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08040228 BUILDING DIVISION PERMIT ,4,CONTRACTORINF0RMA1:I, BUILDING ADDRESS: PERMIT NO. 7668 WEST HILL LN UNITED SITE SERVICES 08040228 OWNER'S NAME: PERMIT ISSUE DATE NITIN GUGLE 3408 HILLCAP AVE 04/30/2008 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO TEMPORARY POWER POLE aO eO O O u O O LICENSED CONTRACTOR'S DECLARATION aid^t I bmtby affirm NU l am Mattoon shut,pmviaimu of Chaplet 9(mmmcncing Job Description .Sadon 7=)or Division 3 of Me Business and Professors Code.and my licenm is I.full force and erten j = Limnse Clan Lic.g Dam Contractor ARCHITECTS DECLARATION I understand my Plans shall be haled as public retard, JdV g C Licensed Professional OWNER-BUILDER DECLARATION ECC I Mraso .(Then that 1am 1. .Busa amen U r Contractors o e:My c Law for tic ECC following moan.(Bad^^]Tn1.7,Busnms and improve, de tans Code:Any oily m county S$ which its issuance. i sa n e.also re cammcL stmt.impove,demaHN,m repair try stmctum i prior%its ,elanrequires Neathmstafar such Permit mfileasigned Chlemont < deuhemer,wJ PuemW ONe pmvisino3 of a,Beat for and Professions (Chapter Sq.Ft. Floor Area Valuation iFs-Q (canmcsexeraiNSaffornadMDivisio^7 of Ma,eegedCo and Pt,Any viCade)of _ Nat k u exempt Umsefmm and Ne loss fm dee alleged ewnptim.Any violation of Section 7031.5 by any applicant fa a permit mbjau the 9PPlicanuo a civil pemlty of APN Number - Occupancy Type mm mart Nan five hundred dollars(3500). P Y YP 1,u owner of tax pmpvry,a my wploym vied wages u Ne'v vele compewUm, and do Newons and dee structureurot, Lt aaae does to an,Butlrcos and Rty wh obu Code:The Conmcton.Liaise Law dam hat apply o an owner of Required InSpeChODS pmpeny who builds M ed Chat ach inpr and who dom:tint ended oraelfM Waugh his .... ave ever.the Wilding i Nu mob ire I.sold nu are not intended maRercd for m4.It. however,Nebuildinga ner of pmentg veldedid n, year ofmproefarNeawner- huiloer will have W burdan of proving Nat he did rot build a improv fix purpose of role.). O 1,as owner of rbc pmpcny.w exclusively contracting was Bcamed mntramma w construct Ne pmjca(See.7014.9usname;and Professions Code:)Tlr Comnetm's Li- camm law does not apply to an owner of pmpeny who builds or impovex Nemo^,and, who c.nancls for such pm)ecu wide a Contracor(s)licensed pursm ten Ne Coroactor's Licenx Law. ❑isum exempt u^dm Sm ,B&P C fm Nu msas�aa Owner Ilnlr�_ Data O U O R 'S COMPENSATION DECLARATION I bercby aRm under penalty of perjury one of W fallowing declamuons: 1 ham and wiU maintain a Casifcam ofConseM to self-insum for WatiCompcn- mUon,an provided for by Sanson 7TW of Ne Labor Code.in,dee performance M the wort for which this permit is issued. ❑1 bate and will maintain Worker's CDmPOT310011 Insurance,u required by Section 3M.f labor Code,for W perfmmanmofdle wast far which this permft u issued ' My Work e,Compemadon lusunnee carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thissection need Out he completed Kate Permit Isfmane hundred doll=(3100) or tau) 1 Certify that in dee Pcffomonce M the wont fm which this Permit is issued,l"I ret employ any pew^in my manner m u lo become�u en tae Wo�en'CompensaUan La ws of CallTamiat to �tY 2 Jy t f 6 APPlicam ^ - NOIICE TO APPtGCA :IL after making Nu Cenifcam of Eumpim,Toe oouw .J zha.me object m e Wohefs Campenseuon ppermihe- -- -of Use labs Cade,you mus foMwide comply with,such povism.or Nu t shall decreed rawked. z.,O CONST ucnON LENDING AGENCY Ihereby affirm that Vert u a consraunn knding.pec,for to performance of tri > the wont for which Nus permit Is issued(Ste.3097,Cin Q --' 4 Q Lender's Name z Lenders Addle•. U O 1 Certify that 1 have read Nis application and sum Nu dee shote infofm Um,is corra'L I agree b Comply wide all city and county ordinances,and