03030122 (3) CITY OF CUPERTINO =�^?'"yet / --+'/�' "
BUILDING DIVISION PERT �C� 8 u +TOR 11\� V A51+Y i
BUILDING ADDRESS: PERMIT NO.
?A�lr MC C:TRIIA.N RQ
t OWNER'S NAME: PEEDi A
15122--
SANITARY N OL N0.
ARCHITECT/ GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION
vm 1 Mmhy arfon that 1 am licensed.neer provision,of Ch,pter 9(rommeming Job Description
<n< with Section 7000)of Division 3ofthe Busineasand Profcist..Code,and my licaae4
In full forte and erfeel.
FF q� LImmc CW. Lk.Aore KITCHEN REMODEIFPN'A ®- M-
9 W ARCHITECTS DECLARATION
I understand my pleas dull the used u public racants t')�4v� �. 2 2003
Ic Llccrumd Professional
OWNER-BUILDER DECLARATION
gy I hemby affirm that I em exempt from the Contractor.Llcenm Lew for Ine BUILDING
n c following reason.(Secdon 703 1.5,Business and Profusluns Code:Any city a county
g(v which regolms a permit to construct,dmr,Impmw,demolish,or repair any.muclum
�K+ poor to its issuance,also requires the applicant for uch famitto Ole a Signed statement
�< that he is licensed pursuant to the provisions of the Conu¢mrs License Us,(Charles 9 Sq.Ft. Floor Area �a,ILLij(IOn
(commencing with Section 7000)of Division 3 or tire Business and Profession,Cade)a UUU VV
$ that he is a¢mpt detefrom and the basis for the alleged Assumption.Any violation of
Semon 7031.5 by any Applicant fora permit subjects the applicant to a civil penalty of pry��r7w,
not more than Ew hundred doled($50% 3'.rIA YB nrttV gcr 0 0 Occupancy Type
❑I.As omerofthe pmpmy.rrmyemploNes with voiles utheirsokeornponntloo,
willdo the work.and the structure fame Intended IX.fTemd retail.(Sec.7044,Bualnu. 101 - FOUNDAW4tWd Inspections
an9 ProfAsim.Cade:The Contractors Llama Law den ant apply in an ower of
property who Wildsmimprovutheeon.Arad who doee.uchwarkemuifortlwugh his 102 — PIERS
ownemployen,provided that such Improvements Are not intended orortered for sale.TL 103 — UFER
however.the building or Improvement Is into within one you of completion,the owner-
bullder .will have tire burden of proving that he did net Mid or Improve run purpose of 104 - REBAR
ask.).
641,as owner Of the property.am uchativety contracting with licensed contractors to 105 — ANCHOR BOLTS
convect the pmjm(Sec.7044,Business and Rofudoas Cede:)The Cmntractar.U. 106 — SEWER & WATER
tense law does not apply an an owner of propemy who Node or impn.ets Nft...and 202 — UNDERFLOOR PLUMBING
who conumels for such pmjeth aeonuactIXg) m licenced pursuant the Conuunces
Lkenlaw. 203 - UNDERFLOOR MECHANICAL
❑TumLacmpl under See ,Bkas
PCfar this mon
D„�/ 6 �-'r 24 RCN' 204 - UNDERFLOOR FRAME
Rs COMPENsnnofmECua nDt� 205 - UNDERFLOOR INSULATION
I hereby affirm under penalty,of perjury one of tbe following decluationm 301 - ROUGH PLUMBING
Pve and*111 maintain•CodEnte of Common to self-Imam for Workers campers- 302 — TUB & OR SHOWER
as provided for by Sedan 37m of the Labor code,for the perfamamtt of the 303 - ROUGH MECHANICAL
or which this permit is issued.
0 I hoc and will maintain Workrs Compensation Insurance.as requited by Section 304 - ROUGH ELECTRICAL
3710 of the lana Coda,for the performance of the work for which this permit M i,sued. 305 — FRAME
My Workers Compensation Insurance came and Policy number am:
Center.
_ 306 - HOLDOWNS
CERTIFICATE OFEXEMPIONFROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
nrlrujm,ecBrm Acted Act Ncanplated iftN tromp 4faae hundred dollars(Sim) 309 - EXTERIOR LATH
1 cattily that In tN�anca of the work fns which this permit fa Issued.I shall oat 310 INTERIOR LATH
In my penes t mannertn use esub'ecttothe n'compwdme 311 — SCRATCH COAT
Laws of C. err rZj ( 2fT
ADP�ca 313 - ROOF NAIL
N011 T �1-gRarending this Certificate orEaempdon,you should 501 - FINAL ELECTRICAL ENERGY
bec a subject to the Worker's Compeuelion provisions of the Labor Code,you mut
�. forthwith comply with such pmvlsinu An this Permit Shall W deemed revoked.
Z� 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby.Rim Nat dem 4 a rnmtmction lending Agency forthe prfarmanmof
a>
the.IXkfor which th4pmlt6Issued(Sm.3097,CmC.) 504 - FINAL BUILDING ENERGY
W q
Us
0, 505 - FINAL ELECTRICAL
=Z Zanders Address —
U O 1 506 GAS TEST
certify that 1 haw mad this application and sum that the.bow Information I.
B.E-t coact.1 Agree m comply with ail city and county oAinamcs and state Ism totaling to 507 - FINAL PLUMBING
p U buildingcononapro andhercbysuNorimrcptuenulivc,orthlwitymenmrupon the FIN MEC CAL
shave-meemned properly sur lnpemon purposes.
