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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; �_T/ 71'kr=rsr 4I,-, Ir e r 3CI1-.r ;zr7l Ir t . h CELL.AI''EOUS PROM: CI• ADDRESS C X I f PIT g CO( Z! v Ove )44 I PfiO. F / j� I E.: STRasT P TJDP.ESS �� C i , STATE, I FAX CORiACT �At+ct I P:i01\a E-1J4� STY.. SDDR SS , C STAT ZiP f I FF.X ❑ OAS =R ❑ OV -3L�T D=it ❑OJT ACD? Crop. COKIRtiC O? AG�T 13AR C�CTJ ❑ BNCM1r-^i ❑ D=1niAPM ❑ E i? CD? T? k ❑ CGN?.0.CTOR I + M I LiC� "' NUI ER I LICa' SSE i E I BUS. LIC Co". NAIf' E-]✓dII I FAX STP ---7 ADDR=- S I Crit, STAT ZIP c� I PHOhL �_ --• fLRCiu-TECiMZD'M._ERN. L I LicaTSE1�TUitR BUS. LIC CONPf?�YITAIJ� FrIJrAII I FAX S-1 P1_r_T ADDRESS CrIY, STATE, ZIP PHONTE '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. .r- f— ®� 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