06020083 CITY OFCUPERTINO «,• :,; ,u
BUILDING DIVISION PERMIT CONT CTOR TMORMATION:"
BUILDING ADDRESS: LANIER ELECTRIC CO PERMffN0.06020083
OWNER'S NAME: PERMIT ISSUE DATE
KEN PATEL 1285 KIMBER14Y D 06
NE: SANITARY NO. CONTROL NO.
(408) 723-0812
ARCHITECTIENGINEER: BUILDINO PERMITINFO
BLDG EO PLUMB MMOCH
LICENSED CONTRACT'OR'S DECLARATION Job Description
4 1 hereby affirm Nn 1 am licenced under previsions of Chapter 9(commencing p
with Scotiou T0(a)of Divialon 3 o(thc Business and Professions Coda.and my license Is
j Z I fillromaaundiff -tJ Lk.N Svgt21 DIESEL GENERATOR TEMP. POWER
Dau f Contractor ata r N
C ARCHITECTS DECLARATION
I understand my plana shall W used as public reemis
So
k
Licensed Professional
`7y OWNER-BUILDER DECLARATION
Contractor's
ON T43tyi�
4 Q O 1 hereby.(Sero that 11. exempt s an the ConvanCo License Law for the
p O following mama.permit
i ]11313,Business roti Pm(caium Coda:Any city or county a.p,
5$ which requires a pommel m construct,slur,improve,dcmnirh,or repair my structure a n $1000
licensed
pursuant
tloma Ncapplinnlf Contractor's fileasLawoCl mmem
momm in&wit purwanuOlbe pm visions offt Contractor's Licence Law(Chaptm9 Sq. F[. Floor AT vJnn� Valuation
H$ (comm"In exe exempt
Section7000) basison3often eged exxemtion.Ayvi Como( 4HM
- or
WI io r 31.5 b thertfmm and die Eur for be alleged exemption.in Any l violation of
Section 7031.3 by any red doll fora permit subjects me Applicant to a civil penally of p (�."n Occupancy Type
not mom Nen Bve hundred dollar($300). -
❑I,uawneref Jle property,ermyamployces with wageaar theirmlecomperundon,
will do the wor"tal the awnum Is notintanded eroffmol Rotate(W.7061,Business Required ins ec leo s.�
and Professions Code:The Conuacemes License Law does ml apply m an owner of q p
propeny who builds or imporms Nemun,and who doessuc h work himself or through his
ownemployem,provided that such Improvements an,not Intended mo@red(male.If.
however.the building or improvement isanld within one year of completion.the owner.
builder will base the burden of proving that he did rot Wild of Impove for purpose of
sale..
❑1,as owner of the property.am exclusively contracting with licensed contractors to
construct the pmjecl(Sec.7044,Business and Professions Code:)The Contractor's Ll.
cause Law docs not apply 0 an owner of property who Wilds or improves themon.rod,
who contracts for such projects with a eemmaclnr(s)licensed pursuant in the Con inemes
LlceMe TJw.
❑Tameaemptunder Sac .BAPCforthrramn
wner Dau
WORKERS COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury one of Ne following dwlarstiom:
I Mound will maintain aCenificamof Consent to ce161nsum for WorFeYa Compcm
Von,a provided for by Section 3700 0(Jen Labor Code,for the performance of the
work for which this permit Is issued,
❑1 haw and will maintain Workers Compensation Inmrmw,As rcquimd by Section
3700 of the Inbar Cade,for the performance of the wark for which this permit u issued.
My WorketeC pronation lneu nm artier and Policy number art:
Cartier. (,P N Policy No.:
C RTIFIC •OF MEMPION FROM WORKERS'
COMPENSATION INSURANCE
(Thracctionaced not be completed ifthe tempt is for one hundred dollars(SIM) '
or less.
1 certify,that In Ne performance of me work for which this permit is leaned,I shall not
employ anypersq en in my manyfrsu become subject m the Worker'Compensation
Laws of Califnmia.Dam =s3"V ed
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Q forthwith comply with such provisions or this permit shall be deemed mvnked.
