Loading...
15050140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10255 MIRA VISTA AVE CONTRACTOR:' �v� I PERMIT NO: 15050140 OWNER'S NAME: VENKATAPATHY RAMANATHAN N AND PRASA /9�� �j�®^/f��/G�r- DATE ISSUED: 05/22/2015 OWNER'S PHONE: 4252339328 ❑ LICENSED CONTRACTOR'S DECLARATION License Class _ �_ L - - - - S-1 40 d - Contractor i iy _Date� _ I hereby affirm that I a licensed un the provisions of Chapter 9 (commencing with Secti n 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 erformance of the work for which this permit is issued. Phave 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 permit is issued. APPLICANT CERTIFICATION lDertify 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point so�e regu%�ionZ__ the Cupertino Municipal Code, Section 9 1.8:.=�, s-S,l�l . . // , _ r / ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Signature. Date JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL INSTALL RECESSED LIGHTS IN FAMILY ROOM, KITCHEN AND DINING ROOM (16 TOTAL). Sq. Ft Floor Area: I Valuation: $2800 APN Number: 35702034 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. r Issued by: � 'q/✓ _ Z_ Date: " RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with IN per Municipal Code, Chapter 9.12 and the Health &Safety Code, Seci550533�ayfl 25534. Owner or CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 27 6 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 q CUPERTINO ❑PLUMBING F1 MECHANICAL I' (ELECTRICAL Fl MISCELLANEOUS rt (408) 777-3228 •FAX (408) 777-3333 • building(a.cupe ino.or PROJECT ADDRESS MI44 V tsrA kD APN# �i� 7 . �� i 1 J OV✓NERNAME A fI � Zs Z33- 3z$ E-MAIL�p(�/ �! /�q�,yA/L• Co vs My �� STREETADDRESS/0 Zr� �O '7'T CITY, STATE, ZIP /1u /D, p� Qr-FAX / CONTACT NAME /V,ets . C /�O PHONE( / S }6 g- 2L33 STREET ADDRESS _ / we-^ /O"AINER-BUIIAER t' C NATE, ZIPP r O s / FAX � 0117.NER ❑ ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER �❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p/ p, /O LICENSFrNLR_1BER Cn pO0 LICENSFy�ME, BUS. LIC J�(�0 0 (A4 Q/� COMPS '(�/I/�,•S'a C �✓� EIW ta C v M FAX STRE ADD 1 S" C' CI TATE ZIP J% sow/ NE f ��i�-2233 ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONTE USE OF SFD or DUPLEX ❑ MULTI-FAME.Y PROJECT IN =LAND ❑ YES ❑ YES IS THE BLDG AN ❑ YES BLIILDLN`NG: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO TPLOIECT'� OOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATI02 : N /(!®D " Yom' rY r € ''RECEIVEDBJ�vt 4MGM-, _ M 3._u By my signature below, I certify 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 pro 'd is cone . I have ;pad the Description of Work and verify it is accurate. I agree to comply with all applicable local `connt7uc. ordinances and state laws relating to bu' I orize representatives of Cupertino to enter the above -identified pr erty fo inspection purposes. Si�atureofApplicantlAgent: Date: ZZ v/ J SUPPLEMENT INFORMA ION REQUIRED Q ut, � °�.,<� :F q;omw' OFFTCE[15E;0„IjLl .�g�^�,�; �OVER�TIiE COTi TER. � u S H K S ^�EXPESS cU MEP17iscApp_011.doc revised 06121/11 �M CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10255 MIRA VISTA ROAD DATE: 05/22/2016 REVIEWED BY: SEAN APN: BP#: *VALUATION: $2,800 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY PENTAMATION 1 REAP 11 USE: SFD or Duplex PERMIT TYPE: WORK INSTALL RECESSED LIGHTS IN FAMILY ROOM KITCHEN AND DINING ROOM 16 TOTAL). SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Fixtures, Lighting IBREMFIXT Other Elec. Insp. 0.0 hrs $48.00 16 # $72 Perrnit Fee: SupPl, In Sp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $72.00 , NOTE: This estimate does not mctuaejees aue to Omer "eputu......� v— _ ...... :-ay - - - .. -_. _ _ __ _, _ _ n,... s....f 4L. 11nnf . —4.4"tl info_ District, etc . 'These fees are oasea on the reumtnur FEE ITEMS (Fee Resolution 11-053 Ef'. 7/f 1/13) Nfech. Plan (:'heck Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00 Meeh. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT A/ech. Insp. Oilier Plumb Insp. Other Elec. Insp. 0.0 hrs $48.00 Follf":1:.. Insp. Fee: _ _ Plumb. hasp. Fee - i•-..�_____'___ t)..L/:., TZ Elec. Insp. Fee: -1- 17- C-.;f-.C~or Dictrirt_ Rrhoal NOTE: This estimate does not mctuaejees aue to Omer "eputu......� v— _ ...... :-ay - - - .. -_. _ _ __ _, _ _ n,... s....f 4L. 11nnf . —4.4"tl info_ District, etc . 'These fees are oasea on the reumtnur FEE ITEMS (Fee Resolution 11-053 Ef'. 7/f 1/13) m urlltuuva uruuuosc FEE ••••» »• QTY/FEE �••• - - MISC ITEMS Plan Check Fee: ,SuCpl. PC Fee PME Plan Check: $0.00 Perrnit Fee: SupPl, In Sp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fees: A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission .Fee: IBCBSC $1.00 -SUBTOTALS,-'$214.50 $0.00 TOTAL FEE: $214.50 f1AC r%0VIJG.