B-2016-2268 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2268
10255 MIRA VISTA RD CUPERTINO,CA 95014-2704(357 02 034) ARKAY
CONSTRUCTION
ENERGY SOLUTIONS
SAN JOSE,CA 95120
OWNER'S NAME: VENKATAPATHY RAMANATHAN N AND PRASAD SAUMYA DATE ISSUED:07/06/2016
OWNER'S PHONE:425-868-9328 PHONE NO:(408)218-7956
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#1006157
ContractorARKAY CONSTRUCTION ENERGY SOLUTIONS Date 08/31/2017 X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCLAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 50 GAL WATER HEATER(FRONT,LEI T SIDE GARAGE)&
9I he b y affirm under penalty of perjury one of the following two declarations: RELOCATE(E)WASHER/DRYER(FROM LEFT SIDE GARAGE TO
I have and will maintain a certificate of consent to self-insure for Worker's REAR,RIGHT GARAGE AREA)
CCC�w Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
12:�2 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. Sq.Ft Floor Area: Valuation:$2500.00
APPLICANT CERTIFICATION
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 57 Number: Occupancy Type:
357
and state laws relating to building construction,and hereby authorize 302 034
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 18p DAYS OF PERMIT ISSUANCE OR
Additionally,the licant under ands and will comply with all non-point
source regul ons per p ino Municipal Code,Section 9.18. 1$0 DAYS FR +` Q-�
Signature' Date 07/06/2016 Issued by: IS
Date:07/06/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material b ing installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to rei iove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property;am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044;Business&Professions Code). Date:07/06/2016
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A'OR BETTER
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. HAZARDOUS MATERIAL DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25 33,and 25534. I will
maintain compliance with the Cupertino Municipal Co e,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I stor or handle hazardous
s. 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 material. Additionally,should I use equipment or davit s which emit hazardous
air contaminants as defined by the Bay Area Air Qualit i Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipa Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,.S ,and 2
5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATION Date:07/06/2016
I certify that I have read this application and state that the above information is N is N LEND A N Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm That there construction lending , ncy for the performances
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,C v C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands ARC
and will comply with all non-point source regulations per the Cupertino Municipal T L
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 07/06/2016 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building a_cupertino.org
CUPtRTINO 13 - Z ( 6 - 2Z
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT10 ADDRESS Z155- tVidof- VISJT 9-0, C2fI0 g5D� APN# 3 � az- ` 0
OWNER NAMEHO ��� E-MAIL
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FAX
CONTACT NAME i / _ PHONE C
STREET ADDRESS CITY,STATE ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOI ER ❑ TENANT
CONTRACTOR NAME fid PVFrLE LICENSE NUMBER LICENSE TYPE Ig BUS.LIC#
COMPANYNAME C*WV`t
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STREET ADDRESS CITY,STATE,ZIP PHO
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP, ._ PHONE
DESCRIPTION OF WORK h,+ _
EXISTING USE - PROPOSED USE CONSTR.TYPE #?STORIES
USE TYPE OCC. SQ.FT. ALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA.. .
BATHROOM KITCHEN OTHER -
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - -
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT El YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? - ❑NO .
PRE-APPLICATION ❑YES T YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VAL. ATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? QNO 5, „'� - !2 0��
By my signature below,I certify to each of the following: I ani the property owner or authorized agent t e property owner's behalf. I have r ad this
application and the information I have provided' I d the Description of Work and n it is accurate. I agree to comply with all app 'cable local
ordinances and state laws relating to buil co I a sentatives of Cupertino to enter the above-ide tified`property for inspectioi i purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
, PLAN'✓HECKTYPEy
_ VIC
New SFD or Multifamily dwellings: Apply for demolition perDit forovER c�rlNzi BUD n11vc PL REvE
existing building(s). Demolition permit is required prior to issuance of building 0
permit for new budding. - �XPxEss f ,ANNINo PL REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure M, STAND"ARD ❑ ru�Lrc Woxxs
form if any Hazardous Materials are being used as part of this project. LARGE ;
; ,r
❑ FIRE DEPT'I
Copy of Planning Approval Letter or Meeting with Planning prior to
I]' MAJOR' Q SANTrARYSEW RDISTRICT
submittal of Building Permit application.
„.=; ❑ E1VIRONIENt HEALTH ..'
BldgApp 2011.doc r vised 06121111
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