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B-2017-1899 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1899 10230 PENINSULA AVE CUPERTINO,CA 95014-1211(326 22 021) JORGIK ELECTRIC INC GILROY,CA 95020 OWNER'S NAME: SUBBIAH RAGHUPATHI AND RAGHUPATHI KALAIVANI DATE ISSUED: 11/06/2017 OWNER'S PHONE:650-861-1162 PHONE NO:(408)665-5547 J IC'RNSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#1009904 Contractor JORGIK ELECTRIC INC Date 03/31/2019 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(E)PANEL(200 AMP);CHANGE ELECTRICAL SERVICE I hereby affirm under penalty of perjury one of the following two declarations: TO UNDERGROUND-SEE PERMIT#13110079 t. I have and will maintain a certificate of consent to self-insure for Worker's P ---Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. z. 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:$2000.00 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 22 021 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 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. , r �(� Signature : `,` �'� Date 11-06-2017 Issued by:Kim Dunbar Date: 11/06/2017 OWNER-BUILDER DECLARATION 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 being 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 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: 11-06-2017 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authoagent: APPLICANT CERTIFICATION Date:11-06-2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for 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 11-06-2017 Professional CONSTRUCT' d PERMIT APPLICATION COMMUNITY DEVELOPN NT DEPARTMENT •• BUILDING DIVISIONB f 10300 TORRE AV ,NUE • CUPERTINO CA 95014-3255 �+ St!D� v! (408)773228 • buildingc�j7cupertino.org PEMIT#B-40 (1' - I S i CUPERTINO REV# DEF# r,� NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. IIRIEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT.ADDRESS ( U 2 3 40 Pen kIn S tti1a Ave APN t 3^ - 2 2 -D� OWNER RA61N V?AIR1 Sve•g)r11.4 ME PHONE65o 861 111,- E-MAIL125v8131 A►-iQ SyNoPciS • cool STREET ADDRESS Ll l Y, STATE,ZIP 10,30 .f eN!NSVLA ANS Lu PERT1 Nn ._ LiltCilt q55njL!' %CONTRACTOR NAM 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE ...1:6_ '2\etT111 e l��qqy C STREET ADDRESS ►� CITY, ZIP E-MAILPHONE BUS.LIC t �ob,rY.! L3ogCI 12Z*2‘\,100-0"1, AA 66b SS11-4., - 1 - S09-s1 0 ARCHITECT ❑OWNER.❑OWNER AGENT ❑CONTRACTORTAGENT 0 ENGINEER❑DEVELOPER ❑TENANT CONTACT NAME RA 6�N v p A7 Al S u(331 A'14 E-MAIL K 5 u 33 I/4I4 € Sy No p s•f 5 • corm STREET ADDRESS CITY,STATE,ZIP PHONE 102.30 faNiNSvloA- AVE Lu fERTI,No c-A- (15o14 6so 861 1 ) 62.. DECRIPTON Cetir+ o- pL i�2(cosl_ cQ:a'2N/1C.-" —7,0 J'-C,T? 2 J NID j `d a'3- CF--1.) 2©o AY-10 u-lr41.1 NF t._,/ Cl ) 20D An° , pAtJ .L._ , ^� ,--(11- - (31 1 b0---7 r z _ ❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES t TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE .-I❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISING ❑YES EICHLER D YES SECOND STORY ADDITION DYES FIRE SPRINKLERS❑NO ❑ NO 0 NO DWELLING SECOND DWELLING ❑yEs 0 ATTACHED 0 DETACHED OTHER UNITS!' UNITADDITON: ❑NO SF POOLSI ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED . POOL-SF SPA-SF I SPA ATTACHED DYES ❑ NO I TOTAL-SF -d/ RE Y: / i• .11 •N: Commercial or Multi-Familu Buildings with Public Swinuuine Pools repuire5 Department of Environmental Heath approval ' • � RE-ROOF EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD INGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑1' ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES t OF LAYERS THICKNESS❑5/8" OTHER ❑OSB 0 CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES ❑WOOD SHAKES OWOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF rof 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's behalf. 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 with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for record. ( _ Signature of Applicant/Agentgent: 0 ____ _ SUPPLEMENTAL INFORMA ON REQUIRED *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 B/dgApp_2017.doc revised 08;'Olil7 UTILITY RELEASE REQUEST FORM 1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E.,C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(a cupertino.orq PURPOSE For residential single family or duplex construction,there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy Upon approval from the building inspector,the City of Cupertino is allowing both utilities to be released prior to the final sign-off of the building. INSTRUCTIONS 1 Download this form at: http.//www.cupertino.org/index.aspx?page=297 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor 3 Fax,E-Mail,Mail or hand deliver the original signed form to City of Cupertino Building Division Attn. Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino,CA 95014 building0,cupertmo.org 4 Schedule a Gas Meter Release inspection(#403) and/or Electric Meter Release inspection(11104) Please note, a Gas Test inspection(#506)is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information) APN BLDG PERMIT# isqq DATE. SITE ADDRESS: O -2-3® P- Yl t 1'1 S td Atit OWNER'S NAME. PHONE#' {�6,44-upAT41 su(36)41- FAX 50 sbr He 2-- MAILING ie2-- MAILING ADDRESS(if different from site address): C NTRAC OR: PHONE#' \ vS( \ls.1 C FAX#: CONTACT PHONGC s S ��� FAX#E# I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign-offs and the City has issued a certificate of occupancy for the building. Owner �. 0 . . Print: F G1,4-Ut� '? �..,.Sv(3'3tA: Date: 1.1. l.(/ z 17 Contractor .. Print: ---7'`?y'}SL-: . ' Date: <<. .J UtilityReleaseForm 2011.doc revised 08/09/11