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03010055CITY OF CUPERTINO BUILDING DIVISION PERMIT TRACTORANFORMATION w� 420 . BUILDING ADDRESS: WM H FRY CONSTRUCTION comp1my4jrNO. 20791 SCOFIELD DR 03010055 NER:SNAME: 10351 SAN FERNANDO AVE APPLICATION SUB DATE RAJIU CHAMRAJ 01/09/2003 [PHONE 4 O B 9 9 - 817 3 SANITARY NO. CONTROL NO. ARCHITECT,'ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S D[CLARA'1'ION 1ion70(dof ThalIem licenttillyrilerprovisionsof Chapter9(commencing - .lOb I�CSCrlptlOn with Section 7f011)of Division3nl Ne ss and Professions Code, and mylicense ia in 1.1 one,n rr,0. �- SZo"�B7a ADD 2 SKYLITES / UPGRADE ELECT PANEL en Cla Lis. At ConvtlA.O l�]C'� .�i t ARCallthaTSDLY[ARATIDN lundcrtand FIN /� a E® 1 FgBv v my plans shallbeuscd as public moths MAY 072003 �°'�-�Ln' Oa1�a� Licensed Pmfeasirnal OWNER-BUILDER am-BUILDER DE Ce hereby I exempt from the Contractors License taw for the . (See t. 1 ! sonsC Tei mason. (Section 71D1 5, Business and Professions Code: Any city nr county which alter, improve, demolish, repair any which requires a pmt in cores file namean; the, signed xtatemem prier to its issuance, also requires the applicant for such merino f Ie thouhe licensed am unbe sof the s S $3g�hfiLtion mencing otD Code) or (commencing Sec eBuinessnd Professions Section711(0)of Division3 ofsheeged BusinessandProfessions Cndc) or Nn u exempt tbemfrom and the Aura tat he pt Ibe alleged Any violation of Occupancy Occu anC Type P Y YP o Section Any its to Permit subjects Ne epPlicanna a civil penally of applicant l do][.. not more Nen fve hundred Jollan (g500). not m dra.5 five hundred ❑ 1, As owner of she pmpcny, or my employees with wages as their sale compensation, te Ved Inspections will do the wok, and the structure is not intended or offered for sale (Sec. 704,L Business Professions Code: The ComfortLicense Law does and not apply en en owner of 102 - PIERS PIER- pmperty who builds or improves thereon, and who does such work himself or through his man employees, provided that such improvements am not intended or offered for sale. If, 103 — UFER however, the building or improvement is said within one year of completion. the mvnep lO4 — REBAR builder will have the burden of moving Nal he did not Wild or improve for purpose of "le) 105 - ANCHOR BOLTS [1 1, as owner of Ne property, am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct the project (Sec. 7094, Business and Professions Code:)The Contractors Li- examlawdreanotapplymanownerofproWnywhobut]daortmproveatbemon,and ' 202 - UNDERFLOOR PLUMBING iien.wu for such Projects, with acnmraan(s)hansed pursuant to the Contractors License 203 — UNDERFLOOR MECHANICAL ❑ 1 am exempt under Sic. ,B&PCfor this rnamn 204 - UNDERFLOOR FRAME •wre, Dam 205 - UNDERFLOOR INSULATION. WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I herebyalfr under penally of perjury one of the following declarations: 3O2 — TUB & OR SHOWER ED 1 have and will maintain a Cenifcam of Comenno self insum for Worker's Comment aati m, as provided for by Section 3710 of the labor Code, for the performance of the 3 03 - ROUGH MECHANICAL work for which NisPermit isissued. 304 - ROUGH ELECTRICAL 1 have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 37(0 of Ne labor Code, or he due.... of the work for which this permit is hmed. yW rker's Compensation lnsumnce carticr and Pulicy num ram: ` 306 307 — HOEDOWNS - INSULATION CERTIFICATE OP [iXEMPf10NF 0 ORKERS' �T`�h� 0`PENSATION INSU E 308 - SHEETROCK (This aeaion recd net he complewd if Ne peril is for one hundred dollars o 1(A) 309 - EXTERIOR LATH micas.) 