APN# 2 C 7- I Q /O OWNER NAME A\W' I So,�ck � � �!/� E-MAIL STREET ADDRESS �7 �„O k\ �� CITY,STATE,ZIP D� FAX .}-- /� CONTACT NAME �`�` (• "'`I�. PH03 V O CJ 1 61-13+E-MAIL` / ' �I s `O t 1 5��Ll(-0 N( _I STREET ADDRESS I 1 s De A-n 7_0 (j r� �I CITY,STATE,ZIP QrT- CA 47 5 I Z-1 FAX Jq ko.). `O ` v` �+I Ih Jv 1 I 1 ❑OwNER ❑ OwNEAR-BUDDER ❑OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME�J f _^ {{{I------LIC---ENSE NUMBER D Q' LICENSE TYPE BUS.LIC# COMPANY NAME/ L i 1 rr l ' ! E-MAIL / FAX ff r_ r .� STREET ADDRESS O I ' CITY,STATE,ZIP S(T q 5- I z-q PH rog) QCf(y _�4/? ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# J o / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY I PROJECT IN VA DLAND ❑ YES I PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL I` URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK IA17 P PO tve/ M /to_ /e QD TOTAL VALUATION: z tw��•''2t....,4i'' ��'.:? By my signature below,I certijbu' ollowing: I am the property owner or authorized agerltlo act on the propetty owner' f. I have`read thisT?5Y application and the informatio is correct. I have read the Description of Work and verify it is accurate. I agre o c�ith all applicable local ordinances and state laws relatc'nstruction. I authorize representatives of Cupertino to enter the above-identlfi prope for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE INFORMATION REQUIRED ` '` *'• -s MINX �I�OVER=°TH>rCOLi1�R;-�`y' F± E7PRESSBa�_ i;wtCr ?. ®BAR D,�Vo... ter.. - ,_� MEPMiscApp_2011.d6c revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21700 ALCAZAR AVE I DATE: 09/24/2013 REVIEWED BY: MELISSA APN: 357 19 109 I BP#: `VALUATION: 1$250 1 %PERMIT TYPE: Electrical Permit I PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: p I PERMIT TYPE: 1 REAP14� WORK TEMPORARY POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $47 TOTALS: F $47.00 m_ '.z1`�' `a,' w :i':s`. ;,.'1- :':'"":µfr;;, 'd:':.;,<.:;.zz,,z<<'�z•s.r:.<, wi Mech. Plan('heck I Phimb, Plan Check I I Elec.Plan Check 10.0 hrs $0.00 I;Lteclt. Perinit Fire: I Plumb.Permit Fee: I Elec.Permit Fee: IEPERMIT Other,Vech.Insp. I Other Plumb Insp. a I Other Elec.Insp. El hrs I $47.00 aiech. Insp. Fee: Plumb. Insp.Fee: lilec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 11 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE I MISC ITEMS Plan Check Fee: Srtplrl. PC Fc,e n PME Plan Check: $0.00 Permit Fee: Sztppl. Insp I,ce n PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction Tax: n Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes ie) No $0.00 Advanc eel Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 I -' $186.50 $0.00 TtQ `AL' 'EE4 $186.50 Revised: 08/01/2013 r Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ,2 00 Al Cc �� AA/e , PERMIT# / .30 OWNER'S NAME: PHONE#. `L�O$ ;?:�� —Z! tDRESS:k0k\ CITY/ZIPCOD'E:NERAL CONTRACTOR: AP�g CvY►s 'I�u� BUSINESS LICENSE# *Our municipal code requires all businesses wor 'ng in the city to have a City of:Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S)..WILL.BE-:SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED-A. CITY OF CU ERTINO BUSINESS LICENSE. I am not using any subcontractors: rplete ture to Please check applicable subcontractors an c the-following information: . V 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