�a (WA)agnA m taw.meemmur arta keAP ItamlAu IN city ar c.l><tlino.g.wl 0 9 F I �7
I,) liabilities.fudgmenu,costs and asp.which may In any myattme geinsl said city
Q in consequence of the granting of this permit. 5 NG
tom— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
\ sou untws. I CHz00
Re-roofs
g p manUContnctmData
HAZARDOUS MATERIALS DISCLOSU Type of Roof
Will the Applicant or futum building occupant store or handle hendaus material
as defined by the CupertinXN.
pet Code.Chapter 9.12,and the Health and Safety
Cine,Section 25532(e)7
I]Yes
All roofs shall be inspected prior to any roofing material being installed.
Will the applicantWilding occupant me equipment err dcvicn which If a roof is installed without first obtaining an inspection,I agree to remove
irs7 ua co
umoA4 ntamimnts As dclined by Six Bay Aru Air Quality Management all new materials for inspection.
ct
❑Yes
I he.mad the hazardous mamroll requirements under Chapter 6.95 of the Califon
n4 Build,A,Safay Code,Sttdon 25505,25533 and 25534.I undcntand Nm l(the Wilding
docs not currently law a anent,that It 4 my responfiritZ nilly de occupant a the
require; wis uptemetpdonofamancerdaccmfcam .eery. Signature of Applicant Date
mqf(N 01/3 All roof coverings to be Class"B"or better
O omcd agent Da¢
_J
204
8 ' 70 34 ' 34 58
E S '
W1836L : W W3036 MFD
------ T
: DB15 4 ; T1824X9 33
624-16SS2 .B SB3 B. DISH. 24" DWR
F F'
614 EMM2
3
95 2szss
V ED
c k"T' vE CITY
IN ACCD49�P29_ ==1
CUPERiItv`0 r SES ACSD RDtpNCES
O 36R REF-BD
324 OATE � 630-1B O
SIGNED_ _ — 32i
-- ---------- ---
�i c;1„cihca*i�.ns I`AUST - -------------
Tt;is set :,j p<:ns _:: i --- --
h kept on the job at a:i tiaras ant it is un W2436 W3024 Ia7LMM W3624
craenasGr alteraUGns
6
.�;; ' cn pC:rri:59Vu
.. '1JUt
q building
-'OP t., IL
U,y r:.
h
�icn and �3 -focDe.
24
ha:d to P •
arms : :---^' 204
approval Gf the violation Gt an N ' .
jj oily City Urd;nance Or StatO Law.
All dimensions 8 size designations THE This is an original design and must 20708525 Scale:maximum Design: 02/07/03 Dwg no.
given are subject to verification on not be released or copied unless Date : 02/12/03
jib site and adjustment to fit job HOME DEPOT applicable fee has been paid or job SANJAY SUNITA SHITOLE
conditions. order placed. 7856 MC CLELLAN RD Designer
CUPERTINO CA ANTONIA
204
' 36 —�— 30 30 ,' 21 ---/6.' 81
TT _
14 14
151a,in
91
� o
594 119 ��oo
0
108
94
® QD cop ,
571 I�
343 ITTA
' 36 ' 30 .' 30 ,' 27 — 93 - 24
By
_ All dimensions 8 size designations TME This is an original design and must 20718525 - Scale:ma>amum, Dwg no.
given are subjtotion
unless
job site and adjustment `fR jobn opied
HOME DEPOT applicable fee has not be released orc
tbeen paid or job SANJAY SUNITA SHITOLE gNYONIA
7856 MC CLELLAN RD
conditions. order placed. CUPERTINO CA Wall/C Line# 4
204 '
f 8 L 70 5V61-- 15 -/6.' 362 i 6/ 30 .`3' 18 --7/
TT
12 113
283
592 o
108
C L4 op ! 94
573 0 0
343
SUBMIT A D.
11 LJ
' 112 34Y 1 58
' 84 24 .s' 33 � 24 18
All dimensions&size designations TME This is an original design and must 20708525 Scale:maximum• Dwg no.
e subject to verification
• job sdegiven rand adjustment to fit job HOME DEPOT appnot lcableefee hhasbeen paid or job sed or copied unless uesgner
SANJAY SUNITA SHITOLE ANTI IA
7856 MC CLELLAN RD
conditions. order placed. CUPERTINO CA WaIVC Line# 2
CtY OF CUPERTINO 0 3 0 3 0 / 2 ?
ITY OF :. .
CUPEF�TINo PERMIT APPLICATION FORM
N# / C> p ., j Date: Z Fh m �R C M 2 0.( 3.
Building Addr s: 7856 MCC,LUUA P CUPGRTIND CP .95p1 i ,
Owner's Name: S A NJAY / • SWC—rotC Phone#: 6g _ 2S5— 1 7 3�
Contractor: License#:
. tom Ke � � a� . . 703694-
Contact: 408 _ -39 0 _ 6g GI 1 Cupertino Business License#:
uili ing Permit Info:
Bl L�1 Elect Plum ech
o escripti
Res is 52' K r N R F m o D Commercial ❑
Sq.Ft. Floor Areg- $/Sq.Ft.:
Cost of P jec 3000 Occupancy Gro per' '
Type of 00a t ctio
Quantity, Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK 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 <_,I OOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit.-Fee ,BU//ILDING
Iof3
PITY OF CUPERTINO •
cuPEr�T1No PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL .
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifami] Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM . New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME 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
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/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
BREWMAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixtiire ELECTRICAL
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