310 - INTERIOR LATH 1 crony that in the perfaron. of the work our which this Permit is issaed. I shat] not 311 - SCRATCH COAT employ any penton in any manner sit tee to become subject o the WorkersCompensation Laws of California. Dam 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOT ICE TO APPLICANT: I L after making this Cenifcane of Exemption, you should become Subject m the Worker's Compensation provisions of the fabs Cale. you must 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this merit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY Ihere byamrmmatCare isaconawmonlending agency Iorthe performance of 504 - FINAL BUILDING ENERGY the w r k Underfor which this permit is issued (Sec. 30y97. Civ. C.) erName 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Address 1 eerify Nat 1 have read this application and sum that the above information is 507 - FINAL PLUMBING correct I agree to comply with all city add county ordinances and state laws relating to building construction, and betehy, authorim representatives of Nis city to enter uptm Its, 5 FINAL MECHANICAL above-menlionedpmpeny for inspcnionpurposes. 09 FIWWORKS (We) agree m save, indemnify and keep harmless the City of Cupertino against liabilitics.judgmenu, costs and cameos which may in any way aecoe ageinv said Cily 5 PPLICpseq cncca OERSTANDSof tbt WI LCOMPLY WITH ALL N-POINT Issued by5l Date SOU C E LATIONS. Re-roofs Type of Roof Igna c fApplic..VCunuse r` Dam IIAZ R USMATERIALS DISCLOSURE iB she applicant or future building occupant tom or handle hamdous mmerial As tred by the Cupertino oal Code, Chapter, 9.13, and the Health and Safely e.Secfenzss3xaT1 All roofs shall be inspected prior lG an roofing material being installed. P P Y g gWill ❑Yea �Ni, If a roof is installed without first obtaining an inspection, I agree to remove ilding occupant use cyuiprom or devices which emit hacallous air ctudamilinrJ hythe Be, Arca Air Quality Managemem the applicam oX.I.i! all new materials for inspection. Dishier) ❑Yes ///��� I on. mad Ne hvaralsrequiremenuunderChapter695ofNeCalifor- rimllealN&Safety Cy�,Sudons 8(u9fff5. 553 d="ill untlaruan iObe Wilding Nes not c rtenty,lf a tenant, Na I i Pomibility m notify tbe et] and of Ne is m t e mat hemetp r eaf.Cenlneatearaeup Signature of Applicant Date 3 All roof coverings to be Class "B" or better tern nr""agent Date INSP. 'IT EAR OFF INSPECTION: INSP. DXITE PLYWOOD: INSP. _ BATTENS: DATE INSP. DATE IN -PROGRESS: INSP. DATE FINAL: DATE INSP, DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION CITY OF CUPERTINO BUILDING DIVISION PERMIT �s ECONTRACGTT6RINFORMATION BUILDING ADDRESS PERMIT NO. OWNER'S NAME: RAJTU CRAMRAJ 10351 SAN FERNANDQ AVE APPLICATION SUB DATE 01/09/2003 ZONE: SANITARY NO. CONTROL NO. ;o ARCHITLCTJENGINEER: PHONE N: ADD 2 SKYLITES UPGRADE ELE BUILDING PERMIT INFO IL" NEIELECT PLUMB MECH TCPAC= D O 'r +� I 1 /j< - U O ' t =c t— - :in, ".l"`�`yi- (' INSPECTION$ f %ATE 1INSPEP '''' 'J" TO ARRANGE INSPECTION CALL 777-3228 MONDAY - FRIDAY 24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS ANDPERMITaARENEEDEDWHENPIIONING. RESIDENTIAL _ COMMERCIAL_ OTHER_ HAZARDOUS FIRE AREA ❑YES If yes -I undersand that Clercs Arnnf asscmhly is required. E] NO misial IGe.o.a EXISTING ROOF COVERIN . Number ofesisting coverings To heremoved �o ber's1 T O F O :RING EXISTING: ❑ ihRoof BUILDING ❑AsAsphalt alt Shingles N ❑ Wood Shakes , D Wood Shingles ❑ Other(Specify) JOB DESCRIPTION RESIDENTIAL: ❑ SFDWI, [I ❑ADDITION ❑ ❑ MULTI -UNIT CISTRUCTURAL 0INTERIOR ❑CHIMNEY IMPROVEMENT ❑SWIMMING ❑BATA Ii13MODEL/REPAIR ODEMOLITION ❑ OTHER COMMERCIAL: ❑ NEW BLDG/ADDITION ❑ ❑ TENANT ❑ IMPROVEMENT 0OTHER PROPOSED: - ❑ Built-up Roof ❑ Asphalt Shingles Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Provide LCM0. Report No. Provide Mfgr. Installation Specs. KITCHEN REMODEL PLUMBING RE -PIPE MODIFICATION REPAIR POOLS DEMOLITION FOOD SERVICE FOUNDATION/PIERS/H.D.S. UFER GROUND PAD/SETBACK-CERT GARAGE SLABS/PREGUNITE , POUR NO CONCRETE UNTIL ABOVE HA$BFEN�SIGNFD : UNDERGROUND/SLAB UNDERGROUND PLUMBING UNDERGROUND ELECTRICAL ADO,NOTsPOUR-:FLOOR UN9-1L`ABOV LfHAS