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04060021 CITY OF CUPERTINO PERMIT v au UPON, BUILDING DIVISION BVILDING ADDRESS: PERMIT NO04060021 1,TRRRTY ("P OWNER'S NAME: PERMIT ISUEDATE MALA MENROTRA E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Yo0 LICENSED CONTRACTOR'S DECLARATION O O O 1 hcrcb,affirm tar 1 am licensed under provisions of Chapter 9(commencing Job Deseriodo �� with Section 71)(a))la))of Division 3 of the Business,and Remotions Coda and my license is gdl in full force and effect UPGRADE PANEL 200 AMP a License Clue Lie.« JUN lo- 2004 — Dau wned Go , ARCHTIECI'S DECLARATION �i I understand my plans shall W used u public medNs 5�a BUILDING Licensed Piaksoonal OWNER-BUILDER aamnaDECLARATION j:<F I hereby.(firm that 1 1. exempt from the Conlns Coo License Law for the is O which re moon.(Scotian Icon LA Business and improve, de oli Cade:My city or county 5$ which payuime a permit ac cnnswcL Blur,improve h Permit t or mash any uderm m _Zy thnnn at hes itsIssuance,for also acquires pro isionsof for uchpermiuofdeasigned maumem (commeslkcnud PSewsn7000)of Divisio of the s Businohnd Proflaw(Chapur9 Sq.Ft.Floor Area Valuation $ Met he Is (commencingwishSermon and the Division f r armsBusiness �xe andon.fAny vi Cndn)of ., That he Is eumpl therefrom and Ne owls for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty oIN Z01r ibcr0 0 Occupancy e not mom than five hundred dollars(550)). P Y '7 7;�P ❑I.a a owner of the property,or my employees with wages as their sole compensation, will do the work end the structure is not intended or offered Tarsale(Sec.7044,Business and Professions Cook:The Convenor's Licence Law don not apply an an owner of Required Inspections property who Wildsm improve,thereon.mol whodas suchworkhimulforthroughhie own employees,provided that such improvements are notirm nded ooBemd forstim.If, however.the building or improvement is sold within one Sear of completion,the owner. builder will have the burden of proving Net IN did not build or improve for purpose of In.). as awns,of the property,am isch"vely connecting with licensed ronvacon to destruct the perfect(Sec.7044.Business and Profvvans Cade:)The Contractors Li. cove law doss imalmly in an owner of property who builds or improves thereon,and who contracts for hpmjecn with aco mucor(s)licensed pursuant in the Contractors License law. ❑ m lae tun rSe. ,B&P Nie son Can / au K EN D RATIO 1 herelam, by I -underpevllY o(pe0ury the follow' sllons: 1haveand will maintainaCa r3mmofCoventmulf-insumfarWaM1eraCompen- ulion,as provided for by Section 3700 of the labor Cade,for the performance of the work for which this Permit is issued. ❑I have and will maintain Workers Compensation Insurance,as hequmed by Section 3700 of the labor Code,for the performance or the work for which this permit is issued. My Workers Compensation Insu .carrier and Polity number art: Cartier. Polity Na.; _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (tris enation need not W completed if the Permit is resume hundred dollars($100) nr IcssJ 1 certify that in the performance of the work for which this Permit is issued.I shall not employ any person in any manner an as in become subject o the Workers'Compevallon Laws of Califonia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become i ubjecr in Ne Workers Compensadon previsions of the labor Code,you mum .JO forthwith comply with such Provinces or this permit shall be coupled mwsked. CONSTRUCTION LENDING AGENCY [—ice Ihereby Mr.that then misconstruction lcndingagenq for the poicrmanxuf pi the work fur which than permit Is issued(See 3097,Civ.C.) Q Lender's Name =z Lenders Addma, V Q 1 certify that I have mad this application and sou that the ehme information is F Correct.1 agree to Comply with all city and county Ordinances and Nle laws palating to QO building construction,and hereby authorize,representatives of this City to tour upon the move-rommoned Property for inspection puryeses. (We)agree to save,indcmm(y and keep harmlom the City of Cupertino against y liabilities,judgments,coma and expenses which may in any way..me a Sam..said City Uz in consequence u(the gra go(thia permit. '" APPLICANT UN E ANDS AND W C PLY WITH ALL NON DINT Issued by: Date SOURCEREGU ONS. o Re-roofs Signature uta ont ser HAZA DOUS RIALSDISCLOSURE Type of Roof the applicant or future building occupant sore n hart usmaunial as deM by to Cupertino Municipal Code,Chapter 9.13,and Ne Health and Safety Code,Suction 2553x(.) All roofs shall be inspected prior to any roofing material being installed. Yrs o Will the applicant or f lu builtling o<upam tau cyuipmenl dr devices which If a roof is installed without first obtaining an inspection,I agree to remove it haaardous air comamina s u dcrined by the Bay Amo Air Quality Management all new materials for inspection. 7docanotcu strict? ❑Yes I have road the hvaal male' Is rtquirtments unek,Clspur6.95ofIMCelifor- HulN&SafelyCode,Seed 5,25533 and lundcrNndthmifthe Wilding qtly have a un Nal i s y ms sibil'y m ndtilj the ocupanyt f'N uirements muss ctpni a fa nifueteofOccupanq eyfreOfApplicant Dale if r:amdr I p All roof coverings to be Class"B" or better INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO . PERMIT INVOICE OPERATOR: christya Sec : Twp : Rng: Sub : Blk: Lot : APN 35611070 . 00 INVOICE DATE . . . . . . : 06/02/2004 REFERENCE ID # . . . : 04060021 SITE ADDRESS . . . . . : 914 LIBERTY CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MALA MENROTRA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4018 CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : . FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE - --- ------ - ----------- -- - ---------- ------ ---- ---------- CT SVCS 600V <=200A 4117 P 27 . 25 0 . 00 27 . 25 SEISMIC FEE RES 2013 P 0 . 50 0 . 00 0 . 50 ELEC PERMIT ISSUANCE 4117 P 35 . 52 0 . 00 35 . 52 ------------ ---- ----- --- --------- --- 63 . 27 0 . 00 63 . 27 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • D yv6 t7oz/ 16 CITY OF CUPERTINO CUPEt�TINO, PERMIT APPLICATION FORM Ah APN# ��?z ! �- 0 Date: :�z Y!T Building Addre , M ' ' Addr s differ*t from uilding address): Owner's Nam � hone Contractmn� / �v License#: Contact:y Phone:/� y+ Cupertino Business License#: L� Fax: b n Building Permit Info: Bldg ❑ E19KEl Plumb ❑ Mech ❑ Job Description: I' / Residential ❑ `-d ercial ❑ Sq.Ft. Floor Area: �2 G 0 ���f $/Sq.Ft.: Cost of Project: it OccupanGroup: Type of Construction: Cly Please eck this if the project is a 41 1 second-sto a dition: ❑ Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group 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> IM 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 1 of3 • 2� 0 'r CITY OF CUPERTINO CUPEI�r 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 BPINfERCEP 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 rinkler/Backflo PLUMBING BPSTORM Stomi/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING lop BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAEUiAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFLXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL 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 BREEMRESAPP Remodel Res Appliance ELECTRICAL ! 2 of 3 CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM ua tity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Issue PLUMBING PPLBG PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3