03060189 (4) CITY OF CUPERTINO CONTRACTOR INk'OT.2MAI '
BUILDING DIVISION PERMIT • ,, ;., x ,, g
eu1LDlNC ADDRess: DESHPANDE SIDHAKUMAR G AND Wl NO03060189
NER'S NAME: . PERMIT ISSUE DAM
PHONE: SANITARY NO. CONTROL NO.
ARCHITELTIENGINEER: - BUILDING PGRMITINFO
BLDG ELECT PLUMB MECH
uOg LICENSED CONTRACTOR'S DECLARATION
I hereby afro chat I am licensed made(provisions of Chapin 9(commencing - Job Description
with Section nlfk))Of Division 3 of me Businessand Prufcssinns Code,and my license is
ra y in mmaand errec`' DECK REPLACEMENT
m�Z Licencnsc Class Lin.g
;f
Data Conduct., av
epp ARCHITECTS DECLARATION +// s�
C 3< 1 undersand my plans shall he used as puhlie records
k o
Licensed Professional
��0It
3 h9 OWNER-BUILDER DECLARATION
Z n C I hoary affirm that 1 1. exempt Tram the CosionsC s License Law co me
_ca O following mason.(Section 703 1.5,Business and improve,
demob Code:Any city or county
3 w which requires a permit a construct,alteq improve,demolish,car repair any nuucmm
_ZY poorm its ixmance,alsu requires theaplicml fariuch permit a file asignedsate °cat
EP that he is licensed pursuant to the pnrvisionsOrthe CommaLarsLicense aw(Chapter 9 Sq. Ft. Floor Area Valuation
9H� (commencing with Section 7")of Division 3 of the B usiness and Professions Coda)or
y that he is empire therefore and the basis far the alleged exemption.Any violation of 36218021 . 00
Section?031.5 by any applicant for a permit subjects to applicant o a civil penalty of APN Number Occupancy Type
not more than rvc hundred dollars(5500).
1,as owner of the property,or my employees with wages as their sole compensation, (�i�T
will do Ne work and me swm cais not inumdel or offered for sale(Sec. Business - C�ulrCd Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 10 2 - PIERS
pmperty who builds or improves thereon,and who doesauch work himselfor through his
own employcos,provided that such improvements are not intended Or offered for sode.It, 103 - UFER
however,the building or improvement is sold within one later of completion,the owner-
builder will have the burden of proving mat he did net build or improve for purpose of 104 — REBAR
sale.). 105 - ANCHOR BOLTS
❑l,as owner of me property,am exclusively contracting with licensed convectors m 106 - SEWER & WATER
Construct the project(Sec.7044,Business and Pmfcutioro Cade:)The Contractors Lt
cense law does not apply to an owner of properly who builds or improves themon,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with acontratLoa s)licensed pursuant to the Contractor'
License Law. 203 - UNDERFLOOR MECHANICAL
13 1 ren exempt under Sec. .B&P C for this reason
' `f pr 204 - UNDERFLOOR FRAME
..6 ION DECLAICATION47 205 - UNDERFLOOR INSULATION
I hereby affirm under Penalty of perjury ow of the following declarations: 301 - ROUGH PLUMBING
❑l have and will mainmine CenificmcofConsentmxlf-insure mrworkersCompen. 302 — TUB Tic OR SHOWER
sation,as pmvided for by Section 3700 of the labor Code,for the Performance of the 3 03 - ROUGH MECHANICAL
work for which this permit is issued.
❑1 have and will maintain WOrkcri Compensation Insurance,u rcquimd by Section 3 04 - ROUGH ELECTRICAL
3700 of the Labor Code,for da performance of the work for which this Permit is issued. 305 - FRAME
My Worker's Compensation losuranm carrier end Policy mother me: 306 - HOLDOWNS
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
mustsection need not he completed if the Permit is for one hundred dollars 1$10fp 309 - EXTERIOR LATH
or lass.)
1 cattily that in the performance of the work for which this permit is is ued,I shall not 310 - INTERIOR LATH
employ any Person in any manner m as to become subject to the Workers'Compensation 311 - SCRATCH COAT
Laws of California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject m the Waher's Compensation provisions of the Labor Cade,you must
ciz forthwith comply with such previsions or this permit shall be deemed revnkcd. 502 - FINAL PLUMBING ENERGY
z2 CONSTRUMON LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hamby afrom that mere ts a aom'mction lending agency or the performance of 504 - FINAL BUILDING ENERGY
BYt> me work far which this permit is issued(Sec.3097,Civ.CJ
W Q Leaders Name- 505 - FINAL ELECTRICAL
� z <nderanadesa 506 - GAS TEST
U O 1 certify that I have read this application and state that me above information is 507 - FINAL PLUMBING
F correct.l agree to comply with all city and county ordinances and state laws miming to
DU building construction,and hereby summon representatives ofthiscity 10 enter upon the FIN MECjtNG
AL
4i1 ehovcmcmionctl property for inspection purposes.
