04010001 (2) Cl'PY OF cuPEWFINo y ; + o-�n • "� "
BmLmncDIVISION PE RA
BUILDING ADDRESS: RAJEEV fiC VARSHA JOSHI PERMITNQ04010001
10162 COLRY ANT
OWNER'S NAME: PERMIT ISSUE DATE
RAJEEV & VA
NE: SANITARY N0. 2 CONTROL NO.
7A�l HITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o LICENSED CONTRACTOR'S DECLARATION
U I hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description
with Scaiun)(N10)of Division 3 of me flusiness and Professions Code,and my license is
��jnfnnform,and ofren. KITCHEN REMODEL
License Class Ce.0 '
�Fp Dam Convector
°{ ARCHITECTS DECLARATION
�i i I understand my plans shall be used as public records
Wu
a h Licensed Premssional
OWNER-BUILDER DECLARATION
tli S I hereby affirm that I am exempt from the Contractors Licenu taw for be
0 c following reason.(Section 703 IS,Business and professions Code:Any city Of county
K int which mquiree a permit to cnnaruer,alter,improve,demolish,or repair any structure
prionois issuance,also requires the applicant forsuch pemolm f lcasigmed summed,
i< that her is licensed pursuant to me provisions of the Contractor's UcenseLaw(Chapter 9 Sq. Ft. Floor Area Valuation
Y~n (commencing with Section 700)Of Division 3 or the Business and Professions Cmm)or _
_ that he is exempt mcmfrom and the basis for the alleged exemption.Any violation of
@Crdon 7031.5 by any applicant felt a permit subjects the applicant to a civil Penalty of 31A 213,Wiber00 Occupancy Type
re N
eras more flue hundred delta.(SSW).
P Y YP
01,as owner of the property,or my employees with wages as mcir sole cam pensation,
will do me work,and the structure is not immndcd or offered for sale(See.9014,Business
and.Pmfessiona Code:The Contractor's License taw does mol apply to an owner of Required Inspections
Papery who builds or int proves menton,anti who are
o work himselfor edthrough M1f.
n car.Onebuiprovided mat such improvements w is ere not near ofd monitored terrible.owner.
build,, the building or improvement issoltlwithinane,cad of completion,me owner.
builder will have th burden of proving mat he did not build or improv for purpose of
le,
❑T,as owner of c.cdy.em exclusively convecting withlicensed contractors �
construct the project(Sec.2044, msad PCaere) he Counramos Lt.
c taw does not apply to an Owner of pmpcny who Wilds or improves themed.and,
who /O
ace for such projccu with a convmorta)licensed pursuant to the Contractor'sLice
License
Law,
®land nae l(undlp-r-See .B h P C for this reavon
r\Qwnep VUSV"' Date 1 .2 ADI9
�(/ WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of✓thett-
following declvnions
1 have and will maintain a Coni ficam of Consent to self-insure for Worker's Compri. -
satum.as provided Tor by Section 3700 of lye Labor Code,for be pcomm uric.of the
work Tor which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,ss required by Section
3700 of One labor Cade,for lee performance of the work for which this permit is issued.
My Workers Compensation Insurance artier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS*
COMPENSATION INSURANCE
(This section recd not bccompiced robe Permit is for one hundred dollrs RIW)
'fir less.) '
I codify that in the performance of,he work for which this Permit is Issued.l shell no,
employ any person in any manner ser u or become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccdifcam of Exemption,you should
become subject o the Workers Compensation provisions of the Labor Code,you must
.JO forthwith comply with such provisions or this perm it shall be deemed revoked.
z M CONSTRUCTION LENDING AGENCY
F" I hereby affirm that there is construction lending agency for the perrurmance Or
a the work(Or which this permit is issued(Sec.3099.Civ.C.)
fA Lender's Name
G lender's Address
az
U O 1 certiry that 1 have read this application and sum that me above information it
Lq (•-' coraL 1 agree to comply with all city and county ordinances and state laws relating to -
OU building construction,and hereby authorian mpresematives of this city to enter upon the
,hove-menluded property for imbrodem purposes.
Hy (We)agree to save,indemnify and keep harmless the City of Cupertino against
req Held ities.judgmedu,eosu and eapcescs which may in any way accrue against said City
U Z, in consequence of the graining of this Permit.
