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14080269A CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 N STELLING RD CONTRACTOR: MANA GENERAL PERMIT NO: 14080269 CONTRACTOR OWNER'S NAME: MURUGESAN SINNASSAMY 1839 TAMPA WAY DATE ISSUED: 08/28/2014 OWNER'S PHONE: 4083070903 SAN JOSE, CA 95122 PHONE NO: (408)375-4288 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL License Class Lic. #//�� — t 9 10 r INSTALL TEMPORARY POWER j p— Date Contractor 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: $300 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32608054 00 Occupancy Type: Section 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 O IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 1 T CALLED INSPECTION. 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 te: Z ' granting of this permit. Additionally, the applicant understands and will co y with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9 18. // �j,I,� Signature �� [/`P (,Date �i� 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(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: X0�t7 `C Date: 8 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 CONSTRUCTION LENDING AGENCY 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 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 E P COMMUNITY DEVELOPfdiENT DEPART MiiENT • BUILDING DIVISION! 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 40B 777-322B • FA.X (408) 7777-3333 - building a5-cuDe fino.ora m I SO �UrEr�T�C�iC> ❑PLUi�,3Il�G ❑htiA1�ZC4L ELECTRIC.a.L ❑I.ZSCELLAh_OUS - f_V 1 % t Q a8 - 0S Ot��><�.� go� S`/c�vrg�C 3b-7 a S7 R:=- ADDP..cSS C+//_ A� /� I C71 -Y, STAT c, Zp . =VLtII : 12 2 D � CONiACI 0 l L W r7 I 71,22 I 1J kII ca=r .�Dp cgS CITY, STAT';, Zt� I FF> OWI t '13 Oti - t•3liII D 13AC-h7 CORP 4C OR ❑ COhTZLk CTOR AC_ T? ARC��-CT i ^1CT�r-R I] D:I I O? ❑i>\7 CGI�isACT R.' I ucm"SBxmaBI LICBI;SETYPB j7 13US.LICr COIJvF ' •. ) I T:_1Jid.II. I FAX STh'_a DF.'rS5 _ rilq I .Ci -i 1', ST ZT3 � Z� I > 3 � S .. 1-4CA Ai CHBBCT�Gfi-ZPLXIAIIS I LiCzTSBXUA0BER I BUS. LIC COIJPAhrYI�AIJ$ I B 1JArT. FAX S i -R -,_7 ADDRESS I CITY, STATF, ZIP I PriO? t SSSB OF ❑ SFD or D-JPLcX ❑ mmn-F uZLY I PROTECT ZK WIIALAND ❑ YES I PROJECT IN BLIID�G E3COVmEpC1SL IWANII.-1-ERFArMAP A ';0 FLOOD ZONE ❑ Y-rS ❑ 1"0 I IS TBE BLDG IN YFS BICrL-Zi HO1J 1 ❑ I0 . DESCRIPTION OF WORK m p - w2 Mt TOTAj,VpTUA1jON-. DO =`R...m_ By my sign_tilre bdoty, I ceri:=y to ea.;h of the following: I am the property owner or autho-H - __. n. act on e prope,, s ehalf I have reg s application and the infor anon I have provided is correct. I have read the Description of Vrork and verify it is acre ate ' _ ee to mply dth all applicable local ordinances and state laws relating toAAbui ding cons fiction. I a ' ori e representatives of Cupertino to enter the above-identi=,ed p oo� for Lsaection purposes. S ia_nature Of Applicant'A gent: c /V 6 Nip. ICAQ �Date: SUPPLER,MNTA.L D\TFOP_NQJION RE Uji 2ED Q . _ _e�_ - �� M 'tom: �=•_ �_-- Iv1jEPl,jisc1pp 201Ldocrevised06/21/11 CITY OF CUPERTINO TUU UQ rT1V4 A rrnu — T2TTTT ."1NC iITVTRTON ADDRESS: 10858 N STELLING RD DATE: 08/28/2014 REVIEWED BY: MELISSA APN: 326 08 054 BP#: *VALUATION: $300 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex FP1 REAP14 PERMIT TYPE: USE: WORKINSTALL TEMPORARY POWER PME Unit Fee: $48.00 PME Permit Fee: SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $48 TOTALS: $48.00 (uh, i tsf, Phinrb. Pleat i'Irsxl F'hrnh, l'� rrtzft T�i<, Other P!Vmb frasp. Phei tb. huff. F, e Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp.0.0 hrs L$48.00 NOTE: This estimate does not mctuae fees aue to orner lueparrments (i.e. x-turrrnueg, I • ., ••»•.. ----1•--1 -_-, _ ___ _ _ _ __r_u ..._,i --- ..t....- /'ns,tnrt tho vont for addn'1 info. urstrict, etc.). inese ees ure uuaeu oa rrae .crr..rr,rw. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) ". �•„•�••�•• w•». FEE �.� _. _ QTY/FEE _.-- __-- __ - MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 IE Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 i Travel Documentation Fee: 1TRA VDOC $48.00 Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 ^45QLS $190.50 $0.00 TOTAL FEE: $190.50 meviseu. Uat1-Utw 1•+