05010119 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CONTRACTORANFOItMA JON`
BUILDING ADDRESS: VIJAY P GARDE PERMIT NOO 5 O 10119
519 BARNHART PI.
OWNER'S NAME: PERMIT ISSUE DATE
VIJAY P GADDE 01/20/2005
ONE: SANITARY NO. CONTROL NO.
ARCUMCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oo LICENSED CONTRAC'IUR'S DECLARATION
u 1 hereby afrom that I.m licensed ondef Provisions nr chapter 9(eomommi-I Job Description
Zed with Section 7(M))of Division 3 from Businetsand Professing Codo,and my license is
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in full REPLAE FRUNACE
E2� License Claw Lie.N
Date Cannaemr
t21 ARCHMCPS DECLARATION
F l understand my plana shank oxides punk mmrda
JyU
o Licensed Pndcssional
OWNER-BUILDER DECLARATION
N y 1 hereby maso affirm Net 1 1. cacmpl from Ne Contractor's o e:Any c law for the
O following axon. ormil in
]cont. Business and ve do rmli Code:Any city on roomy
ar which sequins n e.also to ennalrveL eller,improve,demolish,ore a rig any tWdme $1800
that heor r its cense pursuant
therinr theapplicantforsuch Permitto rens,Lw(ned stammcm
0 (Commencin WiopSesuamtomeofDianoofineCnntmmorsndProelsw(Chaptery 'Sq. Ft. Floor Area Valuation
(commencing mitt Scnfroin and of Division 3 of the Business and on.Any
vi Cade)ion tar
� that k is exempt therefrom and da baso for Ne alleged exemption.Any violation or
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penally of 36^�N6' er00 Occupancy Type
nm more Than fin hundred dollar:(s50o). P Y YP
❑1,as owner or the property,or my employees with wages as mcir.sole,compensation,
will do me work.and me structure is not intended or offered(or sale(Sec.]844,Business
and Podcadom Code:The Contractors License Law does not apply to an owner or Required Inspections
property who builds vi improara thereon,and who doesauch work himselfedmmugh hisowmD
however.o,buil building
or improvement
improvement hire ne earofamortetaa formLe.It,
the ower- �� �p D
however,me building or impmvemem is old within one year of completion,me owner- tt11P
builder will have the burden of proving that k did not build or int prove for purpose of
alt.).
❑1.as owner or the props",.m exclusively contracting with licensed comae o s to
conswet the pmject(Sm.0114,Business and Tmressions Coal no Contractor's Li- •��� .^y
Li-
come taw docs not apply to an owner of progeny who be Ids or improves demon. it A T bu
who contracts for such projects with a contractor(sj licensed pursuant to the Contractor's
License Taw, p 11
❑ Tem P,1 under Sec. Data PC Of 99phis �„ rat�p Mall����
Owner ❑ ( Dam19
tj(jJpp lyni7ryNL`�/rpt U -
h P S ON DECLARATION I '
1 hereby affirm under Penalty of pe jury one of the following declaNdons:
I have and will maintain a Cermlimm of Cmwma to self-insure for Worlecr's Compo"
sation,as provided for by Section 37W of the labor Code.for Ik performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Cade,for the performance of the work for which this permit is issued.
My Worker's Cnmpensadon Insurance carrier and Policy numkr are:
Cartier: Poli,No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not the completed if the Permit is forone hundred dollars(SI0KB
Inset
I certify that in the psrf nerance of the work for which this permit is issued.1 ahal not
employ any person in any manner so ss w keome subject to the Wo eciss Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.at making this Certificate of Exemption.you should -
became Subject to the Worker's Compensation provisions of the Labor Come.you muse
forthwith comply with such provisions or this armil atoll k deemed reversed.
CON STRUCTION LENDING AGENCY
1 hereby affirm that Nene is a construction lending agency for Ik psrrormanim of
1' the work for which this permit is issued(Sec.309),Civ.C.)
YI Qfandcrs Name
3. tamer's Addreas 5
7 Z
J p 1 cenify Nat 1 have read this application and sum that the above information is
correct.1 gree to comply with all city and county ordinances and slate laws relating to
J V building consuunion,and hereby authorive representatives of this city to enter upon the
W
� gy abovproperty lmimpcNonpurposes.
(We)agmemvv,indemnify and keep
barmlcss -
But City of Cupertino agamn is U,
rq fiabiliumijudgments,costs and expenses which may in any way avenue against said City
JZ in consequence of the granting of this Permit. Q
^ APP WICANT UNDER TANDS AND WILL COMPLY WITH ALL N-P INT Issued by: Date
SOU REGULATI0 9
fi Xe I OJ Re-roofs
Signa co ApphcanUConma m
clor De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hvarduus material
m defined by the Cute vino Municipal Code,Chapter 9.12.and me Health and Safety
Amilicods,S6 Y.255J2(a)? 461So All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haraNnua air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
iurie"
❑Yo No
I hive mad the hazardous materials requirements under Chapter 695 of the Cali for
Iia F�alN&Safciy Calc Sccbom 25585,25533 and 25534.I undersand Nat if d¢Wilding
don of curtcmly hate a¢n t.Nat it is my maponanu d m notary the rc Pant n Nc
rcy calf which aw t prim to issuance ora CcNficate of Occu x Signature of Applicant Date
d O - All roof coverings to be Class "B"or better
Own r r atahwi,ed agcnl nate
CITY OF CUPERTINO
aae,1 FURNACE/AC 1
&UPEkTINOCITY PERMIT APPLICATION FORM
Date:
b 2,006
Building Address:
e,E
Owner's Name: /' HDd� •� 1F D g - 2�,rj 7 — 'v /
Contractor: P one: License #:
�w�,e� A 'g - 22 3l
Contact: Phone: Cupertino Business License
Building Permit Info:
Bldg Elect Plumb ❑ Mech
Job Description:
Ro- plat/ �46,na lye a )nc
Residential -,(Commercial ❑
For Residential Installations:
Attic ❑ 1s` floor 0 2nd floor❑
dhere to min set back requirement m
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑ -
Structural Calculations required for new installation
New installation Planning A proval Required F]Cost of Proje : j a00 Type of Construction: Occupancy group:
Strapped i On Platform Bonded Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
A l ble Fee ID Fee Description Fee Grou
BENERGY Energy BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 c$n MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING