Loading...
04070175 CITY OFC PERTINO * -' ' BUILDING DIVISION PE S ' FT"oAZUZ,Nl tit11 an,�. N BUIL DING ADDRESS: NIVI PADHY & MANO PUTHUKUD ""'04070175 OWNER'S NAME: PERMIGI .9UEDATE NIVI PADHY N6: SANITARY NO. CONTROL N0. ARCHITECTIENOINEER; BUILDING PERMIT INFO RUP ELACT PLUMB MECH 5-.6 LICENSED CONTRACTOR'S DECLARATION IbDe$Cn Description i� F 1 Waeby name that 1 me lianscd under provisions of ChO Chapter 9(commencing P OF with Section 7")of Division Sof the Business and Professions Code,and my license is infull Come and affect. KITCHEN REMODEL/DEMO PANTRY WALLS 5 3 License Classun.g all Contractor ARCHITECTS DECLARATION ' I untlen,end ety plena shall he used as public recoNs U o G Licensed Profoaional OWNER-BUILDER DECLARATION E 1 hereby affirm that 1.camp,from the Conuacmrs License Lew for the 0 o following came.(section 703 1.5,Business and Professions Coda:Any city or county $ which re owes a permit to cnnsuuc4 alter,improve.demolish,or repair any sweture Pilar In its iauaree.tlao requires the applicam for such Permit to rile a signed lament Valuation that he is licensed pursuant I.the provisions of the Contractor's Liana Law(Chapter 9 Sq.Ft.Floor Area FFA (commencing with section TONT)of Division 3 of the Businessland Profcsalora,Cook)or �.. that he Is exempt therefrom and the basis for the alleged ebmption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 35&N$431rkber00 Occupancy Type oat come than five hundred dollars(S500). 0 I,a owner of the progeny,m my employes with wage a then tele compewtion, will do the work end rhe awctum is notimended oroffated for,aic(Sec.7044,Businea and Professions Code:The Contractor',Loans,Lew does not apply to an owner of Required Inspections _ property who build,or Improves rhesean,andwho doessuch work himselforNmugh his - .a employees,provided tWt such Imp.wments.om intended ma@red foraw.If. hywewr,the boldingm improvement is sold within ane year of completion.rhe owner. builder will have Ne buAcn of proving Wt he did not Wild or improve fm purpose of b ����� uild. 0 1,a chimer of the property.am exclusively connecting with licensed convators to construct the Pmjen(Sec.7044.Business and Prons fessioCode:)The Contractors W- ceme law does not apply in an owner of propeny who Wilds or improves thereon,and. who convects(or such pmjecu with a conlnctor(s)licensed prolamin the Convectors /.4� License Law. 1AN 2/� ius1y 0 1 am exempt under see. .B 8 P'C far this moon or v Dem "'t 2 y OWING V W0RKER'g COMP ENS AT IOM RATION 1 hereby of um under penalty of perjury,one of woe following declaa ons: 1 hew and will mointein a Cenineam of Cement to alf-insure for WorkeraCompen- sation,u provided for by Section 37M of the IA Wf Code,for the performance of the weak for which this permit is issued. ❑1 haw and will maintain Workara Compensation balance,ss required by Section 3700 of the LaborCiew.for the performance of the work forwhich this permit is Issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Paltry No.: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f"Mesad.need nm hecmoplemd If the Imailis faane hundred doll.(SIM) or Inas.) 1 ar ify that In the performance of who work for which Nis prmh is issued,f staff rad employ any person in my manner an as the become subject to the Worken'Cmmpena0on Lows of Calif., Appl N IC TOA 1 .'If,after eking this Cerin o emption,you should he. a subject m won Worker,Campmeadon pm huimi of the la Wr Code,you most Q O I wiwo comply with such pswi,ina or this permit shall W damnd cooked. r CONSTRUCTION LENDING AGENCY l hereby aRnm that Vert is a mmvuction lending agency for the Performance of a ti Me work for which this permit Is issued(Sec.3097,Ci,Cd WLender,Name W Q z Lender,Address YJ Q 1 anify that 1 haw read this application and stere the,the show Information la {L!+ cmrett 1 agree a comply with all city and county an maces and sum laws relining m Q SU^ Wilding constriction,and hereby authone,mpmmnutnoes of this city m sour upon the W shove-mcmimned property for ismeedon purposes. FL (We)agree to sew.indemnify and kap hanntess the City of Cupertino against pj Ilabiliticajudgmems,cosh,andexpema which may In any way accrvcagew,said City U 7 in cantequeme of the grating of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:, e RCE REGULATIONS. SyU fin."..: ( 2 04 Re-roofs Si sure of ADplian onem HAZARDOUS MATERIALS DISCLOSURE1— Type of Roof '1 Will the applicant or forum Wilding Occupant store or handle townsman materiala dcfnad by Ne Cupertino Municipal el Cadc.Chepmr 9.12.and the Health and Safety Cadc,Serum 155324? All roofs shall be inspected prior to any roofing material being installed. Lit0rs Yes ),Nuill the applicant or future building Occupant use equipment or dcvlas which haIf a roof is installed without first obtaining an inspection,I agree to remove mit hardnus air canmminan,s u defend by the Bay Area Air Quality Managementall new materials for inspection. District ���[[[ OYes ¢J No I hove mad the hasamausm mer als requirements under Chapmr6.95 ordm Calif.- ria Heetth&safetyCedc,Sermon 15505,25573 and25534.I understand Nazifthe building does not currently haw'':neon,that it is my reapansihility in modify the oecupat of the uiremcnm which mush metpoor m issuance of a Ccrofinte of u Signature of Applicant Date weer sir eu,harirad,ycm D,�n_ All roof coverings to be Class "B" Or better CITY OF CUPERTINO, em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . : 35618011 . 