14030059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 IMPERIAL AVE CONTRACTOR:DRAIN DOCTOR PERMIT NO: 14030059
OWNER'S NAME: RAGHU KUMAR DEVARAKONDA 480 ALDO AVE DATE ISSUED:03/10/2014
OWNER'S PHONE: 4082184277 SANTA CLARA,CA 95054 PHONE NO:(408)370-3082
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
REPLACE(E)SEWER LINE&INSTALL FOUNDATION&
License Class Lic.# 2, G cg PROPERTY LINE CLEANOUTS
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: SANITARY
have and will maintain a certificate of consent to self-insure for Worker's
mpensation,as provided for by Section 3700 of the Labor Code,for the
p rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7750
I ave and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:35719052.00 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 T 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 LLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the z G
granting of this permit. Additionally,the applicant understands and will comply lusty: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature n--- Date 1►7 1 Y- 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
1,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 i
Owner or authorized agent: /�/� Date: I !17 I
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 O E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 117
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0
(408)777-3228•FAX(408)777-3333•buildinaC5cupertino.org Lk MISC
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ! 9 Q ' ` Q I APN# n S ( Q
OWNERNAME J PHONE i E Mil
A0. 1,�. Aub�.ro.�cprJ�a� I o1)
STREET ADDRESS CITY, STATE,ZIP I FAX
.c.._.-
CONTACT NAME PHONE
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER '❑ o-AI R-BUILDE2 ❑ OIAWMAGE 7 ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DE'VEL.OPER ❑ TENANT
CONTRACTOR NAME �yr� LICENSE NUMBER % Q LICENSE TYPE T BUS.LIC#
COMPANY NAME /►�W �`!�—v E-MAIL (^• 6 FAX
STREET ADDRESS t ( per. ^_.) w.� 1� CITY,STATE,ZIP PHONE
Ck
ARCHTTBCT/ENGINEERNAMF Yl V LICENSENUMBER BUS.LIC# `j S
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI DLAND ❑ YES -PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INvTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLM HOME? ❑NO
DESCRIPTION OF WORK j. �` P j _ .IL
tA,' ,.A/ld'i1�C/� l O�M iN�
_e tUr rn L - 4 ' t
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope er 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 building contra ' n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT INFORMATION REQUIRED �
OFT(ETJSE 011IMY ,
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I, �1k1'i�'DARD�
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10300 IMPERIAL AVE DATE: REVIEWED BY:
APN: 357 19 052 BP#: *VALUATION: 1$7,750
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPS A
WORK REPLACE E SEWER LINE & INSTALL FOUNDATION & PROPERTY LINE CLEANOUTS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $24
TOTALS: $24.00
dh 1
Well. Pan Chclj�' Plumb.Plan Check 0.0 hrs $0.00 E'ir�r._ r"i rn Ch'Cr
��1�>a'r. Torr?ri 1'ei>: Plumb.Permit Fee: IPPERMIT hlf=r. PrtFti f.<..
C)dic; U�zch�. Ir"sp, Other Plumb Insp. 0.0 hrs $47.00 0""Wr t iec Ins/). Lj
'k"J Iris. ,,:,c,. Phinih. hap. Fee 1 ('-Inst
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . Thesefees are based on the prelimina in ormation available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS
Pia;-" Che(4: t''cc
Sappl. t'C'1°CW
PME Plan Check: $0.00
Perinit Fcu:
hlsp
PME Unit Fee: $24.00
PME Permit Fee: $47.00
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
/I(J c iMAI(I Plan)7in r Fees:
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: 1BSEISMICR $0.78 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$163.78 $0.00 TOTAL FEE: $163.78
Revised: 01/15/2014
Three Galleria Tower Telephone 214.866.3518
13155 Noel Road Fax 214.550.7001
Suite 1600
Dallas,TX 75240
Fe&xOffice.
City of Cupertino-Building Dept.
10300 Torre Ave.
Cupertino, CA 95014
408-777-3228
RE: FedEx Office Remodel 20660 Homestead Rd., Cupertino, CA 95014
To Whom It May Concern,
Please accept this letter as a request by FedEx Office to void expired permit#05040160. No work was
done under this permit.
Please feel free to contact me if you have further questions or have any other concerns.Thank you.
Alex Chu,AIA, NCARB
Regional Design Manager
FedEx Office
13155 Noel Rd.,Suite 1600
Dallas, TX 75240
Tel; (214) 866-3518