stale laws mladng lo rU' building construction.and herebyauNaris mprurnrauve,of this city m e^ser upon Me yahove-menudgm interparty fan impaction Purposes (Wo)agree m save,indemnify and kmp harmkst the City of Cupertino against ,.y Z incouues,judg,of ents, esu and of this ,which may in any way name agalmt said City V z A APPLICANT of D RSTAN of this D WILL ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G/—�U SOURCE REG TIOULA d.5, i,. Ll Sgneurc of Ap�l can anYxl.r ! Oa Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof ' Will Wapplicanterrfuture building—Parnsore or handle Weard umammal to defined by 0e Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code.Section 15532(W❑Yu �,6All roofs shall be inspected prior to any roofing material being installed. WII thea IIcNI err More building axe If a roof is installed without first obtaining an inspection,I agree to remove Pp t wen tine eyni it Qu^t devices which g P g .nithu.Wnu aircmuminanu udcfin 'W Bay Arta Air Quality Manetement all new materials for inspection. trimT ❑Yu I have reel On hanaMem materials mquiromeau undo,Oupmr6.95.fare Calif.,. his Hml"SafctyCodc,Srcdau15515,25533 anti 25534.1 understood Natifde building data not currently haw a enanl Nm it is my aspansihilay m notify Me occupant of de requlremenu h m be met pact In issuable of a Caufmam of p CY. `f'I SignatureofApplicant Date Owne,on sued be gent Dam All roof coverings to be Class')4.a'or better INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36227020. 00 INVOICE DATE. . . . . . : 04/30/2008 REFERENCE ID # . . . : 08040228 SITE ADDRESS . . . . . : 7668 WEST HILL LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NITIN GUGLE ADDRESS . . . . . . . . . . : 7668 WEST HILL IN CITY/STATE/ZIP . . . : CUPERTINO, CA 95008 CONTRACTOR . . . . . . . : KEVIN MELLIFONT LIC # 742 COMPANY . . . . . . . . . . : UNITED SITE SERVICES ADDRESS . . . . . . . . . . : 3408 HILLCAP AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 295-2263 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- • SEISMIC RESIDENTIAL PRINTING PERMIT 0. 50 0. 50 0 . 00 ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 40.79 0. 00 RES TEMP POWER <200 AMPS PRINTING PERMIT 40 .79 40 .79 0 .00 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40 .79 40. 79 0. 00 ---------- ---------- ---------- 122 . 87 122 . 87 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER • -� CITY OF CUPERTINO TEMP POWER CITCUPERTINO PERMIT APPLICATION FORM APN # 3 Gw ,�� 3,o I op Building Address: X 6 ( 8 WC_.LF La,AQ �1 i Owner's Name: Phone #: 9i4� 40 !� 6 �-� 0103 Contractor: U 4 ^ �, ^ � Phone #: 2s I I C1 G 3 1 �kR Fax #: 1 Contact: e,. 3 � 0 9 i Il (af - Phone#: Contractor License #: 0 — 5 1 1 1 0 6 Cupertino Business License #: -7 t 1 2— Job Job Description: Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No C]—� Residential Commercial ❑ Valuation (cost of project): 3 , Quantity Fee ID Fee Description Fee Group Permit Type 1 ERT>I K Res. Temp Power>1 K E 1REAP14 Amps / 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E / IELCPLNCK Electric Plan Check E / IBSEISMICR Seismic Residential B CITY OF CUPERTINO ai TEMP POWER CUPEI,TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 IECT<200 Commercial Temp Power E <200 Amps IECT>1K Commercial Temp Power E >1KAm s IECT2001K Commercial Temp Power E 100-1K Amps I 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B • • Community Development e 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 *UPEkTINO Building De artment JOB ADDRESS: X66$ WeB�� ( ( PERMIT # G) ) Lc 0 OWNER'S NAME: Ni k PHONE # 408 6-77 0103 GENERAL CONTRACTOR: r U S (ZYN4 FAX # I am not using any subcontractors: p S gnature 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile 3o v8 ner/Contractor Signature Date