14020035 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6165 SHADYGROVE DR CONTRACTOR:INTERIORNET PERMIT NO: 14020035
OWNER'S NAME: RAHUL PANDIT DATE ISSUED:02/05/2014
OWNER'S PHONE: 4084107852 SAN MATEO,CA 94402 PHONE NO:(650)787-5134
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
1- L� !� PANEL UPGRADE 200 AMP
License Class G-�� � Lic.# P-14 K `u
Contractor .. Date Q2•'0,5-—1Z,l
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
kerfitrmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000
and will maintain Worker's Compensation Insurance,as provided for by
on 3700 of the Labor Code,for the performance of the work for which this APN Number:37540014 00 Occupancy Type:
it 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 OF 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 DAY �M BAST CALLED 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. Additionally,the applicant understands and will comply
with all non-point source regu ions per the Cupertino Municipal Code,Section
9 18. ;'-�
O2, Q � ' RE-ROOFS:
Signature _=-�- Date //a 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
1,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 25 ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: r Date: 2 A
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 MEP
- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buildingacuoertino.org �,l
MISC
CUaEATIN0
❑PLUMBING ❑MECHANICAL ECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS (a (�,.p C t+^ A ts 0 —
��U APN# �/J5 O G r_ t r �✓
OWINTERNAME O'M� f'L -Jk�JY U 1 i PHONE 1'(V1 W 7 F MAIL
STREET ADDRESS 1 CITY, STATE,ZIP I FAX
CONTACT NAME I^1IIa(i1 (J. ,' � PHONE `g,^ EI'LAII
STREET ADDRESS CITY,STATE,ZIP ,` FAX
❑ OWNER ❑ OWNER-B=ER ❑ OIANER AGENT V�COATIRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME �^ LICENSENUMBERt LICENSETYPL^lO BUS.LIC#
COMPANY NAMEE-MAIL FAX
"�
STREETADDRESS CITY,STATE,ZIP�tn W VL1 V )1 ��T'T'�Z PHONTTE&C-0-lei '
ARCHITECTMNGINEERNAME LICENSE NUMBER +<�11 BUS.LIC#
COMPANY NAMEE MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IM SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES
BUII DING: ❑COMMERCIAL URBAN U TTEIRFACE AREA ❑ NO FLOOD TONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
3 ' "'7Cc;oAoLn
_ M:
TOTAL VALUATION: IV, 7ooa go 0.
By my signature below,I certify to each of the following: I am the property owner or au agent to act on the property ovner' eh . 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 y vt ith all applicable local
ordinances and state laws relating to building con, tlo�ng I au ori a representatives of Cupertino to enter the above-identi roperty for inspection purposes.
Signature of Applicant/Agent: `---—'�� Date: JZ�
SUPPLEMENTAL INFORMATION REQUIRED m or Us
. oV.TJR TSI+ic9-IJTEZ ..
. ,
ow,
� 7k
�v M -
WE I=
MEPMisc.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 6165 shadygrove dr DATE: 02/05/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$3,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP
WORK panel upgrade 200 am
SCOPE
555
ZIM
IN
EA
1ect.. >t£rrr('taccF 111nnib, /'tarn("I ec•k Elec.Plan Check 0.0 hrs $0.00
ritih Fee: Ph-o"h, her•r dt Fee" Elec.Permit Fee: 1 EPERMIT
other r T'cit. tn:ct'. Other Phar Imp, 07- Other Elec.Insp. El
hrs $47.00
Lic>c€, tras��. t�z:e: I'frkrratr.Lms .Fere: hur . Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These-Ts are based on the prelimina information available and are only an estimate. Contact the Dept./or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $47.00 IBELEC200 Services
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction i4. "
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.001 1
$139.50 $47.00 f TOTAL FEE:, $186.50
Revised: 01/15/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6165 SHADYGROVE DR CONTRACTOR:INTERIORNET PERMIT NO: 14020035
OWNER'S NAME: RAHUL PANDIT DATE ISSUED:02/05/2014
OWNER'S PHONE: 4084107852 SAN MATEO,CA 94402 PHONE NO:(650)787-5134
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
'nn �F^� PANEL UPGRADE 200 AMP;
License Class C`1 V Lic.# �/�� '30 REVISION 41 REPLACE(2)BATHROOM FANS-ISSD OTC
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:
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:$3000
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:37540014 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 DA ERMIT 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 FRO A T CALLED 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 /NIS-
granting of this permit. Additionally,the applicant understands and will complyIssued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date O 1-09-2-P
�rl f 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. 1 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,Sectio :255;"A5, 32,and 25534.
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 thi's 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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(&cupertino.org f t_ '�"�'� misc
❑PLUMBING ❑MECHANICAL ZrELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN# 3—7c�— qO
OWNER NAMEl 1 J IAC_ PHONE E-MAIL
`f o • U• 7 �-
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME EMAIL, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMB,Y PROJECT IN WIIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: RECIT�BIBY
By my signature below,I to each of the following: I am the property 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. IDescription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin ns ction. 0ee resentatives of Cupertino to enter the above-identified property for inspection purposes.
/ /Y�
Signature of Applicant/Agent: Date: /
SUPPLEMENTAL INFO ATION REQUIRED � _` "
-���;oFT�zcE usi:ONLY
wi
OVER THE-COT7NTER w
a
STA
DA RD
'AWOR` .
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 6165 kentwood DATE: 01/08/2015 REVIEWED BY: Mendez
APN: BP#: EVALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 GENRE
WORK I REVISION#1 REPLACE 2 BATHROOM FANS- ISSD OTC 1/9/2015
SCOPE
Mech.Plan Check TO.0 hrs $0.00 1'honF. Plan Chc4c L;iczc. P/,lri C7=ec
Mech.Permit Fee: IMPERMIT t'tarmh. Permit Fee:
Other Mech.Insp. 0.0 hrs $48.00 Other Plumb Irup. 01her 1"Icc t=asp.
Pha llb, h1q). Fee: f;lec:_Insp, 1, <>:
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 prelimina information available and are only an estimate Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00 # Mechanical
Permit Fee: $0.00 $50.00 IBREMvENF Ventilation Fan
Suppl. Insp.Fee:Q Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $48.00
T7
Cou,�,Twucfion Tom-
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITPA VDOC $48.00 Building or Structure 0
i
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg*Stds Commission Fee: $0.00
11
fL � r TAL FEE:
$141.00 $50.00 TO
$191.00
lirl � r
Revised: 01/06/2015
P12-
�per4 c�-
1
6ALI
PERTINO
i ! Pi ilk Ino ngnsrtmeril
i
p it
i�
PC; .
J vdeO BY
MUST b�o kept at the
P.
it is Vl3WIUI rrB"*e ally
v 1 su �
lW3 i,
J t-/i of
0 tvc 0013