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05060191 CITY OF CUPERTINO ea�' ryzaa� . p�^ BUILDING DIVISION PERMIT �OL\xL� � �RI11F NYlk y $' '4f .E't'/.'.'4.- BUILDING ADDRESS: PERMI"'05060191 NOO5060191 OWNER'S NAME: PERMIT ISSUE DAIS Ahk VIJAYA PARUPALLT ONE: SANITARY NO. CONTROL NO, ARCHRECTIENGiNEER: BUILDING PERMIT INFO BLDO ELECT PLUMB MECH a86 LICENSED CONTRACTOR'S DECLARATION r� I hemby affirm that I am licensed under Provisions of Chapter 9(commencing Job Description with Section 7000)of Division 3 of Ban Businnss and Profmdons Cede.and my lie.... ^ in full fora end critics. it. Lmenseclass Lie.0 aS' UPGRADE ELECT PANEL (200AMP) Dam 9- '_7 cmucam"r CONTRACTOR: ROOMY ELECTRIC. RCHRECrS DECLARATIO 1 andcmunJ my pedes shill bo mind u public records Licensed Profcummat OWNER-BUILDER DECLARATION Faf 1 borchy.(firm that 11. exempt from the Codons o License ty for the F.O o which ire mean.(Section]const Bmine44 and in.de lura Cade:My city sur auhny n 9r whichm9uirosapctmit recnnsvueLalar.nt for suh remits fiempair mygned shruetum �(+�,'1/.". ', �ja(�' Ny Bud heor R,iucensencrmant also Wires Revision o far Commacm's Lice se signed wtement s < Nat(commis licensed purnant Wthe provisions of the Conencing with Section 7ODIB or Division 3 or the usines'a License law(Chafer9 Sq.Ft.Floor Area' �•��` t/ �]s and professions Code)ou valu4)2000 Net he is..pt therefrom and the basis fm to allojed exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant W a civil penalty of AFN Number ` Occupancy Type eat mom than Rw hundred dollars($500). 6 El1,uownerofthepropmy,army employer with wagesa B¢irwlecompewtlon, 375050,30 .r0pv _ will do the work,and the structure is not intended or offemd fonah(Sm.7044,Bothnia L—))It i r(; '+A+ver and Proleuion.Cade:The Contractors uame Law does ret appy k,an owner of L�jI ft Required Inspections property who builds orimproves Nerean,and whii auchwork himanifor through his `vtJQGI (1 own employee;provided that such improvements w mat intended eronered(resale.if. V heammu.Ne building or improvement is sold within ane yearof completion,the awner. builder will have the burden of proving that he did not Wild in Improve for purpose of um,). 0 1,as owner of to propony,am eaclmively convecting with limited conuacton W constsam the pmjca(Sec.7044,Business and Profmdom Code:)M Conmemrs U. mn¢law does not apply N an owner of property who Wilds or Improves do m in,and who convects fic such projects with a cintracWr(s)licensed pursues W Be Contractors License Law. 0 lomesemptumer Sec ,Bk PCfmrlhlsmamn Owner Data WORKERS COMPENSATION DECLARATION 1 hereby of ivn under penalty of perjury use of the following declamtlem: 1 have and will maintain a Cenificam of Consent W selFlnaum for WorkersCompm- 137M lon,u provided for by Sce on 3700 of the later Cole.for the performance of Ne rk for which Nis permit is issued. 1 have and will maintain Workers Compensation Ins marIm,u mouthed by Section of the Labor Cade,for to performance ofNe work for which this persk is Issued. yWorkedC�pmype it Inw11F ca�Lr,Icr and Policy number am: rrier. dLf/12 Il4poh I O'll-I� Policy Na.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thio scalae need not Im compmed If the permit Is ferone hundred dollars($100) or leu.) I Unify that in the performance of the work for which this Permit is issued.I Nd1 not employ anyperson in any mannerso u in become subject W Ban Wortas'Cmmpeosa0on Laws of California Deal Applicant NOTICE TO APPLICANT:If.after making this Cenificaw of Exemption.you should become subject W the Workers Compensation provision,of the labor Code,you must O O foMwith amply with such provisions or this Permit Nall bo dcemed revoked. y y CONSrRUCOON LENDING AGENCY (� 1Wrohy.frum Nat Nem Its construction lendingagency for Nc perfmmancc of pv,i� Ne ,it for which this permit Is issued(Sec.3097.Civ.C.) aA Iancier's Name Q z Lenders Address f)Q I«Nfy that 1 haw read this application and solo thin No above Inform W a is IL correct.l agree W comply with ell city and county oNinancea and sure laws mlating W Q building construction.and lamb,authorise represematives of this city to color upon the {d7 above-mentioned property for impaction purposes. L�,y,Chh (We)agree W save,indemnify and keep harmless to City of Cupertino against 6,s r/1 Inumiiuea.judgments,ants and cap.which may in any way ace.agtirst said City V 7 in consequence of the granting of this permit. F APPLICANT UNDERSTANDS A IT ILL COMPLY WITH ALL NON-POINT Issued by: Date 6,-,2 rdeflned U NS. Re-roofs ppli nV onLrnr w HAZARDOUS M IALS DISCLOSURE Type of Roof caPplinm ser(atom Wil ng eccupantmaremlundhe hundam material the Cupenina Municipal Code.Chspier 9.13,and the Health and Safety 25533(a)? All roofs shall be inspected prior to any roofing material being.installed. e applicant m future Wilding occupant use equipment or dt which If a roof is installed without first obtaining an inspection,I agree to remove air comarriname,u defined by the Bay Area Air Quality Management all new materials for inspection. OYcs i2N. I have mW the hocardmasnoucrials requirements underchapmr1950ftho C.lifor- nisHcallhS:Safotycade,Smil.25X15,25533 am125534.1 underwd maifde Wilding does not oily have a motion.Nu it is my res�MD. t of the requi mywhichmust Signature of Applicant Date ow tet All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 11 OCF Fax(408)777-3333 �UPEI�TINO Bu.ilding Department JOB ADDRESS: Jq373 F ah e PERMIT# 6-50601 OWNER'S NAME: ViJa a le(A.Pnitt, PHONE # —o GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing v Electrical j C 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 bfner/Contra tune Da e acEoCITY OF CUPERTINO CUP fTINO PERMIT APPLICATION FORM APN# ��J 0 0 Date: 2 0 �� S Building Address: F9-3-73 rH i (, (fie Mailing Address (if different from building address): CU 21-t rip _� qi o( Owner's Name: -V(Jq r G rrnYU jCA((l Phone#: T.,,,,) Qq 6 _0�; 6 Contractor: License#: D MAIL Contact: hone: ) S" Cupertino Busirkss License#: Fax: Building Permit Info: U Qhe� se�vic2 .. 2o�Ar"r 'r Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: � e' GtiGh�e Residential r Commercial E) Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard � Laze ❑ Ma'or ❑ 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> 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 di BINVESTIGA Investigation fee BUILDING 3 � � �P � 1of3 CITY OF CUPERTINO CUP Eif�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMNIE New Comm Electric' ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTUVIE 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING go BPTRAP Kitchen Trap PLUMBING go 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 BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMEEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus —ELECTRICAL BRENR RAPP Rem Non-Res Appliance 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 Remodel Res Appliance ELECTRICAL 2 of 3 1' CITY OF CUPERTINO m PERMIT APPLICATION TORM CUPERTINO Quantity Fee 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 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 Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3