CL (We)agree m save,indemnify and keep harmless the City of Cupertino against Q 9 FI
t,i Liabilities,judgments.costs and expenses which may in anyway accrue against said City 5 in
of the granting of
his permit.
U s77- APPLICANTeUNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued b ORKS Date U
SOURCE REGULATIONS. �J /�—•o'y, y5
Signmur pp man- d,�ectan` Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - Type of ROOF
Will me applicant or future building Occupant store or handle luoWdous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532nd? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 240
Win the applicant or future build!ngoacupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hayarduus air contaminants es defined by me Bay Area Air Quality Management all new materials for inspection.
District? /
C]Yea VYP
1 have mad me hosaNOus materials mquimm res under Chapter 6.95 of the Califon
nia Health&Safety Coda,Secdoas M05,25533 and 25534.1 understand Lou if he building
does not cunemly hove a mnank mat it is my resparuibility,an notify the Occupant of the
requimacrunwhichaus'bemmpo tuissuancwfaCcrd11 to focu ay. Signature of Applicant Dale
(/f �fa1
away orauthorized agent Data All roof coverings to be Class "B" or better
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36218021 . 00
DATE ISSUED. . . . . . . : 06/30/2003
RECEIPT 4 . . . . . . . . . : 22315
REFERENCE ID # . . . : 03060189
SITE ADDRESS . . . . . : 7756 OROGRANDE PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DESHPANDE SIDHAKUMAR G AND SMI
ADDRESS
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4144
RECEIVED FROM . . . . : SID DESHPANDE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : DESHPANDE SIDHAKUMAR G AND SMI
ADDRESS . . . . . . . . . . :
• CITY/STATE/ZIP . . . CUPERTINO CA, 95014-4144
TELEPHONE .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 77 . 00 23 . 10 0 . 00 23 . 10 0 . 00
BPERMFEE VALUATION 2 , 500 . 0,0 77 . 00 0 . 00 77 . 00 0 . 00
BSEISMICRE VALUATION 2 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BPLANCHK PERMIT FEE 77 . 00 65 . 45 0 . 00 65 . 45 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 166 . 05 0 . 00 166 . 05 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 166 . 05 7299
TOTAL RECEIPT 166 . 05
•
WNOR-BUILDER VERIFICATION•
• 1. (Check one) I or/my immediate family (parent, spouse or child) will perform:
A. ✓ All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature � ✓!�p�� Date: 1643' �3
Job Address: .J�757iJ E ggl n x '/ _ Permit#
• Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
' - OF CUPERTINO U
• cTM°F' PERMIT APPLICATION FORM 3
CUPEkTINO
APN# Date:
6
Building Address:
Owner's Name: Phone#: 60.9 -, 7 2 S-- p 07'
`�SiD t Spyi7-A TDASHP.,nrz)1E o— 409 - 4,39- 175;6
Contractor:
09 — —
Contractor: / — License#:
Contact: J�C 7y Cupertino Business License#:
Bui it Info:
ld / Elect ❑ Plumb ❑ Mech ❑
ob bciption:
_R'esarential ❑ erci
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Grou .
r
ype of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of
Cy OF CUPERTINO
0 PERMIT APPLICATION FORM
• CUP'ETINO
Quantity Fee 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 Multifamily Res ELECTRICAL
BNUCOM1vIE 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENIAIRHAN A/C Units<= 10,000 cfin 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
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISc Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREN20LE Pole/Platform Fixture ELECTRICAL.
2 of 3
CITY OF CUPERTIO
CITY OF? PERMIT APPLICATION FORM
CUPEI�TINO •
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL j
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT _ Repair/Alter Heating MECHANICAL
BREMRESAPP- Remodel Res Appliance ELECTRICAL 1
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection" BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
: 1 � 0
E APP.f30VE, n
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j 1
IN AGCOLIDANCE`WITti TLLEL`�(' S
I Ct1 IWI DES A',J'6RDI�n E3
K
OAT
lcs SMED_ -
This set of pla..s and speci;icat ns MUST
ue kept on the job at all titres nd itis art•
r laWlul to make any changes r, a.oft tonsrog
on same without written pe mission f
_ ,the building Dept,, Gity Of no
d Sp cfications
The stamping i ` ' ;"
pe held.to permit oc to he as
A + .
SUB
appro+aiCC0 he�iOW16N of any proYis�
SUU (C) aftr,•City-QE0inanM-KSP1t% LLOW-
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