The URL can be used to link to this page

03010113 CITY OF CUPERTINO - BUILDING DIVISION PERMIT ,,CONTRA'C'T-ORINFORMATI ' BUILDING ADDRESS: PERMIT NO. 10325 ANN ARBOR AV OWNER'S NAME: APPLICATION SUB DATE SRINIVASAN LEELA V AND GANAP T 01/22/2003 ONE: SANITARY NO. CONTROL NO, ARCHITECnENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 ICO LICENSED mthat IamCONTRACTOR'S DECLARATION Job Desc tl0 1 hereby dorm Nal I am licensed under rad Polemical of Chapter 9(commencing p, �� with Section]1100)ofDivisionJoftM Business and Nafeuiom Cade,end mylicense is Is-..� in full forte and effect. REPLACE WINDOWS/REPLACE ROOFING ZpaZ Lkenso Clan Lic.g F_— Dem Con x y�g�yur H ARCHITECTS DECLARATION I undcrsuntl my plena shall he used ea public records 6 •Y�f LLLicensed Professional sl� OWNER-BUILDER DECLARATION / u� Y I thereby affirm that 1 am taempl from rite Conuamors License Law for IW +fit g:a 0 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a Permit to consumer,alter,improve,demolish,in repair any stricture t-a'S+ yybrtoits issuance,al mi uima ft applicant for such permit to file a signed comment G that he is licenaJ pursammlbe provisions of Use,Contocturs License Law(Chapter 9 Sq. Ft.Floor Area $7 VaOtottion ,Sp (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3$ that he is exempt therefrom and the basis far the alleged exemption.My vlahuon of Section 7031.5 by any applicant for a permit mbjecu the applicant to a civil penally ofOGen araC notmom then foe hundred clothn(S5f10). Occupancy Type ❑I,as owner of the properly,or my employes with wages u their wk compensation. will do the work and Ne mnectum isnot intended or offered forule(Sec.7044,Business an propertynet PI .. who builds or improv sthemon,and who does such work himself or through his own employe".provided torrents Improvements sac not lmmmdedmoffered forsam.If, 103 — UFER however,Ne Wilding or improvement is sold within one Sem of completion.Ne owner- builder will have the When of proving thus,he did not Wild or Improve forPropose of 104 - REBAR We')' 105 — ANCHOR BOLTS I.as owner of the property.amnclnively conumemal with licensed contractors m, 106 — SEWER & WATER onsuuct the project(Sec.7044,Business and Profession Code:)The Contractors Li- ane Law dot not apply la an owner of property who wads or improws themon,and. 202 — UNDERFLOOR PLUMBING LKenaaon�Wu for much proietuwith.contrumr(apursuanta pursuant to dm Consumers 203 - UNDERFLOOR MECHANICAL ❑11'empttuminSce. ,B&PCforthhrruon 204 — UNDERFLOOR FRAME Ga° / a �01A1 �z 2cOj 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECL R N 301 — ROUGH PLUMBING I hereby iffum under penalty of perjury one of the following declaratimm: 302 — TUB H OR SHOWER I have and will mainW n a Certificate of Consent to self-intim for WorkebCompen- ation,as provided for by Section 3700 of she IAWr Cade,for the performamte of dm 303 — ROUGH MECHANICAL work for whichmhpermitisissued. 