14120023FW
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11204 MOUNT CREST DR
CONTRACTOR: BOTAD CONSTRUCTION
PERMIT NO: 14120023
COMPANY
OWNER'S NAME: SANDEEP CHOPRA
2675 GLEN ELK CT
DATE ISSUED: 12/03/2014
OWNER'S PHONE: 4154204156
SAN JOSE, CA 95148
PHONE NO: (408) 758-8850
LW LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
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INSTALL TEMP POWER
License Class Li,c.�#
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Contractor t i��✓.�/V �i{Yf'!V rv"v i
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: $500
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35626017 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 RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 80 D S OF P 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 DAYS R LAST 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
Date:
Issued by: /
granting of this p mit. Addi ally, the applicant understands and will comply
with all non -poi source re I ions per the Cupertino M nicipal Code, Section
9 18.
q, if
Signature Date 2 —t 7
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
4
/
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNE -BUILDER DECLARATION
Date:
Signature of Applicant:
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, Sect 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater
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
CUPERTINO
GENERAL PERMIT APPLICATION
d
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION�
\
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCa)cupertino.org
MEP
misc
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11204 mount crest dr DATE: 12103/2014 REVIEWED BY: Mendez
*111 LUATION:
APN: BP#:
PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY PENTAMATION 1REAP14
USE: SFD or Duplex PERMIT TYPE:
WORK �install temp power
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Temporary Power
A
1 ERT<200
100
Amps
$48
PME Plan Check:
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
TOTALS:
Administrative Fee:
$48.00
$45.00_
Wt,!,
Elec. Plan Check 0.0 rhrs $0.00
'0
Elec. d$OOO
Elec. Permit Fee: ]EPERMIT
M,�w�il Fee: Plum!). Permit Fee:
Other Elec. In p.
lkvj��T /nv, Other Plumb fn,�n.
Pho"ib. h;sp. Fee:
NOTE. This estimate does not mcluaeJees aue zo other "upurtmum- v-
1)vntfnraddn'1i.nfa.
District, etc.). 7hese lees are toasea on the prettamunar
FEE ITEMS (Fee Resolution 11-053 fff 7111131
inlurm civic u ---
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Administrative Fee:
]ADMIN
$45.00_
Work Without Permit? 0 Yes (F) No
$0.00
zl(htunccd Plartning Pees:
77=
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee:
lBSEISMICR
$0.50
0 # Revisions
$0.001 ]kEVRESADD Addition
Bldg Stds Commission Fee: IBCBSC
$1.001
MAIVEM llg
5
$190. 0
01"—T T"AL FEE.T
$0.0 0
$190.50
$19
F\Uvlou I I