05060166 (2) CITY OF CUP ERTINO -iz+ 11 „-
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,,.
BUILDING WEST HOME AIR PERMIT NO.5060166
2 0269
MW
OWNER'S NAME: PERMIT LSUEDATE
PRAKAS NAIR 5801 SANTA TERRqA RT.Vh —.06/24 /2009
lip ONE: SANITARY NO. CONTROL NO.
(408) 202-9693
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BUMB MUCH
O ELECT O PLIC O
Loo LICENSED CONTRACTOR'S DECLARATION Job Description
FC 1 hemby affirm Was 1 am licensed under provision of Chapter 9(commencing p
<W with Section 7000)of Division 3 ofthe Business and Profession Codc,md my license is
mfell fomeaneeryect. REPLACE FURNACE & ADD A/C
,a a License Class Lr,g
4-0 Date ARCHITECT'SD Contractor
(� n
m U I understand my Plans shall he used a public mcofdt—�
30 Licensed Professional �J
OWNER-BUILDER DECLARATION
gm I hereby AM.that I am Attempt from Use Conhamols License Law far she sr
00 following mason.(Section M1.5,Business and Professions Cc&:Any city of county VY/t�� r
1.4ff which fcquima a permit to consui alter.improve,demolish,or repair my structure r 20ris
—It prior to its issuance,also mquims the applicant(orsuch permit to file a signed statement r�
FZO that he is licensed pursuant the previsions of the Commcmr's Licanc Law(Chapter 9 Sq.Ft.Floor Area l/ Valuation
mI-$ (eommrning with Section 70001 of Division 3 of the Business and Profession Code)or f�f� j' 1, 11 ! (ItNpe�
.� — that he u eaemps therefrom and the basis for We alleged exemption.Any violation of Int) I+F'\\'1
Section 7031.5 by any applicantfora permit subjects the applicant to a civil penalty of
than e100 — "— uU V\\Occupancy Type
nos mart five hundred dollars(53(10). \
0 1,As owner of We property,Or my employees with wages As their sole compensation,
will do We work and the structure M not intended or offered for sale(Sec.7061.Business
and Pmf.m.,Code:The Commend License Law does trot apply to an owner of Required Inspections
property who builds.,inprovessheseon,and w1mccoa eth work himself or through his
own employers,pmWded that such improvements art notimnded oroffrsed for ale,B,
however,the building or improvement is sold within one year of completion.he owner,
builder will hat the burden of proving mat he did not Mold or improve far purpose of
sale.).
❑1.As Owner of dre Property.Am uclusively convecting with licensed canracmrs to
construct the project(Sec.7014.Buainea and Rofesvons Cade:)The Comncmr's Li-
mmic Law does not apply to an owner of property who Wilds or improves thereon,and
who concocts for such pmjecM with a eonvamer(s)licensed pursuant in the Comosimes
License Law.
lam exempt under Sec. ,B k P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One of me following drdarations:
1 have and will maintain A CemBeare of Consent so self-intim far worme,COmpcn-
ation,As provided for by Section 37M of the labor Code,for the pefformance of the
work for which this P:rmiI is issued.
1 have and will maintain Workers Compensation Instance,a myui id by Section
3700 of the Labor Code,for Lou perfofmmm of the work for which this permit is issued.
My Warkses Compensation Inannee carrier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed not W completed time permit Is(none hundred dollars(SIM)
or less.
I cenify that in me Performance of Is for which this Permit u issued,I shall nos
employanypatun in any manreruM In come slbjhtt rkers Compewdm
Laws of Califurim.Dam ��I�I"YYY11 / O Y�I
Applicant —4I Vs wo'-
NOTICE TO APPLICANT:IL after making this Cenifiaa of Exemption,you Would
become subject to me Worker's Commination previsions of the Labor Code,you most
.J.z foMwim comply with such provision or this Permit mail W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[—� I hereby affirm that them is a construction binding agency lot the Performance of
a
she work for which this permit is issued(See.3097,Civ.C.)
Lender's Name
= Z Lenderi Address
U Q I certify that 1 have read this application and all mat me shove information is
LL Pcorrect-1 agate m comply with all city and county on inas nceand sone laws relating to
DU building convection,and hereby Authadre mpmsentatims of this city m enter upon me
ahovc-mentioned mammy for inspection purwhich BA
F y (We)agree m ave,indemnify and Lap harmless da City of Cupertino against
IA In Imotiachume a(themma. roti"osts of th A Kewhich they in anyway seine against said City
U aZ in conegnena of We grana of this permit-
r. SOURCE APPLICANT UNDER N S AND WI L OMPLY WITH ALL NON-POINT Issued by: Date
Signetum of ApplmanUComme Re-roofs
Date
HAZARDOUS MATERIALS DISCLOSUREType of Roof
Will the appliam ser future Wilding occupant am oorhandle haardmet maurial ,
az eek,Secdefinedtibyon the Cup35533(ertino Municipei Codd.Cltammr 9.13,and the Health and Safetyx)? �/
[Dy. 04 All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future building accupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
7does
it hanodous air contaminants u defined by me Bay Area Air Quality Management all new materials for inspection.
istrict?