304 — ROUGH ELECTRICAL ❑1 have and will maintain Workers Compensation Insurance,as acquired by Section 305 — FRAME 3700 of the Labor Code,for the Performance of the work for which this permit is Issued. My Worker's Compensation Insurance caller and Policy number mac: 306 — HOLDOWNS . Carrier Policy No.: 307 — INSULATION CERTIFICATECOMPENSATION EXEMPTION WORKERS' INSURANCE S RAN308 — SHEETROCK (Thheectlon neednotbecomplemdifdm permlt lsforonehundreddollm(Sloo) 309 — EXTERIOR LATH nr leas.) 310 — INTERIOR LATH 1 certify her in the performance of the work for which this pe it is issued,I alml net 311 — SCRATCH COAT employanypersonin any men u Lecom sp 'eel to `m or kers'Compemation Iawsofalifam Di�Iee �y 313 — ROOF NAIL APPlicant � 1 Fn `L7 s a. VTLQ�I NorK'F/roAPPLICAN.It,After making this CtiifcamofEscmpuon.you should 501 — FINAL ELECTRICAL ENERGY Wcc�G+mbjecuo the WoAmes Compensation provisions of the Labor Code,you mot 502 — FINAL PLUMBING ENERGY Qz, forthwith comply with such provisions or this Permit shall deemed mvoked, 'zi..lQ CONSfRUCf10NLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY F K, Ihereby mithat thcrtincomtrusii,reingagenryfor thepe,formamxuf 504 — FINAL BUILDING ENERGY a > the work m: whichthisp mit isisseed(See.7097,Civ.C.) enden505 — FINAL ELECTRICAL W > thName Lamer Add. 506 — GAS TEST U O 1 certify that 1 have mad this application and sum that the above information is 507 — FINAL PLUMBING W f" correct.I agree to comply with all city and county ordinances and sum laws relating to Q V building conswction,and hemby authorise representatives of this city to enter upon be 5 FINAL MECHANICAL W Shove-mentioned property for inspeNon PmPrwaL O 9 FIN (We)agree to saw,indemnify and keep hmmlm the City of Cupertino against v) liabilitm&judgmenu,cosuAnita.,.,which may in any way accmc agaitw said City Cj N G U in con"uence of the granting of his permit L7 APPLICANT UNDERSTANDS AR WILL COMPLY WITH ALL NON.POINT Issued by51 WORKS Date SOUR REGULATIONS. \.c1-'l. nJ 2L _4 Re-roofs 5 num of Applicam/Commctor Dato HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dm applicant or future Wilding occupant mom or handle haardous material as defined by Be Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(")? ,,,0' All roofs shall be inspected prior to any roofing material being installed. Ycs lgpo Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hassrdous air contaminants u dcRmsd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Inca )00 1 have mad the hanNnuf materials requirements under Choplcr 6.95of the Califon nice Health&Safcly Code,Section 25505,25533 and 25534,1 understood bestir the Wilding does not currently he a to L that' s my m_spamibillty leImufy do eempanl of the rtqu' mwhich mumWmetpdo UJismmxcofaCcrdfmam of upmry�l I Lb c�n coon G,a: vf�cu't) 2L/1 3gnature of Applicant Date ncr m iniumdud agent Dam All roof coverings to be Class "8"Or better Planning 10325—windows Wednesday, January 22, 2003 F t ;171,�3 �':xidays!!E D r LDAN *0F )INANGIS Ot ! ,`: NCES0MUSit is un --pcs r alterations d^- l pet i'ssion from ri> >rtino. 'ts^.' nd pecifications ni' cr to be an SUBMITTAL e I pravisicn< .: Law. #1 Srinivasan 10325 Ann Arbor Ave, Cupertino, CA 95014 �>?2 , CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM o3 o I o 113 APN# Date: -�y Building Address: }9-/V/v ARBOR A-VE, Owner's Name: Phone#: C,. R K L6'E 14 S21 dV I V45 6IV C44%) 4:4 6 a66 Contractor: —T—B-T License#: Contact: L _ 1Phone#: SR �IV�s�n/ Applicant/Contractor: _1 Fax#: QBld g P rmit Info: Bldg Elect Plumb Mech cription: / \ U� / .� _ Residential: J o er is . Sq.Ft. Floor Area: ,� F Architect/Engineer: Valuation: \ ype of Construction: Occupancy Gro+: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL, BFLEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM I New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING lof3 ,-� 2 Z 3 . 7