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05120073 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT :�vON�RACTQR INFQI2MAlIgIV `; BUILDING ADDRESS: PERMIT NO.0 5120073 OWNER'S NAME: PERMIT ISSUE DATE SAMEER NANDA 12/14/2005 NE: SANITARY NO, CONTROL NO, ARCHRECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 300 LICENSED CONTRACTOR'S DECLARATION lobDescri tion 1 hereby warms that[am licensed under pmu viaiwof Chapter 9(commencing P with Sal 7").f Division 3 of the Businessland PrOlm"I mCode.and my license is a'1 mfwlmtaaneerr a0 g, jgq 2-PL/FAN COMBO, 5-SINGLE POLE SWITCHES, 3-CIRCU z Liense ISa Lt..t F Dam cpnInclmr 1-RECEPTACLE, 100-200A SERVICE UPGRADE, 14 RECE k6$ ARCHIIECoadaspLARA Dds b144rtC_ FIXTURES KITCHEN 1 BATH 1 BEDROOM I undcntind my plans shall be used u CLARrecordsKnON s a� Licensed Pmfceaimel OWNER-BUILDER axe DER DECLARATION �A j 1 hereby (Sect That 11. exempt from due Contncmrs License law for the p O following meson.Permit t Rons5.Business and Improve, de rum Coda:Any city structure County $ which myuive a Permit re cnmtmcL pplia Impmw,h ermit t err masa any at —Z� prior m its issuance,also requites the applicant n for Com permit sties a algae(aatemem that he ulittnsed Purmantmda provisions of ala Cmnlrwetera Liceve law(CNPar9 Sq.Ft.Floor Area Valuation I� (Commencing with Section 7000)of Division 3 of the Businessland Professions Code)or $10000 g$— that he is exempt Nemfmm and the basis for the alleged exemption.Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not marc thin five hundred dollen(ill ❑I,as owner of the Property.a my employees with wages at Neo sole Compewtim, 00 will do the work.and the structure u not intended or offered for sale(Sm.70/4,Bmittess Required Inspections end Profmccom Coda:The Con amor'a License Law does not apply m an owner of q P propenywho buildsorimprates thereon,andwhodoessuch Stock himself oc Waugh his awn couplayw,provided Nat soh improwments am Satlnteeded aroRel locaale if. however.the building or improvement is mid within one year of completion.the owner. builder will have Ne human of proving that be did not build a improve for purpose of salt ❑1.as Owner of Ne property,am exclusively contracting with licensed cxmmctaa to construct da project(Sec.7014.Business and Professions Cade:)The ConuamaM1 U. cesue law does not apply m an owner of propertywonbuilds or improve themmn.and who commets for aitch projects with a contractor(s)licensed pumuanl OR the Contnclar's License law. ❑1 am exempt under Ser. .B At P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hall alarm motor aaally of perjury,aro of due following declamations: 1 haft and will maintain a Certificate of Consent to self-imus focwakeYsCompen- .do.,as provided for by Section 3700 of me labor Coale,for the Performance of the work for which this Permit is issued. _ ❑1 haw and will maimuin Waftes Compensation laiumace,as required by Section 37W often labor Cade,for the performance of the work furl this Permit is Issued. My Workcta CCa�ampaaenw� do�Ins�um�y a artier and Policy number tie: Carver. 87'sMa� �4aV� Policy NO.:1.g�..4�p�.wrin05 CERTIFICATEOFFXEMPTION FROMORKERW S COMPENSATION INSURANCE (DtuseNm need notbecamplead if the permit Is fauns hundred dollen(g100) or teas) 1¢nify that In the performance of the work for which an Permit is issued.l shall am employ anypenan In any moral ss lo become subject rode Workers'Compensation Laws of California.Dem Applicant NOTICE TO APPLICANT:If,after making this CentOmte of Exemption,you should become subject to the workv's Compensation provisions of the Labs Code.you muse 0 z forthwith Comply with such provisions or this Permit all be deemed revoked. rO CONSTRUCTION LENDING AGENCY EI hereby affirm Wt Wm semtw I.. ucdon lending agency fame mtfarmance of > the work for which this permit is Intend(Sc.309].CO.C.) 14 Q Undch Name , z Lenders Address U 0 I certify dust I Tuve mad this application and sum Nat the Show Inform W un is V,f" correct.l agree m comply with all city and county ordinances and sum laws mlat ng m 0 C) building convection,and hereby Rural representatives ofthis city to coal upon the {st .hove-mendaned"'.1­7101 Inspection PurPoxx (We)agree to sew,indemnify and jeep hatmmas tie City of Cupertino spinut Cj fiat lides,judpal Cosa and expenses which may in anyway acme Spirits Said City U in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z SOU EREGULN'IONfv n/n lzhS. f0/ Si nature of App ican nwctoc Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will W applicant or future building Occupant store or handle hmrdoes mammi d as donned by da Cupertino Man Code,Chapter 9.13,anal be Health and Safety Code.