14090113CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 891 E ESTATES DR
CONTRACTOR: ROCHA'S COMPANY
PERMIT NO: 14090113
OWNER'S NAME: CHAUDHARY VIVEK AND MALIK SHILPA
2191 MONTICELLO AVE
DATE ISSUED: 09/18/2014
OWNER'S PHONE: 4086621972
SAN JOSE, CA 95125
PHONE NO: (408)593-7405
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
INSTALL TEMP POWER
2
License ClasLic. #�
Contracto ale ate `"
I hereby Arm that I am licensed under the provisions of CJiapter 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
Sq. Ft Floor Area:
Valuation: $300
performance of the work for which this permit is issued.
1 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: 36924023 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 1 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 IM LA CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
he
costs, and expenses which may accrue against said City in consequence of the.
granting of this permit Additionally, the applicant u stands and will comply
Issued by: Date:
with all non -point s rce regula 'ons per Cu o Municipal Code, Section
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.
❑ 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 Ar Air Quality Man ement District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupe no Muni ' e h ter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sections 2 5, 255 , an 5
Section 3700 of the Labor Code, for the performance of the work for which this
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
J
culyl A No
M
GENERAL L PEF�%�[T ,4PPLICA [ [OttE P
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 85014-3255 �v
(40B) 777-3228 - FAX (40B) 777-3333 - building0ouDetno.010 m1sk;
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'SSE OF ❑ SD or DUPLEX ❑ MULTI-FAIZLY PROJECT W WILDL A IT'D ❑ YES
SUII.DLNG: ❑ C01✓,MEP.Q•SL IMBAN Il. F .CE AREA [3",o
I PROMECT R ❑ YES
FLOOD ZOIC ❑ NO
I IS TM BLDG M ❑ YES
BICHL•1t HOW.=•! ❑ NO
DESCRIPTION OF WORK
-
TOTAL V LUA710.
By Jay sima«re below, I certify to each of the follow; _. I am the pr o;;mer o _ i z� . t to act on the proper: o -,„m 's behalf. I have read this
zpplication and the info ration I ha:=e provided is r, ect I haa� ad ` e Descri " rk ve iy it is acc>>-ate. I a�*ee to comply vdth all applicable local
ordinances and state I<,vs relating to building L, ction. I thor' represe .� ' es Cu - mo to enter the above -identified proper':y for inspection purposes.
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S i --nature of : _pplicanfa.....^.tt Date:
SUPPLEMENTAL
NrOt'tAION REQU-IlLD
CDTM
1✓EPh./i rcJ.pp_2011. doc revised 06/21/11
CITY OF CUPERTINO
Fm_� FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS: 891 a estates dr
FEE
DATE: 09/18/2014
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: $300
*PERMIT TYPE: Building Permit
0"'w r l'A" h, hr:r».
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
-P clz. basin.
PENTAMATION 1 REAP1
PERMIT TYPE: 19
WORK
teMp power
PME Plan Check:
SCOPE
$0.00
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 Drelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
1'hw1 . i'lrrtr (:"fir r.
Elec. Plan Check 0.0 hrs $0.00
a!,,c r_ M,r wi! Fee:
F'lu nn,. 1,4",rin:" Fee.
Elec. Permit Fee: IEPERMIT
0"'w r l'A" h, hr:r».
orli r t'hwnb 7ns,Tr-L1
Other Elea Insp. 0.0 hrs $48.00
-P clz. basin.
Firsp. 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 Drelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 amps Electrical
$48.00 ]ERT1200Temporary Power
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
C.0}iZ:St7'L{�'�iF}i7Li.1:
Administrative Fee:
]ADMIN
$45.00
0
G
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
1
E)
0
i
Travel Documentation Fee: ]TRAVDOC
$48.00
Stronp- Motion Fee:
]BSEISMICR
$0.50
Select an Administrative Item
Bldg* Stds Commission Fee: 1BCBSC
$1.00
O'Air
$142.50
$48.00
TOTAL FEE:
$190.50
Revised: 08/20/2014