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05060029 CITY OF CUPERTINO 777 BUILDING DIVISION PERMIT v, BUILDING ADDRESS: CUPERTINO PLUMBING 11111%5 0 6 0 02 9 insin PTNF.VTT.T.R AV OWNER'S NAME: PERMIT ISSUE DATE SUJATHA KUMAR 10297 S DE ANZA RT,V nr rLo.3.42ons ONE: ( SANITARY NO. CONTROL NO. 408) 253-0618 BUILDING PERMIT INFO LOG MBCH ARCHITECUENGINBER: -TE, ts PLUMB LICENSED CONTRACTOR'S DECLARATION I hemb,affirm the,I son licensed and.,pro,eki...of Chapter 9 m.ounmml.g Job Description with on 7").f DiAsima Sof Me Business and PmRsisturat Coromod my license is axuy i flit d fr Zmeffia7=1 a," a Lie.1 61 REPIPE/WATER SERVICE & Damcue WATER HEATER ABC— 0% I u m.sh bl, mcmdz CR OJR_a U LARATION aiwoes, I hereby aRmt that I am exempt from the Commuctoes License Law for the EQJfollowing mason.(Section 703 1.5,Business and Professions Code:Any city or county which rectum a Permit to corrourset,shot,improve.demolish,or repair any structure, prior w its issuance.also requires Me applicant for each Permit no rile a signed staturrunt that bc is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valua (commencing with Section 7")of Division 3 of Me Business and professions Cade)err "000 Out he]A exempt detergent and the basis for the alleged exachoon.My violatkon of Section 7031.5 by say applicant for a permit objects Me applicant to a civil penalty or not...Man flw hundred delta.(M). APN Number' A Occupancy I]ype []1,asowner of use property.or my employees with wages as their sole compemunion, 36913031 9 will do the work.and Me mucture is not mumedext or ofifinal for sale(Sm.7044.Business vu and Profession Cade;Th.commemes Lkarrm Law does not apply ka an Owner of ns ,,quii&ICsp&ti8 property who buildsorimphares;thereon,and whodoessuchworkhrouselfor through his Zoo, draw employees provided that such Improvements she notimenothad croffered forsake.If, however,Me building or Improvement is said within on year ofcompletion,Me owner. I builder will how the burden of proving that he did not Wild or Improve for purpose of ole.). 0 1,as Owner of Me property,am exclusively contracting with licensed contractors to consumes the Project(Sec.7044.Business and Profession Code:)Tax Commacher's U. :,t5 came Law does not.,,dy man owner of property who Wilds at Improves Moment.and who contracts for such projects with a commomer(s)licensed passaged In Me Committees License Law. []lore exempt undo Sec. _.B&PCrWNis moon 0 Owner Dam Owner WORKER'S COMPENSATION—DECLARATION I hereby Lffirm under penalty of perjury msc�of the following dissimulator. I I have and will maintain.carificate,or cement I.self-i...mie,waftescompen. sellae,u provided for by Section 3700 of Me Labor Codo,far the performance of Me seem for Which this permit is issued. I have and will maintain Worker's Campomation Insurance as required by Section 1 3 of the Labor Code.for the performance of the work for which Nis permit is lauded. M" My We, rherardPolkyrournhe'arce: C.. ny� J, Policy No.; C'002 06" CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompicuad If the permit is Income hundred dollars($IN) or less.) I testify that In Me performance of Me work for which this permit Is issued.I mail not employ any pcsa m in any manner an as to become subject to Me Worlaus'Compergation Laws of California.Date Applicaum NOTICE TO APPLICANT-.If,error making this Certificate of Exemption,you should become subject to Me Workers compensation previsions of the Labor Code,you mug z forthwith Comply With such Provisions Or this Permit M811 W Lamed revoked. z 0 51 CONSTRUCTION LENDING AGENCY I hereby affirm that them is a counteraction lending agency for Me performmw of the work for which this Permit Is issued(Soc.3097.Civ.C.) Lanclars Name Lender's Address U 0 1 certify mat I how read Ods application and suge Mau Me&how information Is correct.I&&me to comply with all city and county ordinances and scale tam relating to building construction,and hereby sunhorim representatives of Nis city to enter upon the above-mentioned pmpcny,fm Inspection pure L a a he ve.indemnify and�y�rle�m i.1, lCupcatirotaginst remads 'in anyway liabilities,. n age and a. CL againstsaitiCity U in coming of ,grant of Nis Fl APPLIC ifis C PLY WITH ALL NON-POINT Issued by: SOUR DS, Re-roofs 6--3 "wra rx"T.cmucormanuff Data HAZARDOOt�ALS DISCLOSURE Type of Roof Zioll the applicant or future building mcupitntstom orhandle haushious maturial as cleffined by Ma Cupertino Municipal Code.Chapter 9.12.and the Health and Safety (W 1 8 0 J eN U 5wq or I Rc�� A AIIIEndo.Scnumn 25532(m)? All roofs shall be inspected prior to any roofing material being installed. Yes tSN. Will the applicant or future building Occupant use equipment or de-Acca,which If a roof is installed without first obtaining an inspection,I agree to remove it haxamlous air conumninams as defined by the Bay Am Air Quality Management District? all new materials for inspection. Oyu AN. I ham madhAnsuclous materiallrequiruments undarCluiputurri.95 ofthe Califor. niaH.a]Lh&Saf yCWc& 305,25533md25534.lundenwdthmi(Lhe building does ImI care ly hiss met ThatittMYMPGmibiliiymw6lytie=upwlofft require h* r to Instance of.Certificam of occure Signature of Applicant Date 0!3 �4jg�. - (d, - )Date All roof coverings to be Class "B"or better acloF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT # 65-0�vO0 29 /o5-/o Plrle VIIle, jTye OWNER'S NAME: v ca+ha (jrY2r PHONE # yOg `SloS'80Co�1 GENERAL CONTRACTOR a Wymbinq I PIG FAX# y0 2" a,7?5 I am not using any subcontractors: 3-6 Si Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing rw Pium&no We toi Roofing Septic Tank Sheet Metal Sheet Rock Tile 0 er/ ontractor Signature Date f CITY OF CUPERTINO Z, a D 2 CUWco PERMIT APPLICATION FORM ERTINO oS d N# Date: Building Address: Mailing Address (if different from building address): 16glo -Pnc illi Ave- Owner's Name: Phone#: Contrac r: License#: C . GPZNgO s- Contact: P ne: 25`5 O(.vl g Cupertino Business License#: Fax: 253 D '7 I Building Permit Info: Bldg ❑ Elect 2 PlumbX Mech ❑ Job Description: appe✓ p&pe Servi &e "I-6r NCa+cr Residential 19 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: b SOQU , Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ 11kro'ect 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> 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 BINVESTIGA Investigation fee BUILDING 1 of 3 ar(u. CITY OF CUPERTINO COPE WO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING 13MITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTINM Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 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 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 BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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/Alt r Heatin MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO IT o CUPEf�TINO PERMIT APPLICATION FORM 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 Insection BUILDING BSWIN4 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING op ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNU TFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3