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13100076
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10161 PARISH PL CONTRACTOR&W+H+—'6-Bi* PERMIT NO:13100076 ED OWNER'S NAME: SELVARAJ SENTHILKUMAR AND SENTHILKU w khv l nc DATE ISSUED:10/10/2013 OWNER'S PHONE: 8477697771 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL 11 License Class C— O Lie.# 4-16 % REMOVE AND REPLACE FURNACE,ADD A/C ON SIDE OF SFDWL Contractor Date to I b " /9 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 erformance of the work for which this permit is issued.: Sq.Ft Floor Area: Valuation:$5700 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:31644019.00 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 ROM LAST CALLED INSPFICTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the / Issued by: 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. ROOFS: Signature Date All roofs shall be inspected prior to anyny 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: — "'� ate: 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 CONSTRUCTION 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org \ MISC ❑PLUMBING E<ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 10161 r L- APN# / .. Q OWNER NAME b s F-nl`Y v PHONE LVAP- 1t7-769-777/ E-MAIL STREET ADDRESS / (,A P,/S H `PL CITY,STATE,F_)e T I N U GA 9 601 It FAX CONTACT NAMEHAR D t%�r / fk` PHONE f,1206p 9S 7� E-MAIL STREET ADDRESS `G CITY,STATE,ZIP FAX 24 ftnow C t Y CA 9yS 1 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT OONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC# 112 EKg L ZVC C-20 COMPANY NAME E-MAIL FAX 1R E e- G STREET ADDRESS /� CITY,STATE,ZIP / L r PHONE .20 D� G Y' g"d ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 77 USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES 7FDZONEECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK pea ;t✓! f ✓1Q Canr..b YlePt TOTAL VALUATION: ✓ ©O OORECE D$Y �-0 1,< By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi g construction. I authorize representatives of Cupertino to enter the above-identified propertyfor inspection purposes. Signature of Applicant/Agent: Date: 10- 10-15 SUPPLEMENTAL INFORMATION REQUIRED. 10 ��r ' o��TJSEo�u, ter, txEss, , MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION Ila ADDRESS: 10.161 parish pl DATE: 10/10/2013 REVIEWED BY: larrys APN: 316-44-019 1.BP#: "VALUATION: $5,700 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ED QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 A/C Units (<=10K cfm) 1BREMAIR 1 # $70 TOTALS: $209.00Ism q Mech.Plan Check 0.0 hrs $0.00 Phrsib.Plan Check Elec. Plan Check Mech.Permit Fee: 1MPERMIT Plumb.Permit lee: Eke. Permit Fee: Other Mech.Insp. Q.0 hrs $47.00 Other Plumb Inch. Clther Elec,Insp. Alech. Insp,Fete: Plumb. Inst.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.). These ftes are based on the prelimin information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plein Check Fee: Supp/. P('Feer PME Plan Check: $0.00 Permit.Fee: Suppl. Insp Fee PME Unit Fee: $209.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IARWN $44.00 Work Without Permit? ®Yes iq No $0.00 ,Advanced Planning Fees Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.57 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $348.57 $0.00 ,� �= � w��= $348.57 Revised: 10/01/2013 NAME;- 1'uMlR Scz.Vn��hjr Avvabss.- PARKH A_ 1 UPERTINO a CupE2TI/vo, CA ��®/ti uilding Department ScapF:- FORIV.4 F REAartcEi�E�✓r) AoPin,ipt AC r� P-OOM OCT 1 12013 APN REVIEWED FOR CO)E COMPLIANCE 10 m y c Reviewed By: Thi.;s .t of r n^ MUST he kept at the u�1: .11 t4 f rn 0 L Kiillij official. SHATI..i_NOT r JI j 'llLj i GtLiL L aW. O. jU B,4two Tr► `'tee ARA 4,9 Fr a.c r Fkoo/Z 191,A A)