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B-2016-1150CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1150 21351 COLUMBUS AVE CUPERTINO, CA 95014-4921 (362 04 004) (ARAZ ELECTRIC INC) SAN JOSE, CA 95154 OWNER'S NAME: SRINIVAS RAMACHANDRA AND MARUVADA LALITHA V DATE ISSUED: 01/11/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION (�BUILDING Z m i PERMIT INFO: License Class Lie. <f.,�.� L. i �J I Contractor (ARAZ ELECTRIC INC ) Date �) 1 • j X BLDG X ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that d 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. JOB DESCRIPTION: REPLACE (E) 100 AMP PANEL WITH (I) 200 AMP PANEL, SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION 1. 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. MI 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 Sq. Ft Floor Area: Valuation: $1500.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county 62 362 04 004 3 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF T ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS F -QCLLED INSPECTION. Code, Section 9.18. -- / Signatures = Dat.X , Date: OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the projectr(Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read *the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Co11e,Sections-25505; 25533, -and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this shall -' provisions permit Owner or authorized agent be deemed deemed revoked. Date•V %� APPLICANT CERTIFICATION o b . 11, )C7 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all cibj and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date ' CUPERTINO- mph GENERAL PERMIT APPLICATION COMMUNI TY DEVELOPMiEN T DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 015014-3255 (4 08) 777-322`8'• FAX (408) 777-3333 • build! nOO)OUoerino.org ❑ PLUl,/,3 G ❑ NiECN_ANTICAL WELLCTRiCA L am Zo)16.- il-5-7) ❑ 3\6ISCELLA-NE0US C,r p PROr: CT ADDRESS 2 f 3 C I I9C� Q i!4. (9e"Ini ybp OCvTTRNF�JJIJ�V,Q ,N�L�%��c VG� A I Pr'Oh� Cit��'3 -07-43 STS=T: DDRESS J , frvt CITY, ST.4ic,LIPT1�40 FAX CONTACT NA*VB weed A-zar�PiIO\� E-1✓�41�b ��'�z�Lei'�C �' ��►..�� STR-E-I a.DDPESS (Yk V `� CIn, STATE, ZIPf' ya3 F Ax ❑ OF'h_Z W1 N -FR AGENT VCO Q -P 4 CTOR ❑ CON -MI C T OR A GME �T ❑ A.RC-=,1 ZCT D-ITLO?nk ❑ CONTR-..CTOR?,4]"rr`h I LICEI�SE?Lh�ER �l� I © Li I LICSE 1-YPB /' I 13liS. LIC - 3 3 J SO 1P Z� ✓c COIJP.4TY IiA �✓E /1 •/� G / >� ``� C I G' 1'(Y E-NL4tL {tel n L2 off. �r9l�j STRE'tTADDRESS CITY, STATE, ZIP � � ,/ _I H PH6-NE� 5 JAI ARCr1TECTF_NGiI\z-ER N-AJS LICE.NSE I\U BER BUS. LIC =` COMPANY4IvlZ�,� z'�p� ST=UT ADDRESS CITY, ST A E, ZIP I PHONE USE 0. ❑ Sr -D- or DL -PL ❑ MULTI-FA2,0-Y PROj-CT LN' WLDI-k �'D ❑ YES F? OT-- -N ❑ Y=5 IS T:' BLDG AN ❑ �..S BUIIMNIG: ❑ C01'9't�r-" c1I'T- LT3AY LNT---tFACE AREA ❑ KBO FLOOD ZONE ❑ ?d0 EICI�� HO]J.E7 ❑ > 0 I DLSCRIPTION OF WORK P d O b Y, TOTALS J-UATION: ` Ey my signz«e below, I ce, iy to each of the following: I a3 the prope_ty Owner or auuorized went to act on the proper y o;; P ' a_£ I have rend this appliution and `d?e Lnfo=ation I have -orovided is correct. I hive read the Description of Work and verify it s accu ate. 1 ag ee to comply;; ith ail applicable local c:dLmnces and smote laws re g Lo bu ]dine constructio - , 1 o i e represen _tiveS of Cupe.�in0 to enter ue abojve-idea iced property for inspec ion pu noses. Sim ure of.A.pplicpt/Agent: Date: T E i ^ T i I t E Ip - SU-PP_�I,�� i A. Tr ORvI,�,TIO?� IZ.QU�.tD S. MME-E15., �T CTi k IV NPR k"MV (: �z y � 1 � j k h!Er?74'iscAj)p_2011.doc revised 06/21/11 CITY OF CUPERTINO ri-w7W FFT ESTIMATOR - BUILDING DIVISION ADDRESS: 21351 COLUMBUS AVE -DATE: 01/11/2016 REVIEWED BY: MELISSA APN: 362 04 004 1 BP#: o4herblech..bis,p. *VALUATION: 1$1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: hn)). Fee: 7FIERMIT ENTAMATION TYPE: I REAP2 WORK REPLACE (E) 100AMPP TON 200 AMP, SAME LOCATION SCOPE Afech. ;'l to ('.'heck 111ruinb. 11;tzn Cheek Elec. Plan Check 10.0 1 hrs $0.00 '177e: Plan Elec. Permit Fee: ]EPERMIT o4herblech..bis,p. ();1lerPhinib !;?S,0. Other Elec. Insp. 0.0 hrs 1 $48.00 Alech, x` 'r.'. Jywlf.�, P't,(". hn)). Fee: VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public worics, Lire, January yewervis[ricr, acnoot District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for aildn't info. FEE ITEMS (Fee Resolution 11-053 Aff. 711113' FEE QTY/FEE MISC ITEMS Plan Suppl, PME Plan Check: $0.00 F -f PME Unit Fee: $48.00 PME Permit Fee: $48.00 ("'Onaruciion Administrative Fee: 1,4DMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 ,4diwnced Phmning.1"'ees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 ,"$ SUBTOTALS. $190.501 $0.00 TOT L,FEE.. $190.50 Revised: 01/01/2016