=1 All roofs shall be inspected prior to any roofing material being installed. ❑Yin [ qa Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haeardnm air conusimnu u defined by the Bay Area Air Quality Mamgcmenl all new materials for inspection. 7dam tricR ❑Yes /soli No 1 hive mW the haSardtmsmateruhmquirm s ts under Chapaa6.95 orthe Califor. Ill SalmyCode,Suctions 25505,25533aW255N.1 urAm aid thsttfde building not currently haw a ma 1,that it u my ve mihilrly tu notify W Occupant of die uim tswmnnmmm mm dorm a ncemflcaaafO rypancy. Signature of Applicant Date l24t'4 O All roof coverings to be Class"B"or better owneroraulha— rivetll car Daa aC10F Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEI�TINO Building De aAment JOB ADDRESS: PERMIT # tos4t(o LU;\6A-) (ybDz- / --ao ?2 OWNER'S NAME: 3CL" PHONE # 40Y 7,;T5- OW GENERAL CONTRACTOR: V� F # kas tz"— 6 q u0— I am not using any subcontractors: < 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 Ah Tile Owner/Contractor Signature Date alp ��tl Iy�ENT AT� R®JE'C CO R HEE ; CUPEI�TINO t` r �` mk, 4g tiF ma Assessor's Parcel Number: ^ n Name of owner. Project address. Lj'lo LO 'Q 12TC�VL— Contact person. Phone. Fax. k0Y Z—S " Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: / TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the ge? Y� Is privacy protection planting required for the project? Y On what floor(s) is work being done? �� S r Brief description of work. "4VV-1, I — Code editions:2001 CBC (Y -N)2001 CFC ( N)2001 CMC (Y- N) 2001 CPC (Y -N)2001 NECN) Effective 11/1/02 Plan Review Process Work Book Page-B-Revised 4/28/04 Se CITY OF CUPERTINO 051 aoo�3 CUP TYOFR. INo PERMIT APPLICATION FORM N # oda 1 CA5 Date: Building ddress: Mailing Address (if different from building address): o W, erino 96W Owner's Name: Phone#: Sawteiej - _&vJA, 4.R ^2J0 Contractor: License#: 1Le lel ecs�r�C e to IqLA Contact: () �� Phone: Cupertino Business License#: ,� Fax: t4a &CW - 66t H Building Permit Info: �- C;R.i loo - 2ooh Sa+vYK UPC �'e/04CX4'eA) 1- �K X s I�PPoIe S�w� ReaaPb�G �l4 Recease.SL k*—, s t- -d '('� edt Plumb ❑ Mech ❑ Job Descriptio Residential Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: Occupancy GrouD: ' �tOlOoO 3 Type of Construction: Please check this box if the project is a �/� second-sto addition: ❑ ro'ect Size: StandardZ Large ❑ Major ❑ Quant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOlLER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL B130ILER5 Boiler> 1.75MBtu 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 1 of 3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING 14 BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 BPSENVER 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 Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMA KHAN 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 BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance. ELECTRICAL 2of3 A , CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSC13LVD Sob Specific Plan 13UILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICWe Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWiM Swimming Pool 13UILDING BTEMP Temporary Power ELECTRICAL BTEMPPERIA Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance I ELECTRICAL MPERMFEE Mechanicals . foot IvECHANICAL MPERAMFEE 114ech Permit Issuance NI ECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change 13UFLDING f 3 of 3 CITY OF CUPERTINO CUPEfZTINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sigas Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee EMECHANICAL AL BREMTHBATR Theatrical Lighting Fix AL BREMVENFAN Vent Fan Single Duct AL BREMVENSYS Ventilation Systems BSCBLVD Scb S ecific Plan G BSEISAIICOA4 Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEAI Temporary Power ELECTRICAL BTENIPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNIITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot M TCHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbing Permit Issue PLUMING PPLBG Plumbing Fee s foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3