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030800350C Z R, ( U C UC OF F CITY OF CUPERTINO Ga IZL� TQC j1YFORMATI0IV' BUILDING DIVISION PE MIT =, <.»„i i,,.; BUILDING ADDRESS: _ BETA CONSTRUCTION PERMIT No03080035 OWNER'S NAME: 476 S. 2ND ST. PERMIT ISSUE DATE GANGADHAR GADEPALLI E: (408)295-1919 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACT'OR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 701)(B of Division 3 of the Business and Professions Code, and my license is in full theta and effect. • ( (> .6 meLic. C ADD CENTRAL AIR�AC PIIVALED License N Date Class B� Contractor ARCHITECTS DECLARATION he used as records -JAN 2 7 2004 I understand my plans shall public Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 .m exempt from the Contractor's License Low for the BUILDING maso It 7(onstr Business and Professions Cod,: Any city or county rearm permit reconstruct, improve, demolish, m repair any structure requires erten which re which 84400 Sq. FL Floor Area Valuation itsnseddaurdurtheres (be pplic fursuchpermiuufile aicense ned ! its issuance, aw(Calomem ovisiosofant : thalhcisliccnudpursuanunthcprovisinnsnfthcContracmriLiccnxLaw(Cheptcr9 that hes (commencing with Section 7") of Diviski of the Business and PTufessions CodcU r 3 7531028.00 that he is exempt therefrom and be basis for the, alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars MGM. O 1, as owner of the property, or my employees with wages is their sole compensation, - — tlOns will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Comments License Law docs not apply tu on ..or of 303 - ROUGH 1Ltt property who builds orimproves thereon, and who doessuch work himselfor through his own employees, provided that such improvements are not intended or offered faradic, If. 304 — ROUGH ELECTRICAL however. the building or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or improve fur purpose of 501 - FINAL ELECTRICAL ENERGY sale.). 502 - FINAL PLUMBING ENERGY `P 1, as owner of the property, am exclusively contracting with licensed contractors to 503 - FINAL MECHANICAL ENERGY construct the project (Sec. 7044, Business and Perforators Cade:) The Contractor's Li - come Law does not apply to an owner of property who Wilds or improves Imaxon. and , 505 — FINAL ELECTRICAL who contracts for such projects with a comractor(s) licensed pursuant to the Comracmr's 507 - FINAL PLUMBING License Law. O l am exempt under Sec. . R & P C for this ..on 508 - FINAL MECHANICAL Evert, Dam WORKERS COMPENSATION DECLARATION I hereby nation under penalty of perjury one of the fallowing declarations: Certificate of Conseno self -insure for Worker's Camper- and will maintain a u s tumor provided for by Section 37W of the labor Code, for the performance of the work for which this Permit is issued. O I have and will maintain Worker's Compensation Insurance, u required by Section 37W of Bic Labor Code, for the performance of Ne work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section n ed no ba Wropleted if the la:rmit it foronc hundred dollars($100) „ or leaf 1 ccnify Nat in the performance of the work for which this Permit is issued. l shall not employ any person in any manner so ante become subject to the Workcrs• Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject W the Worker's Compensation previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Ost LENDING AGENCY CONSTRUCTION there issued(See.0 lend7,Cis. agency for the performance of Thor by is a construction Ne work for which this permit is issued (sec. JW7, Civ. C.) which hi sc Lender's Name Lender's Address 1 ccnify that I have mad this application and sum That the above ws relating it building I agree m comply with all city and county ordinances and stem laws relating to of constructicil on, and hereby euthrrim representatives of this city to enter upon the dhowtg for Tnspecuonkeeppurposes. shove -(We) gon to averty (We)agme m save, indemnify and kith hay the City against accrue against costsand expenses miwhich may in anywayaccmc against said City in an F in or of this ePLICAN ec rf the --o 3 gaming permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT A v,,, Issued by: Date SOURCEGULATIONS. "�i'GtGs ✓ Al Re -roofs Type of Roof Silmuideof ApplTem/C.mIvcmr ban, HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haarduus motet] as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety ode.S Lion 25532(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONo If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which haardous air conmminanm a defined by the Bay Area Air Quality Management all new materials for inspection. i,t7 ❑ Yes ON. 1 have read the ha ardous materials requirements under Chpmr6.95 of the Cullom. 7dws ealth &Safety Code, Seeuuns 25505.25533 atd15534.1 understand that if the budding not currently have a renam, that it is my oxfortthility m nobly the occupsrt of the rements which must be mat pdpr to issuance of a Centfcls, of Occup cy. /+l//v.'_' Signature of Applicant Datecro All roof coverings to be Class "B" or better authrrisedvpent D e St CITY OF CUPEkTINO a CITY OF CUPERTINO PERMIT APPLICATION FORM MIRPN# 3 7S - _3) - 02 (� Date: l„ G - 0-5 Building Address: J-a� Mailing )d ss (if different from building address): r;p Owner's Nam Phone #: /,' 6 g .� 4 t 9(-O 'f Contractor: RG /J License #: Contact: Phone: o8 4 � B 8 �F �/ Fax: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech Job Description: 'Residential ® Commercial ❑ Sq.Ft. Floor Area: _e- $/Sq.Ft.: Cost of Project oo Occupancy Group: 'OIL Type of Construction: Cb a' z- Please check this box if the project is a second -story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL f BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING qW lof3 ��77.c>9 10 T -y CITY OF CUPERTINO CUPEI,TINO PERMIT APPLICATION FORM 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 Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTLME 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 rffiMerBackflo 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 clin MECHANICAL BREMAIRHAN 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 Fumace > 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 2 of 3 a0oz, CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group 3 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 P umbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 J •