00 DATE ISSUED. . . . . . . : 07/27/2004 RECEIPT # . . . . . . . . . : 26465 REFERENCE ID # . . . : 04070175 SITE ADDRESS . . . . . : 21640 EDWARD WY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER NIVI PADHY & MANO PUTHUKUDY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4765 RECEIVED FROM . . . . : NIVI PADHY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : NIVI PADHY & MANO PUTHUKUDY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4765 TELEPHONE . . . . . . . . : •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 20, 000 . 00 277 . 56 0 . 00 277 . 56 0 . 00 BPFIXTURE UNITS 3 . 00 27 . 00 0 . 00 27 . 00 0 . 00 BPLANCHK PERMIT FEE 277 . 56 370 . 40 0 . 00 370 .40 0 . 00 BREMAPPLI NO OFAPPLIANC 2 . 00 14 . 04 0 . 00 14 . 04 0 . 00 BREMFIXT NO. FIXTURES 2 . 00 2 . 40 0 . 00 2 . 40 0 . 00 BENERGY PERMIT FEE 277 . 56 133 . 23 0 . 00 133 . 23 0 . 00 BREMNRAPP NO APPLICANCE 2 . 00 9 . 60 0 . 00 9 . 60 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMRECEPT NO. OUTLETS 12 . 00 14 .40 0 . 00 14 . 40 ' 0 . 00 BREMVENFAN NO UNITS 1 . 00 45 . 39 0 . 00 45 . 39 0 . 00 BREMVENSYS NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 BSEISMICRE VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 . EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1021 . 39 0 . 00 1021 . 39 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 1021 . 39 VISA TOTAL RECEIPT 1021 . 39 OWER-BUILDER VERIFICATgN 1. (Check one) I or my immediate family (parent,spouse or child) will perform • A All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City, Phone # State License # Type of work to L..P..-C..�...7 VG C .VL4M" 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or ' portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City Phone Number Type of work to be erformed .......................................................:............................................................................................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signature: Date: t'1' z i —0y Job Address: 2,1 6I 6 D Ed wzt VA CLP t. &,wo Permit# O 7 01 7,S' CA- aISO )L, AM chanees to the information provided on this forfn shall be submitted to the City of Cupertino Build Devartment. • City of,Cupertino Building Department I p4CITYF 10300 Torre Avenue • CU PERTINO Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required bylaw to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensation. contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the US.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder . building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors maybe obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacrariiento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. " 1 Very truly yours, Building Deparhnent, City of Cupertino . Printed on Recycled Paper *CITY OF CUPERTINO* LUPE TING PERMIT APPLICATION FORM O � 67 b 7� R N# 3 Date: Building Address: Mailing Address (if different from building address): 40 F oayd wA C Yt' v, o CA- 01S01 Lq Owner's Name: 0 Phone#: N NI PAt> M-/ o MANO PUTHU (<UD Og 77 07x7 Contractor: License#: W V1 fA Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: t en., rc•n ccC2( - vul.,> tp.l j t 3 h e w FCL b of Residential (� al 2rwo a W*AS Commercial ❑ � -Sq.Ft. Floor Area: $/Sq.Ft.: 21 .5 Cost of Project: V P Occupancy Group: a 0oa Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard Se Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Grou - BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL. BBOILER3 Boiler> 500K to 1M 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1p 1 of 3 WITY OF CUPERTINC* CUPEIZLTINO 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 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 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 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 cfm MECHANICAL 2 BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL Z BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREAUNHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL 2 BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE 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 I Remodel Res Appliance ELECTRICAL 2 of 3 r ^ WITY OF CUPERTINOO CUPE 0 PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 Insection 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3of3 1 V a CCA- 9S0 y a ► 6'1 d �d �..�a�I �.J , � etit-�� r is t' io 9 _ 111Ponw cuRei Dbt Cook IN ANORDANC€ WITH THE CITY 0, p vcr• t°r @4 OTIND CODE$ AN ORDINANCES *T 7 2 S� d Th4� tel ® nit afieadons m —� 4 4010% Ik+is Iob at oR M es and it is un 400 % M141 edy Chafl$e or aIle y� % %im b coot written rmissiaa f r tkt@ Wft Dot., City of upertim O� ifs td$of this Plan a speci&a F (1pP ta0 bald to pe it or,to ba a 0t rite ftbd n of, mr to Oidunce at tmY, r as JUL 27 2C34 CFV OF cu. OFFICE COPY t 10 2I6yo &I LiCA� � e-�t'��, C4 �iro)9 ca' N �� c � y .hal NI 11� or 0 "I iC9l y N ys N U G U ••FZLL —+ V ]9 _ _ _ _ _ _ ___ _ _ _ J _ o y , IEZ-00 o m Q j v n , 0 �1]j 0 0 0 O mr �C m � g j ( it l N IIS ``0 lY Q m C �c9 G n OI Ij u 0 p .m n �.f al O 0 _ . _ _. _ . - J s 0 s ICD x E � r � '� a aZ3 ao CI i E"LZo9 .. az'd3a9e 9L9PJN 9L9EM FZTiy —e �%L r r a. WII .zL)f--.9E .9f —n CITY'0' .OZ—r L" �itl4r Z a • Cn tT s ; ' (ti �f cL•-ems., yy •�Yi li :-�w1w tAh 17 Ry tj -4 t". V, CJKt' I it 1Y F4i41- xl I