BFEN$fONFD ,` UNDERFLOOR PLUMBING UNDERFLOOR MECHANICAL UNDERFLOOR ELECTRICAL UNDFRFLOOR FRAMING VENTS UNDERFLOOR INSULATION ; P,1.ACF NO NOFIpOR;UNTILABOVF„ HAS'.BEENSIGNFp, i ROOF SHF:ATH/DIAPHRAGM PLUMBING TUBS & SHOWER PAN MECHANICAL ELECTRICAUPOOL BOND RAMI NG/STAIRS/E. EGRESS SULATION/VENTILATION COVENO N!ORK-UNTI" ABOVE�HAS-BEEN SIGNED`.; EXTERIOR SHEAR/HOLD DOWN INTERIOR SHEAR/HOLD DOWN SPECIAL INSPECTION REQUIRED Q DATE INSP SHEETROCK/SHEETROCK SHEAR - _rrcrlON EXTERIOR LATH/W-SCREED SHOWER LATH �NOpTAPEOR PLASTER UNTILVABOVE HAS,BEEN"SfGNED SCRATCH COAT SFWFR/WATER TEMPORARY APPROVALS OCCUPANCY N j rZ PLANNING 777-3308. GAS TEST c ' ^O^- _ GRADE (RW. 777-3354) O H U pw, FIRE-CALL(408) 37SA010 HANDICAP ELECTRICAL PLUMBING MECHANICAL ENERGY VISUAL FINAL ONLY I BUILDING — xOCCUPANCY OF BUILDIN tG IS NOT PERMITTED opj""" UNTIL BUILDING FINAL ISSIG NED BY BUILDII$ INSI GCT R ' ..,,,,. 1'', €� Iti«s., CERTIFICATE OF OCCUPANCY ❑ INSP. 'IT EAR OFF INSPECTION: INSP. DXITE PLYWOOD: INSP. _ BATTENS: DATE INSP. DATE IN -PROGRESS: INSP. DATE FINAL: DATE INSP, DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION 1Z ex Z �00 OE -Z d0tt 0 to Q� t�a ies:nci 'go lew§ CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: WM H FRY CONSTRUCTION COMPINY41TNO. 20791 SCOFIELD DR 03010055 OWNER'S NAME: 10351 SAN FERNANDO AVE APPLICATION SUB DATE RA,_TIU CHAMRAJ 01/09/2003 PHONE: (408)996-8173 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH = LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am lice d er provisions of Chapter 9 (commencing N,2!cls . Job Description with Section 7000) of Division 3 of and Professions Code, and my license is in full fc� ice" effect.% rc of Lic. # ADD 2 SKYLITES/UPGRADE ELECT PANEL C> —a. con rac-m%6 L,-� K-- 1;�: 1?� ARCHr—mers f3b!aRATION I understand my plans shall be used as public records Licensed Prologsional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Sq. Ft. Floor Area $ 3 ROMition (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of _3bNPMNfiJfibePU Occupancy Type not more than five hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for safe (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of 102 - P I ER'S_'I'� keLqQutired Inspections property who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. If, 103 - OF ER however, the building or improvement is sold within one year of completion, the owner - 104 - REBAR builder will have the burden of proving that he did not build or improve for purpose of sale.). 105 - ANCHOR BOLTS 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The, Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and, 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 203 - UNDERFLOOR MECHANICAL 0 1 am exempt under See, B & P C for this reason 204 - UNDERFLOOR FRAME Owner Date — 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 TUB & OR SHOWER 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's campers- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 ROUGH MECHANICAL work for which this permit is issued. 304 ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 3700 of the Labor Code, for the performance of the work for which this permit is issued. Vy Wprker-s Compensation Insurance carrier and Policy num 306 - HOLDOWNS Policy kq , WEX �Ml 307 - INSULATION CERTIFICATE 0iI TI 0 N FRO 1 MA 0 R K E R S ",,,_E%MPENSATl0N lNSUh6,)4CE 308 - SHEETROCK (This section need not be completed if the permit is forone hundred dollars(5100) 309 - EXTERIOR LATH or less.) 310 — INTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation 311 '" SCRATCH COAT Laws of California. Date 313 - ROOF NAIL Applicant 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT* If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) 505 FINAL ELECTRICAL Lenders Name 506 - - GAS TEST Lender's Address I certify that I have read this application