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06030131r L CITY OF CUPERTINO k , , � � BUILDING DIVISION PERMIT 1,'CONT U"GTORINFORM A, Tib' BUILDING ADDRESS: PERMIT NO. 7712 OAK MEADOW COURT OWNER'S NAME: PERMIT ISSUBDATE h KIRLOSKAR, BRANDA 03/23/2006 ONE: SANITARY NO. CONTROL NO. ARCHMECT(ENGINEER: BUILDING PERMIT INFO BLDG MECH In 17--1 E9 LICENSED CONTRACTORS DECLARATION Job Description I hereby .111. that I A. licensed under provisions of Chat-, 9 cnis with Section 7").fDIA.i.n3.f,h.Buti�.Professions MaC SERVICE PANEL UPGRADE 220V/200AMP in full force and effect. Licenm Clas LIC -8 Dam Can.., ARCHITECTS DECLARATION I understand my plans Mall W used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractori License Low for the Following moon. (Section 7031.5, Bushass and Profamimis Code: My city or county $1800 which implies a Permit to construct, after, Improve, demolish, Or mirth, any SUKLUM poor An its Issuance. aim requires the applicant for such permit to rite a signed statement Ft. Floor Area Valuation Chat he is licensed pursuant to the provislam of to Contractors License Law (Chapter 9 Sq. (Commencing With Section 7000) of Division 3 of the Business And Profession Code) or Met he is exempt therefount and the MIS for the alleged cumindon. my violation of umber Occupancy Type Section 7031.5 by Any applicant for a permit subjects the applicant 10 A Civil PCUIIY Of Am .. than five hundred dollars (M). 0 1, a avorter of the Impiety, or my employces with wages As their =to compensation. Required Inspections Will do me Work. and the suracture is not intended or offered for tale (Sco 7W. Business and Fict(on, ons Code: e C.musesuart, Liam to LAW does an, apply an owner of h property who build, mi innw thencon, and who does such Work Waselfor through hit own employees. provided that Rich I.P.Onts an not intended or -flered fee Sam, It. however, Me Wilding or improvement is mid within can war of complexion, Me ovor- Wilder will how the, buNCn of pmving text he did not build or improve for purpose of Sam.). 1-] 1. AS wair of do protons. am exclusively comursed, with flosmod controacras in construct the project (Sec. 7041, Business and Profession Code:) The Commucter's Ll - come Law COCA not Apply 0 an onmer, of Property whe hads" or Improves thumers. And, who Contracts for Such pmjcm with a comuscorr(s) liceresed pursuant in the Cofluramor Lic-on, Law. 0 1 am exempt under Sec. B & P C for M Moon Dome, Dem — WORKERS COMPENSATION DECLARATION I thereby AM. under Family of perjury one Of the following declarations; -11 have and will maintain aCerthficame of Consent toself-insure for Worker'sCompon. salon, an provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. 0 1 haw and will maintain Workers Compensation hounince, a required by Section 37W of Me Labor Code, for Me performance of the work for which MIS permit is Issued. My Worker's Camilmosailon finsuracreca carrier and Policy number AM: Policy No.: 11(6 A§tFIC—STE 85MMPTION MOM WORKERS' COMPENSATION INSURANCE [Thils Section need not Wcompleted If the Permit Is formic bundmd Wllva (SI W) or Cox) I Certify In., I. the pa,farman'. of the Work for Which this Permit 4 hamed, I Shall not C.pl"..y portion I. my nuarant. As as becomen subject in the Wr1mrs-CorpFccontim. laws .fCalif.im. Dam Applicant NOTICE To APPLICANT. If. After making this Certificate of Exemption. you Should became subject to Me Worloar's Cominoneation proWisimis of the LaMeArCeim. you Must forthwith comply with Such provisions. this permit shall z decioul revedrod. CONSMUCTION LENDING AGENCY I hereby &Mm that Marc is a comusureactinn larding Agency for Me pcifearrosec of Ne work four Which this permit Is issued sm 3097. Civ. C.) Undoes Name Landers Address 1 certify that I haw send MIS application and sum Unit the &Win Information is correct. I Agree In comply with all city and county ordinances and state laws scaling M building construction, and hereby mithorin repoesonaftimi of this city to enter upon Me above-mentioned morwrty for inspection purposes. (We) agree to on, indemnify and keep Notion the City of Cupcnino againat flabiliflea,judgmcriu, costs and exiscruct, wh c 4y In any Way accrue Against mid Chy In comixtucocc of the jimptim; 3 perm) APPLICANT UNDERSTAN AND W L MPL WITH AL N -POINT Issued by: Date 3-2-3- C14C SOUR c&IjEOULaWS. Re -roofs Type of Roof IA, Y--2-9-04- Signature ol'ApplicamfCoromessor I DAM HAZARDOUS MATERIALS DISCLOSURE Will Me applicant or future building occumantsbere or handle haxamalous maimitat AS deffired by the Cupertino Municipal Cock. chapter 9.12. and the Health and Safety Code. Section 25532MI ❑ Yen All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove kmh."Wil"t pplicital or future building Occupant me, equipment Ar dcvicxs which air coommincou . &rimml by Me Bay AMA Air Quality Management all new materials for inspection. 