,z., CONSTRUCTION LENDING AGENCY
'T. I beauty affirm that he.Is construction lending agency for the performance of
14 ? time work for which this peotit is earned(Sec.3097,Civ,C.)
UJ Q Lenders Name ,
z Lenders Addrost
V Q I certify that I Ww read this application and mu Net den above information Is
IA F correct.1 agree to comply with all city and county ordinances and rude laws relating to
0U Wilding convection,and hereby autionw nepreanutivea or this city to cruor upon the
above-memioned property for Inspection purposes
Wm (We)agree to ave,indemnify and keep hornless the City of Cupertino against
,.y ti liabilities,judgments,costs and expenses which may in any way accma against aid City
f,Z inconsequence of theging of id.APPLIANTDERSTANDSANVVMPLYWITHALLNON-POINT Issued by: Date2-0-�5 Op/
�'W\ CN!S`: ESz-13-�� Re-roofs
Signatuwa Appltar Dau
AR OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant marc or handle hmaNms material
As defined by the CupeAna Municipal Code.Chapter 9.13.and the Hetllh and Safety
CoJc.Schon 35533(e)?
Year
All roofs shall be inspected prior to any roofing material being installed.
❑ tL]MO
Will the applicant of"num'
uture Wilding occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
II ha'rardous Airconuminanu a defined by dm Bay Area An Quality Management all new materials for inspection.
iSUicl7 -/
❑Yu CIJTdu
I have mad the hnallous materials requiremcnu under Chapmr 6.95 or the Califar-
nla Hcelth A SaladyCo&,Scctimms33N13.3357J and 37534.1 understand thatifNe Wilding
doer not cu mmly hove a mnan my responsibility m notify IM occupant of the
regi nu ichmusabemet ' ten ea faccrdncatearoccupuuy. Signature of Applicant Date
-( -0?e All roof coverings to be Class"B"or better
O er rot c Dam
• - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: //� � � fIU„) PERM®�D
OWNER'S NAME: (� PHONE # 7,4 346?,
GENERAL CONTRACTOR: IFAX # ea—
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
. Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
2-�3 SCP
er/Contractor Signature Date
T. P-2 CITY OF CUPERTINO
` CITY OF PERMIT APPLICATION FORM
CUPERTINO
N # S S�( I Gx> I Date: Z — IS
uilding Ad d2 a Mailing Address (if different from building address):
Owner's Name � Phone#:
cls `tt/
Contractor.Lo , p I � License I:
Contact Phone:l Phlonne: Cupertino Business License#:
�i0-✓1 Fax:
Building Permit Info:
Bldg ❑ Elect IK Plumb ❑ Mech ❑
Job Description:
Residential ❑ commercial
Sq.Ft. Floor Area: q.Ft.:
Cost ofProiect: i. r-D OccupancyGrun:
Type of Construction: Please check this bog if the project is a
V
second-story addition: ❑
ro'ect Size: Standard Large ❑ Major ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOMER2 Boiler> 100K to 500K Btu MECHANICAL
BB.QILER3. Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1:75701 Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTA)MQ 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
BELEC200 Elee Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
P�rrr f � lV� S 7n S uyt�i j Elm, woC-t
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�'"
CITY OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFMURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUMDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
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 InstaIVAlter Water Pie 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 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lig#ing Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV ReloFurnace> IOKbtu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood Al-ECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
13REMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
OCITY0 , PERMIT APPLICATION FORM
CUPEkTINO
uantiFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREN=ATR 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 Lispection BUILDING
BSVaM SwimminF.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
EPERNE=E Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
NTERMTTFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plambing Permit Issue PLUMBING
PPLBG PlumbingFees foot PLUMBING
PLLONGRNGC PlanningLR Commel Multi-Fam PLANNING
PLLONGRNGR I Planning Long Range Residential PLANNING
ZADDCHG I Address Chane BUILDING
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