'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCj�;)3 o CATIONS. [,
r9''SL 1/�00 7 Re-roofs
53 antreof APdimin Commmor --'-Dem
HAZARDOUS MATERIALS DISCLOSURE i- Type of Roof
Will me applicant or furore building Occupant store or handle havudous material
az defined by the Cupenino Municipal Codc.Chapter 9.12.and the Health and SaRty
Code.Se❑e Yea..25532(a)'/ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mo
building occupant use equipment or device,whim -If a roof is installed without first obtaining an inspection,I agree to remove
til harardous airconmminams as dewed by the Bay Area Air Quart,Management all new materials for inspection.
JiOrictt
❑Yes No
I have mad me buaardouss materials mquircmcou under Chapter 6.95 of de Califor-
nix Hcalm db Safety Code,Sections 25515,25533 and 25534.1 undersand mat if me building
dace no,comedy have a mmol that it is my responsibility to notify me awPant of the
myuimmenu which must be met prior to issuance or a Ccmfiam or Coronary. Signature of Applicant Date
� rflosiL, 1/4200 All roof.coverinas to be Class••B•• or better
O�r Winithorircd agent .d o
R7
i
+i
a
4
pPPROVE0
f09 ACCORD NCE IT TME CITY OU k
ViPERT LADES
OR 1 dl�
� f
r
' e , 2nd specifications MUST
Z5 F sf p
°e k"'6^ and it is Uri'
t o I b achangest 311 eor, alteration
la'AtL4 t2 tr„ce any permission from
W17-1 hh ; 1Ut wri.ten
tie Cuiid.n8Pt., City of Cuperfication
tino.
rhe ,; of"is plan and speci ;
aWALL Nof tr= held to permit or tooklsioM
pp b at ttt=t;,alabon of any p
yzn—v 1'.1—t7 Oi A—K:RL—e
or State Law. L
4 '18
8 70 '(
''-- 38 30
_ I
W W3018 1 ��
j i U18 \
24 OC2724 BP SB30 .FH .I ,
i p��n1
II I
18 F-3LR13E \ l0
TBU
T128
I
• 128
RECEIVED
DISH. SB3 BD24 B24 B 0 4
p I h
W,15 5 W3636
�—--TT--- —� 5 s--- 53 —�
s- —�-- 48 —�--' 58 �g 118
.fes— 30 — 25
176
LEG t---N�---
® �V
Ilov C,1'1
�zC cizi L1�NS
O 5W
Tc 1-k
• 1016$ COLS ,AVE 1 W1�EIZrINO CA 9501 IDvrg no.
Design: 11120/03
--- 6200DO19 Scale: 114"= 1' Date : 1J121D3
This is an original design and must
All l:mensions E size designations THE not be released or copied unless
given are subject to verification on HOME DEPOT applicable fee has been paid or job Designer i
job site and adjustment to fit job order placed. Salvador Martinez
conditions. _
i
S( tITY OF CUPERTINO v o o
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Ask
APN # Date:
316 _ Ag _ 933 JAN oz, Itooy
Building Address:
10168 LJL6Y AVE W?ktr -TINO , CI> Syoltt.
Owner's Name: Phone#:
12AJEEJ $ \/AIZSHA JOSHI 7�7—S66g
Contractor: License #:
SELF .
Contact: Cupertino Business License#:
/AS Aaov�
Buildina Permit Info: ��//�
B1 ❑ Elect!❑ Plum Mee—
Job Description:
Residential [� KITLKEN 1ZEMODt L rcial
Sq.Ft. Floor Area: /Sq.Ft.:
/�,PPcw?5o too
Cost of Project: Occupancy Group:
�[�25 -3o1C• -
Type of Construction:
NEW MP.INETS, toVNTE2 Af UANCG-, uGHTS
•
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELE 200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of 3 $16 /! ��
IWITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res BId s MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New MultifamilyPLUMBING
UMEING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
1 BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
13REMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BRE URN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Aaratus ELECTRICAL
I •
2 of 3
,-ail
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Qu Fee ID Fee Description Fee Group
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
BMISCELL Building Mise Fees BUILDING
•
3 of 3