0 Yet 14N. I have read the hoardous materials imMAAuMli Chapter 6.95 Of Me ifor. Q 3# ;aisinanduairthe building MaH.IM&SAlmyCodo. 50�. 53 a, 255 .1 =f1m.111 Joos oil xuarrouttly how Y , noun ty in y Me occupant of the A Y ' ty -* 4ruta"Tr ocquiparrcr4� no arm OWN.. ocoupasncy. Or. C, Signature of Applicant Date it "B" —19e All roof coverings to be Class or better Owner or auffionSirigant Dal 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36626014. DATE ISSUED.......: 03/23/2006 RECEIPT #.........: 33701 REFERENCE ID # ...: 06030131 SITE ADDRESS .....: 7712 OAK MEADOW COURT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: KIRLOSKAR, BRANDA ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: PVS ELECTRIC CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... TELEPHONE ........: OPERATOR: bethe COPY # : 4 !EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT __________ __________ 172.80 0.00 __________ ---------- 172.80 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ OTHER 172.80 ------------------ AMEX TOTAL RECEIPT 172.80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL -------- 501 -----------------------_---- FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 0 aClOF IOUPEkTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building De artment JOB ADDRESS: viz. OAK N�pow PERMIT # / 3 / e960,10 OWNER'S NAME: I o1ALOS bLA./L PHONE# 40OZZ GENERAL CONTRACTOR - VS j L.: FAX # a a 17B6 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: • pcc� T -Z3.0116 caner/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical ? -1�7V C 8 3 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 • pcc� T -Z3.0116 caner/Contractor Signature Date COTY CUPEP,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM 06030)-31 APN # 36 -a6-mit Date: `�-23—C/ Iffailding Address: Mailing Address (if different from building address): LM Owner's ame: Phone #: Contractw: License #: �3� 44 2/ BBOILER2 Contact: Phone:f6aZZ4 /7OC7� Cupertino Business License#: Fax: u u 1708 Building Permit Info: _:5GAatc.�'=v oaAr-vMe-- '0' 412A',06- Bld ❑ Elect . Plumb ❑ Mech ❑ Job Description: Residential Commercial El Sq.Ft. Floo Area: q.Ft.: Cost of Proiect:Occupancy i8d O GrOUD: Type of Construc 'on: Please check this box if the project is a ❑ �rM�✓IGi NGL- vQ.6/2A,0r I second-sto addition: BCONSTAX Ind/Off/Comm/ nasi ro'ect Size: Standard Lar e ❑ Ma'or ❑ BCONSTAXBQ CJ Quant Fee ID 'Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBDILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3. Boiler > 500K to 1M Btu MECHANICAL BB0ILER4 Boiler> 1M to 1,75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ nasi 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 I BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING E 1 of 3 !I . lell Y V.V %, U1.L'Jl\11 .V PERNUT APPLICATION FORM 2 of 3 cn,p: CUPERTINO CITY OF CUPERTINO PERAUT APPLICATION FORM Quantity Fee ID Fee Description Fee Grou BREMSIGNAD Rmd1 Si 2ns Add Branch ELECTRICAL BREMSIGNS Remodel Sims. Mar we ELECTRICAL BREMTHEATR Theatrical Li2htinz Fix . ELECTRICAL BRENIVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation S stems AIECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOA4 Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecial hispection —B -DING BSW]M swimmin Pool 'BUILDING BTEAIP Temporary Power ELECTRICAL BTENTPEi RM Temporary Bldg Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERAII.TF'EE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERNIITFEE Mech Permit Issuance MMCHANICAL PPERNUME Plambine Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC planning LR Commel Mniti-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3