❑Yes
1 havemadtheha.ardwsmamrialarequirements ,lumhmearm i93orate Califon
ce Halthkrently Code,Sada thinit.3353. 3s5ility.morfy c.ti Wilding
not currently have a met it u my ms omihilisY m nodfY the oecupant nr dR
quimmenu which m et ri.1 not f commit (occupancy.
Signature of Applicant Date
Owner ormmmi.edagent - D„� All roof coverings to be Class"13 or better
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building De artment
JOBADDRESS: a����� NOif l�es� PERMIT# X5-0( 6
OWNER'S NAME: IVAIA- PHONE # O g- S- /gyp 2-
GENERAL
GENERAL CONTRACTOR1� Pte{' Gotntie�-��, Liv FAX#
I am not using any subcontractors: 9/1-C
Signature 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
Owner/Contractor Signature Date
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
Please indicate below which modification(s) are planned for, your property. Provide
brochure(s), if possible, and copy of any proposal(s) including the contractor's
license number. Any modification not expressly listed herein, or not conforming to
the restrictions and requirements listed herein for that modification, will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for approval.
t
Modification Festrictions and Reuuirements
V Air-conditioning unit Unit will be designed for quiet residential use. Unit
will be located within the enclosed yard of the
property. There will be no parts of the unit visible to
common areas. Installed by licensed contractor.
Replacement window/ Must be same size aperture and location of existing
sliding door window or sliding door. Any necessary touch-up
painting is the responsibility of the homeowner.
Installed by licensed contractor.
Garage door Must be windowless and in conformity with general
architectural style of the complex. Repainting to
conform to exterior color scheme is responsibility of
the homeowner. .Installed by licensed contractor.
Satellite dish/receiver Specify type and size below and include sketch of
O intended location. Installation of dish in the least
type: visible location to receive signal. Cables routed inside
size: _ _ attic, crawlspace, or wall near the dish mounting
to minimize visibility. Other guidelines may apply,
Any damages caused to property as a result of modifications will be the
homeowner's responsibility. All prohibitions, restrictions, conditions; and rights of
the Association enumerated under Article V of the Amended and Restated
Covenants, Conditions and Restrictions of the Northpoint Homeowners Association
are applicable to modifications contained herein. City permits may be required.
""o olr,1r
Homeowner Name(s): PAA 0S IVAlk
Property Address: 006` R A Phone: ( �,�/^
Date of Notification:--qa D Date of Completion: f 1 f o S'
Homeowner has six months to complete the designated modifications aanntd is responsible for
notifying management upon project completion.
----------------------------------------------------------------------------------------
-- (ficial Use Only n I
Notification Received by: Date:
Completion Verified & Approved by:_ Date:
FORM ADOPTED 8110/1999 REVISED5100
CITY OF CUPERTINO
Cpm- FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
�Jt
Building Address: .Z c)'2- L �J N 0 P-T H W T-S`T s Q-
C-- \J
-Gv P�'- RT !NO / CF1 - 950 ILI
Owner's Name: A )eA k A S /J l pz Phone#: 2 2
Contractor: W£-.-T " of-) F- A. I P- License#: 8 g
I S)AyROs y4➢�4R 9 �'$
Contact: 5- 901 -Ae SANTA T& TL S A- Cupertino Business License#:
SP�-�J SC's L CG} 95-/23 Te(_ o8- 66/ -boy
Building Permit Info:
Bldg ❑ Elect 01'� Plumb ❑ Mech L,
Job Description:
(Z-F- PLACE" £NT o ;-' OLD FUIZNRCZ �- / NSTAtLA'jl6N o.F iJ;-; �.1 Ac .
Residential [/ Commercial ❑
For Residential Installations:
Attic ❑ 1" floor 22nd floor❑
Adhere to min set back requirement❑
For Commercial Installations:
Replacement 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:
3 90• vo
Strapped a On Platfonn Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
A licable Fee ID Fee Description Fee Group
/ BENERGY Ener BUILDING
BREMFURN Furnace - F0 /< 96- MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm-3 l o rj Uu MECHANICAL
BREMAIRFIAN A/C Units <= 10, 000 cfrn MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
13PERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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