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03110058CITY OF CUPERTINO "'r' " e �' r' *111 BUILDING DIVISION PIJRMI'I' CQNTRAcrro &PORMATION .' P$g+ :F,hd ♦ v rV. IY/i{. £ 5 1.. `� 'c 1 BUILDING ADDRESS: - DELTA ELEC PERM IT NO 03110058 '1974 OWNER'S NAME: 724 COLLEEN DR PERMIT ISSUE DATE RAHULDEO VADODKAR 2003 NE: (408)224-0176 SANITARY NO. CONTROL NO. ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description led 1 hereby affirm shat 1 em limnunder provisions or Chapter 9 (commencing P with Section 7010) of Division 3 ser Ne Busines end Pmfcssions Code, and my license is in mommas erreffecClassLicense ADD BRANCH CIRCUIT/BEAKER ClLIC Dam Contractor ARCHITECTS DECLARATION D 1 understand my be used es mcnrJs / Planuhall public � cry-T\p Licensed OWNER -BUILDER DECLARATION I heresy affirm thin I am exempt from the Licence Law for the hereby affirm �_:� followinglesson.a alter. and femonelor, Tf13 L5, Cole: Any tiny or county whirs inquires a permit re construct, alcor. impmve, demolish, sir repair any structure perm(Sccit t t, improve, demolish. Prietoits cense primmrt to the pr applicant for such Permit RleseLaw(mmmem that him licensed punuenunlMpmvivisionf theeBusinaf and Sq. Ft. Floor Area Valuation Prulaw(C reel or is Division,th theeged m or 31635010.00 pit thandion]and di pl n. Anynmlattion thin he I. Nn he is evempt thertfmm and Ne buts for the alleged uemption. Any violal(on of APN Number Occupancy Type P Y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of hot more than five hundred dollars(5500). I, as owner of the pmpeny, or my employee with wages u their shale compensation, Required Inspections will do the work, and the sWctum ie nal intended oraffered forget. (Sec. ]014, Bmirvs, and Professions cane: The CanBacmr, License law does net appy to an owner or pmMny who builds or improves Ihcmon,and who does such work himself orthrough his awn employees, provided that such improvements art not intended oraRered for ale. IL however, the building or improvement is sold within one year of completion. the owner - builder will hale Ne burden of proving that he did not build or Improve for purpose of a1eJ. Z 1, as owner of the property, am exclusively contracting with licensed coninclors to cdrstrun the project (Sec. 7014, Business and Profession Code:) The, Contractor's Li. cense Law don not apply to an owner of property who builds of improve Ihemon, and who contracts for such projects with a comracmr(s) licensed pursuant o the Contractor's License Law. ❑ 1 am exempt undkLSCC. B A, P C for this neon Owe _ eyye t� 1 0 WORKS PENSATION BECWkR'/RI0. I ffolItlowing heathy affirm under Pcmlty of perjury one of Rhe declarninns: I have and will maintain a Cenificale, of Comern to self-insum for Worker's Compcn- ..tion, mprovided for by Section 37M of the labor Code, for Ne Performance of the work for which Niu i, permit is ued. ❑ 1 have and will maintain Worker's Compensation Insurance, a required by Section 371 of the labor Code. for the performance of the work for which Nis permit is Issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier: Policy No,: _ CERTIFICATE OF EXEM PnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be comPlemd If the permits for arc hundred doltara (Slm) ,it less.) 1 certify then in the performance of the work for which this Permit is iuued, I shall not employ any Person in any manner so as in become subject to the Workers' Cnmpe,madnn Laws of California. Dam Applicant NOTICE TO APPLICANT: IL alter making this Cenifseate of Exemption, you should become suhject 10 the Worker's Compensation provisions of the labor Code, you muss forthwith comply with such provisions or this Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm dun them is a conauunion lending agency for the forformmce of thc work for which this pond is issued (Sec. 3097, Civ. C.) Lendch Name Lender's Adding 1 minify that 1 have read this application and sure that the above information is x correct. I agree to comply with all city and county ordinances and,txm Iewi minting to building concoction, and hereby authorise representatives of this city to enter upon the above-mentioned pmpcny for impenion purposes (Wo) agree to ars, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against aid City in consequence of the granting of this Permit. APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE TIO 12/03 Re -roofs Type of Roof Sng tore of ApphcaluContracsor Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hvsrdoe material - Udefined by the Cupertino Municipal GOM, Chapter 9.12, mJ the Health and Safely dot, Section 25532(,)? All roofs shall be inspected rlor to an roofing material being installed. ❑Yes AN" P P Y 8 g If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant ser mime building aectrPam use equipment Of devices which it haafdnua air contaminants as &flO.d by the Bay Arta Ail Quality M .... count all new materials for inspection. torics? ❑Yes XNo I have mail the husidnos materials requirements under Chaplerli.95 of the Califor- niaBcalth k SafmyCadc. Section, 25501. 25533 end 25534.1 ionkri and un iflM building doe not co a come, 1, h w e tenant One i is my responsibility m nonly the Occupant of Ne re uimmen nbe Lon a sofa CcfsOeam f a q��w p��12p70 Signature of Applicant Date /D� All roof coverings to be Class nB„ or better Owner or inhori.d! agent CITY OF CUPEkTINO WK,coNP Ot 91 Z)I CITY OF CUPERTINO PERMIT APPLICATION FORM o w Z 3 70 1of3 ` 73/ I 0 N # 5` / / o Date: Id Building Address: 19 49 'I TTGupERT(N0.9 14 Owner's Name: RNHU LDCO v ADo D Y A K Phone #: 4-02, 446 !t. o o 3 Contractor: rz— L t_ License #:G, —I O H Z9 Ll 7 7— Contact: Contact: S FJ PN�c �N%S Cupertino Business License#: Building Permit Info: Bld Elect Z, Plumb ❑. Mech ❑ Job Description: + Residential G ` C"ol erc+ 1 Sq.Ft. Floor Area: Cost of Project: O Occupancy Group: Type of Construction: r Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > l 000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING w Z 3 70 1of3 ` 73/ I 0 CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifami] Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 Repipe 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAMIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 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 1 L 2 of 3 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMR.EPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 Sob 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 J fc3off ELI