and state that the above information is 507 - FINAL PLUMBING correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the 5 FINAL MECHANICAL above-mentioned property for inspection purposes, 09 FIN R (We) agree to saw, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and: exile whi h may in any way accrue against said City 5) N G WD in consequence5 he of APPLIC"W = DS YP W/Za, COMPLY WITH ALL NPN,POINT 5 10 Issued by5l 1 WORKS Date CATIONS. Re -roofs Type of Roof i _Z \Aguayre��f Applicant/ContmcDate HAZARDPUS MATERIALS DISCLOSURE ill the applicant or future building occupant store or handle hazardous material as med by the Cupertino Mu ipal Code, Chapter 9.12, and the Health and Safety C e, Section 25532(a)? 0 Yes N( All roofs shall be inspected prior to any roofing material being installed. Will the applicant or zur building occupant use equipment or devices which If a roof is installed without first obtaining an inspection? I agree to remove emit hazardous air corimminan as defined by the Bay Area Air Quality Management all new materials for inspection. District? C] Yes lhave read the Nazar ustr2ri F,,quirementsunderChapter6.95ofthe Califor- isi5m niaHcalth&S�etyC*,Secd=25 not d25534.1 ti build ng ' ' Tlyth., t does not if a tenant' jthait i r ponsithility. � u# lant of the nr ge in 'a cb, req is must be met p r i u a of a Car )CCU Signature of Applicant Date x V All roof coverings to be Class "B" or better or agent 7 Date 14 S -C, Y CUPEkTINO CO - CITY OF CUPERTINO PERMIT APPLICATION FORM APN # -2- C� b Date: Fee Group B u*ildin'g Address: 1BAPPLOTHER, --2- o- 1ck- k S C- 0"Z-- l�L �-1 c "Z -- BCONSTAX Construction TaxrE Owner's Owner's Name: Phone 4: kk 61= L0':'b c\,cA-(,— Lb -2, -2 - Contractor: License #: \N t--, 15 Contact: Phone #: BELEC1000 Elec 600V <= 1000A Lk BELEC1001 Elec 600V > 1 OOOA Applicant/Contractor: Fax BELEC200 ELECTRICAL IA ,IBENERGV-- Building Permit Info: BENERGYADD En Add Multi -Bld Elec Plumb Mech Job Description: N� -,c> ".? Residential: Commercial: Sq.Ft ,Floor Area: $/Sq.Ft.: L\ MECHANICAL Architect/Engineer: Valuation: 10011 New Comm Electric ELECTRICAL \$ -;2' -Z-0 C>;�� Type of Construction: Al Occupancy Group: New Conim Plumb I of 3 Fee Descript Fee Group =�W 1BAPPLOTHER, BCONSTAX Construction TaxrE �Mi BCONSTAX �WF-W-411"mm Con. Tax for BQ Zone BC• ONSTAXH i, Hotel and Motel =�Wmliwvm "10,40 Con Resi/Mobile BELEC1000 Elec 600V <= 1000A BELEC1001 Elec 600V > 1 OOOA BELEC200 ELECTRICAL ,IBENERGV-- BENERGYADD En Add Multi I-BINVESTIGA■Investigation fee II NOW, BMITIGATC Comm. Housj�jg Mit. Fee BMITIGATR Res. Housing Mit Fee ONE ME- in! Fig! 01 BMNEWMULTI MECHANICAL New Multi -family Res ELECTRICAL 10011 New Comm Electric ELECTRICAL 0--ugg "emajuv New Comm Mechanical V New Conim Plumb I of 3 ri .0 0M Fee Desc * KIRtion 3 .13 R a 3 a 1 W.-I I Z, guy Ventilation Systems i Seb Specific Plan K1115 Seismic Commercial lei Lj Seismic Fee Res Mot ky, SiLigle Family New Add I:T,-Iuzrsl M t r! Swi 001 kvl��� TemvorarvB14 Te�nn t BTEMPS'� Temp Dist Svcs ELECTRICAL Businmss icense �W Jill Ms 11? 2 ORIVOI Lul IV goal Elec Permit Issuance VL4tw.,q 0=11 'Mechanical sq. foot 9,7112 of 90 1 M It 3 A Mech Permit Issuance Plumbing Permit Issue InER Eggs i Plumbing Fee N foot EMIR ism Address Change Boiler<= 100,000 Btu UV I Q 9• Boiler> 1 OOK to 500K Btu a Mwlron.� Boiler > 500K to 1M Btu 'Boiler > 1M to 1.75 M Btu It ri .0 0M GENET k NOl , 3 G CO �YA .... t A. ` A d. A ew fioo RAJIV CHAMRAJ RESIDENCE RENOVATION .NYt.1 TG1,A"Al_L 6_A1 AT I T rl, A,I- C)N O1'lI _ _... ANT xxlea. Nmv laxeislxwPiL.unxtlnlrovy�nrihe 7•'fliXmwtYL Ni —111 HGN 20791 SCOFIELD DRIVE CUPERTINO, CA 95014 - - N vlrin,ilrN�at > Y C "10- < (N t C f r Air IIIm No N K. n N s h r y A sit.N U N' ON^ AN INI,) JY N.DI'll T 5 ,A Lit— F1i l AL t Y �;EI'ONIEA T. )PSG :R OC,. 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