06070453 CITY OF CUPERTINO g t�+•.», -•' ' '-p,e r r '' '��
BUILDING DIVISION PERMIT y,COrITRE1CTQR, T.NI, URMATTOi�J- :`
F
ILDING ADDRESS: v LA ASHOK PERMIT NOO6O7O1S3
091 S STELLING RD
NER'S NAME: PERMIT L%UE DATE
LAKDAWALA ASHOK 07/24/2006
NE:
SANITARY NO. CONTROL N0,
ARCHITECffENGINEEW BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ioo LICENSED CONTRACTOR'S DECLARATION O O O O
mF 1 hareby.)firm Nal l Am licensed under provisions of Chapter 9(commencing Job Description
iAt with Section 7")of Division 3 of the Business and professions Code.and my license is
N in full farce and effect. REPLACE FURNACE ADD .A/C
t l2x License ClassL.ic.0
H p Dam Comrxcmr
1 ARCHITECTS DECLARATION
i < I umdcnuad any plans dull be used As puhlie rtcar&
lyU
°Dy Licensed Pmfcssionel
OWNER-BUILDER DECLARATION
Z 1 herehy alTinn that m
1 am exempt from do Comnafs License Law for the
o O following mason.(Secdon 7831.5,Business and Profesaivas Code:Any city or county
$ which requites a permit to ennnrvct.Alm[improve,demolish,or repair any amarum S O O O
-iy pow to its issuance,also requims the applicant forsuch permit to 0k a signed statement
i G
that Mulicensed possumsoOne provisions ofthon
eCudmfsliacnseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
'522 (commencing width Scedoo 7000)of Division 3 oftha Businessand Professions Cade)or
that he empt therefrom and the basis for the alleged exemption.Any violati
duu
on of
Section 7031.5 by any applicant for a petraraft subjects the applicant in a ovil penalty of EMMMTO Occupancy Type
Ins,mom Nan five hundred dallara(SSW),
❑1.As owner of the propony,in my employees with wages As their sole comp nsadon,
will do the wudt and Ileswcmm is ret intinded ter offered for sale(Sec.70,C4,Busieea
and Professions code:The ComosmoYs License Law does,oat apply in an owner of Required Inspections
property who Wildsorimproves Norton.and who doessueh w"k himselforNmugh his /1Q
own cmployteildingdedthmsuch improwmenu artmcoarndedoro@sed for Owner. IU//!!jry__' ��
builder.Neave theorimprowrlwduseldcdid set Wild or
r completion,depose of p r� -
sak.).rwin love the burden of proving Na,ha did rot build"improv far purpose of /j/prr Ylf(a{���Ja/ti
sale.). /g`/JJ�:�%k\J)
CO.as mater of the property.Am uclusively contracting with licensed cemracmrs b
cowl=the projea(Sec 70CC,Business surd profession code:)The conuac ces Li. /I 1 G
terse law dace Inst appy man owner of property who bunds or impresses thereon.and U ?006
who contracts for such pmjccu with a contrdmr(s)licensed pursuant m the Contractor's
License law. D R
❑l Am ea pt under See//���, � � /f�fA� .B&P C for ads reasen
Owner A Q lr ng R-Cdla PSIA1 I DION1✓
vilraQkR�EE RK$3 COMP�3' O•N DECLARATION
I hereby Alton under pemahy,or perjury one of the fallowing deelaruions: ll
1 have and will maintain aCCNficate of Consent to selbinsum far Wwkeri Compcn-
smion,As provided fur by Section 37W of also Lobar Code,far the performance of the
w"k for which Nis permit is owed.
❑1 have and will maintain Worker's Compensation Insunnce,As mouimd by Section
37W of Ne labor Code,for the peolermanecmf the wart fa which this permit is issued.
