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15040014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21723 CASTLETON ST CONTRAC PERMIT NO:15040014 DET E INED OWNER'S NAME: RAMAKRISHNA JOSHI AND NAGARAJA JYOT DATE ISSUED:04/02/2015 OWNER'S PHONE: 4084904923 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] REPLACE 100 AMP ELECTRICAL PANEL License Class �� Lic.# �6rGe G Contractor Ldal'0,Y+o�� 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:$1200 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:35618069 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 WITHINN 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:714"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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date 2 t S� 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. ❑ OWER-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. 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,Sections 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this2� 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 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 918. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0\� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ,�(O (408)777-3228• FAX(408)777-3333•buildingO)cupertino.ord m misc �" Rfl CUPERT[NC3 \'� owl ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS _Z1723 r--�)s LrAPN# ` 1 /at OWI�'ERNAME �� 2 �(Z Gc 2 �c�S ` lrog� p 49 �7 3,5& E-MAIL l U STREET ADDRESS ` 72 CITY,STATE,ZIP FAX CONTACT NAME L) PHONE E-MAIL STREET ADDRESS I CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT `CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR T v L` I LICENS ER LICENSE TYPE r BUS.LIC# COMPANY NAME/ S / F -�^ C E-MAIL ,i A �.I bs Z�f^�f C�•T/1. Z FAX lT /l -r'�t 1,. ",tel STREET ADDRESS �3 TATE ZIP � rO PHONE 4-r9 7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMMY PROJECT IN WILDLAND ❑ YES - PROJECT IN El YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA rll� FLOOD ZONE ®-A7� EICHLER HOME? 9-lcr— DESCRIPTION OF WORK ,i -�C4r2<c Z `C ie K G TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property wner's Walf I have read this application and the information I have p vided is correct. I have read the Description of Work and verify it is accurate. I agr comply with all applicable local ordinances and state laws relating to b ing gbnstruction. I authorize representatives of Cupertino to enter the abo e-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2_r STOPLEME14TAL INFORMATION REQUIRED �r �oF>JCEpsE ori ' R0000"M COVER THE COU(VTER�ti� n' wzIsXPRESS �c. � NMI ON, km MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21723 Castleton st DATE: 04/01/2015 REVIEWED BY: mendez APN: BP#: *VALUATION: 1$1,200 xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: 1 REAP WORK replace 100 amp electrical panel SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $48 TOTALS: $48.00 w a v or. Ah,c'h. Pkart Check Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00 �lecfr. 1'er crit 1'ee: Plumb.Permit Dire: Elec.Permit Fee: IEPERMIT Other.Uech. lrisl?. (tither Plumb bash. Lj Other Elec.Insp. 0.0 hrs $48.00 14ech. /risk). Fee: Numb, Insp.Fee: k ec.Imp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on therelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Cheek P'ee: sujapl. P(:'1"Ce PME Plan Check: $0.00 Permit 14'ee: Szipp11, Insp 1^ice PME Unit Fee: $48.00 PME Permit Fee: $48.00 C;oMtrucflon Tax.- Administrative ax:Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes No $0.00 ,Jdvanced Plarming 1*'ees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion.Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldy-Stds Commission Fee: IBCBSC $1.00 $190.501 $0.00 T(3 ° �� F $190.50 w , Revised: 02/14/2015