14010017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7532 ORANGE BLOSSOM DR CONTRACTOR:T137 7 TO'BE PERMIT NO:14010017
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OWNER'S NAME: SOMANI BASANT K AND PUSHPA k:J-,c*n C DATE ISSUED:01/06/2014
OWNER'S PHONE: 4086576446 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
PANEL UPGRADE TO 200 AMP
License Classs�j�.r Lic.# 9 1 T� � '�'
Contractor L{c c lr M t i Z lbu-1-61 ODate
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:$1750
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:36611066.00 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 allcity and county ordinances and state laws relating WITHIN RMIT 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 DA71F OM LAST CA ED 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
Issued by: Date:
granting of this permit. A y,the applicant understands and will comply
with all non-point sour regulatio s per the Cupertino Municipal Code,Section
918.
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(x)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 Cuper' o u cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:L
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
918.
Signature Date
GENERAL PERMIT APPLICATION MEP
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- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1
(408) 777-3228•FAX(408)777-3333•building MISC
cUPI`FT[NO (Qcupertino.org
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❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS /nomAPN N
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STREET ADDRESS o� /I CITY, STATE,ZIPC� I I FAX
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CONTACT NAME M • Pxo � a
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STREET ADDRESSCITY,STATE,ZIP FAX
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OWNER ❑ OWNER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 6 ws n 0(A� q r /_� LICENSENfJMBER Gk`7� 7T� LICENSE TYP�E� BUS.LIC N
COMPANY NAME CJI r �1eC��Ej1(� F-MAIL FAX
STREET ADDRESS �; CITY,STATE,ZIP 1 PHOt`
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ElSFD or DUPLEX ❑ MULTI-FAMILY PROJECT INWIIALAND ElYES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING-. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO TFLOOD ZONE ❑1 NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK q r -r 'e / M
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IREC1TOTAL VALUATION: �JE � za�_.ON
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By my signature below,I certify to each of the following: I am the op 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 ead a Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I au ri representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: V) at
SUPPLEMENTAL INFORMATION REQUIRED 3
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MEPMiscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7532 orange blossom DATE: 01/06/2014 REVIEWED BY: Mendez
its APN: BP#: *VALUATION: 1$1,750
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1REAP2
USE: PERMIT TYPE: �
WORK ane/ u rade.200 am
SCOPE
Xkech. Flan Check Plumb,Plan Check Elec.Plan Check 0.0 hrs $0.00
F1ech_llern it Fee.- Plumb.Permit/�e: Elec.Permit Fee: IEPERMIT
Other Mcch.Insp. Ocher-Plumb Insp. Li Other Elec.Insp. 0.0 hrs $47.00
Rlech. lnsjp. Fee: Plumb. Irrsh.Tee: Elec.Insp..Fee:
NOTE.This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on:the preffinWha information available and are only an estimate Contact the De t or addn 7 info.
FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl.PC Fee: 0 Reg. ®OT 0.0hrs. $0.00 $47.00 IBELEC200 I Services
PME Plan Check: $0.00
Permit Fee: $0.00
Supp/:Insp.Fee Reg. Q:OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
(Amstruction TtLv.; T-7
Administrative Fee: /ADMIN $44.00
Work Without Permit? ® Yes (E) No $0.00 1 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$139.50 $47.00 _ TOL FEE: $186.50
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Revised: 10/01/2013