My Workefs Compiessaion Warren¢carrier and Policy number art:
Coons. Poll,No.: _
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Btu section need not be completed If Lha permit is formic hundmdoallara(SIM)
is,less)
1 certify Nat in the performance of the work for which this Permit is issued,1 shall trot
employ any perun in any manner u w to become subject o Ne Workers'Compensation
Laws of califoApplicrrya.Liam q,.s�5� I,I.Y 1 f If-� b
NOTICE TO A AN,I - r adng Nd Certificate o , I,I on,you NavIJ
became subject in the Worktfs Compensation provisions of the Labor Cade,you must
0 z fmrNwido comply with such provisions or Nis permit shall be dcamcd revoked.
zO CONMUC71ON LENDING AGENCY
[-+ 1 hereby affirm and them is a construction lending agency for the perfarmdec of
a 7 Ne work for which thus permit is ivsued(Sec.3(X97,Civ.C.) -
aLender's Name
z Landefs Address
U C) i co dfy that 1 have read Nis application srW sem that the above information u
1y f^ correct.I agree to comply with all city and county oNinan es and sole laws minting to
C U building constraction.and hereby authome mpresentatives or this city to enter upon the
H cahove ro mioncd progeny for iroi,cuon purposes.
(We)agree m save.indemnify And keep harmless the City or Cupertino against
fq Liabilities,judgments,case and eapnces which may in any way accrue against=it City
U Z in consequmee of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL
NON-POINT Issued by:
DateSOU� OB TIONS.
h,.Aaor 7iStgnpp manUC
Data Re-roofs
HA].(RDOUS MATERIALS DISCLOSURE Type of Roof
Win dm applicant or future building ottupsmiu.e"Media ha>mdaus material
AA defined by thm Cupertino Municipal Cade.Chapter 9.1 i,and de Health and Safety
Cade,Seevon 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
DYes AN.
will the applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ho>orn us air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
Moore'?
❑Yes rip No
I have mal the Want. undcrChapmr6.95 ofthe Califmr '
ma Health&SafmyCoCe.Swtions 255(X5,25533 anal M34.lundersund thmifthe Wilding
does not currently haw a mount Nat it is my responsibility sea sadly the aceupamt or the
requ mennwhich most Wmet priortousuaoeeOra e"dreaearOccupmcy. Signature of Applicant Date
ow a te >e agtm, Dam All roof coverings to be Class "B"or better
sm Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
oR 1 S • 54-e I I i' )2j, C no ovjSviy, ��o 7 O /S"3
OWNER'S NAME: /f}s o 1< L4, k, � ae.(a PHONE # LfV0 85'- 'i 1 9-2
GENERAL CONTRACTOR • T g D FAX #
I am not using any subcontractors: "17sD
Signature Date
Please check applicable subcontractors and complete the following ' ormatiom
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
i7 1. 2-Fjo(,
Owner/Contra�a Date
CITY OF CUPERTINO
*am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36222003 . 00
DATE ISSUED. . . . . . . : 07/24/2006
RECEIPT 4 . . . . . . . . . : 35346
REFERENCE ID # . . . : 06070153
SITE ADDRESS . . . . . : 1091 S STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LAKDAWALA ASHOK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ASHOK LAKDAWALA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : LAKDAWALA ASHOK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- - ----- --------- - ---------- - -- - - -- --- ---------- -------- --
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 5 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- - - - ---- - - - ---------- ----------
TOTAL PERMIT 176 . 24 0 . 00 176 . 24 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --------- -- - ------
OTHER 176 . 24 VISA
TOTAL RECEIPT 176 . 24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
CITY OF CUPERTINO Owl D 153
FURNACE/AC
41 CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
1091 9 STTE LL ) r-3 , RD . GuFFIQZD nru C/V- `7SID
Owner's Name: Phone#:
Q-S14o K �f} I<Dgr^ �+L� �0&) �7
Contractor: Ta D Phone: License#:
Contact: /�,. Phone: Cupertino Business License#:
/�S1ioIL LA1<,jgfnlq(q yob ) 9-1)b-4182 r�
Building Permit Info: 9-. p cc k-QIci AV-f-r-
Bldg ❑ Elect Plumb Mech
Job Description:
Residential 1 Commercial ❑
For Residential Installations:
Attic ❑ 15` floor �4 2nd floor❑
Adhere to min set back re uirement�
or Commercial Installations:
eplacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: / Type of Construction: �_ Occupancy group:
Strapped ❑ On Platform Bonded M Sq.Ft. Floor Area:
New Location Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 1 0,000cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Reept), Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Pi ing System Fee PLUMBING
BUSLIC Business License BUILDING
. . ,;
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