B-2017-1599 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1599
10571 N STELLING RD CUPERTINO,CA 95014-1647(326 08 055) NAJAF ELECTRIC
SAN JOSE,CA 95122-
3434
OWNER'S NAME: SANTHANAM RAMESH AND RAMESH USHA DATE ISSUED:09/18/2017
OWNER'S PHONE:408-332-0936 PHONE NO:(408)691-5392 )
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#763989
Contractor NAJAF ELECTRIC Date 02/28/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
REPLACE PANEL(200 AMP) ,
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the
/ ,P 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. Sq.Ft Floor Area: Valuation:$1800.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 08 055
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 aga' st said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the-.plicant understands and will comply with all non-point
source regulati.1per the Cupertino M 'cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
1
Signat A.`�ig Q w`er." Date 09-18-2017 Issued by:Kim Dunbar
` / Date:09/18/2017
• A kF L-B I DER DE L • •TI•
I hereby affirm that I ant 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 being installed.If a roof is
i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove 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:09-18-2017 •
I 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 MATERIALS DISCLOSURE
2. I 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 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I,store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the .upertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod• Sections 25505,2 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall 9 It
be deemed revoked. , C7.41164"..I` IF v
Owner or authorized agen it �lit�
APPLICANT CERTIFICATION
Date:09-18-2017 i _ �®
I certify that I have read this application and state that the above information is - to V
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending,-gencyfor the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,:Civ 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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
•
Licensed
Signature _ Date 09-18-2017Professional
CONSTRUCTION PERMIT APPLICATION
\e'' // , COMMUNITY DEVELOPMENT DEPARTMENT •• BUILDING DIVISION
�v 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 15-5
�s�.,,, (408) 777-3228 • building@cupertino.org PEMIT#B- 0 I - 7
CUPERTINO REV# DEF#
El NEW CONSTRUCTION ❑ADDITION El ALTERATION ❑T.I. 'MEP El RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS � Q c ,71 NNi Ste(LL i 4(^ APN✓r 3 2-.(p' - bS - 0,15
OWN RNAME PHONE E-MAIL
4AvEs.0- SANrrikAwA� evog-33z ci3,� PQM - so-e,\rsyc Eitict ei
STREET ADDRESS CITY, STATE,ZIP
071 NIc�c LLI� (n ca i CuPE(e rtN0C� 9COACTOR NAME ❑OWNER-BUILDER. COMPA AME LICENSE NUMBER LICENSE TYPE
5 t d 'S 1N A AP L 6 cc2‘6, G'-- 76 1 c 1 G — 10-
STREET ADDRESS ' ' CITY,STATE, ZIP
2 32- C UC R- -� A Aga SAtJ1 G ( LZ
E-MAIL PHONE BUS.LIC It
0 ARCHITECT '❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON �
l S L-L I�1—M Pi E i C- MA l IN) ��L- C. L +N FL.
1
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES tf TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED '
BATHROOM SF SF SF SF 0 DETACHED ,
EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES '
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑AACHED❑DETACHED OTHER
UNITSI k UNITADDITON: 0N SF ,
_
POOLS! 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED .
POOL-.SF SPA-SF ' I SPA ATTACHED❑YES 0 NO I TOTAL-SF . . 'i'
REE
Commercial or Multi-Familu Buildings with Public Swimming Pools requires Department of Environmental Heath approval TT:41.010N:
ION:
❑BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES WOOD SHINGLES TILE OTHER SPECIFY (, `� (f
RE-ROOFI EXISTING ROOF TYPE B ❑ ❑ ❑ ❑ ( )'
REMOVE./REPLACE 0 NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: 12 ROOF CLASS
111 YES SOF LAYERS THICKNESS❑5/B" OTHER ❑OSB ❑CDX OTHER A
PROPOSED ROOF TYPE:❑BUILT-UP,ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF itof SQUARES
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`sjbehalf. I
have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate: I agree
to comply withall applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection r ses. I acknowledge and authorize all information contained on this application form
to be made available for public record. a
Signature of Applicant/Agent: _____-1, Date: c7 l I I et ' 2 0 17
SUPPLEMENTAL INFORMATION REQUIRED I'
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide'a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this,project.
*Copy of Planning Approval Letter'or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association l
BldgApp_2017.doc revised 08/01/1 7