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07020043
CITE'OF CUPERTINO BUILDING blVl$ION PERMIT R.INFORMATI©�" PERMIT NO. eun.91W15S,OGRANDE PL WATER HEATERS ONLY 07020043 OWNER'S NAME: tL PERMIT ISSUE DATE RAJANI BALARAM 970 E. MAIN ST, SUITE 200 02/08/2007 3NE: (800) 8:35-5946 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i p C LICENSED CONTRACTOR'S DECLARATION Job Description vr— 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE PLAC J!, WATER HEATER r=y in full force and effect 7 v�2 License C1 7 Lic.A 3 `S ±Ftp Date — Contractor A CHITECPS DECLARATION- 7 I understand my plans shall be used as public records )qU tc y Licensed Professional h OWNER-BUILDER DECLARATION i< 1 hereby affirm that I am exempt from the Contractor's License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county `< which requires a permit to construct,alter,improve,demolish,or repair any structure Z>. prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 K=p Sq.Ft.Floor Area $826 t (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L1 that he is exempt therefrom and the basis for the alleged exemption.Any violation of L. Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of epN Number Occupancy Type not more than five hundred dollars(5500). 362180 L 8 .`l7 L! ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License law. ❑I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor code,for the performance of the work for which this permit is issued. My Worker's Compensation I surance carrier and Policy number are: Carrie. Policy No.: y CEItTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not be completed if the permit is foronc hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY E—t rt ) I hereby affirm that there is a construction lending agency for the performance of (Y. the work for which this permit is issued(See.3097,Civ.C.) Lender's Name a z Lender's Address U 0 1 certify that I have read this application and state that the above information is V. r" correct.I agree to comply with all city and county ordinances and state laws relating to O building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►' APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued try: SO GULATION ,J `�j d'L/ Re-roof s Signature of Applicant/Conuactor Date HAZARDOUS MATE ALS DISCLUMME Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ,/ All roofs shall be inspected prior to any roofing material being installed. Cl Yes No Will the applicant future building occupant use equipment or devices which If a roo 7 is installed without first obtaining an inspection,I agree to remove r emit hazardous air contamina B fined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs currently have a tenant,that it is my responsibility to notify the occupant of the Rrc nts which mu be met ' r to issuance of a Certificate of Occupancy. Slgnatu-e Of Applicant Date All roof coverings to be Class "B"or better Owner of authorizeagent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTIN0 Building Department JOB ADDRESS: 777 .��OPERMIT# C 6111 � OWNER'S NAME: l l 4 R. " 3 4 U 01 PHONE # yo e 7 z - 3 Z GENERAL CONTRACT R: ttl� FAX# I am not using any subcontractors: (�4 - C signature 0 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36218018. 00 DATE ISSUED. . . . . . . : 02/08/2007 RECEIPT #. . . . . . . . . . BE000000419 REFERENCE ID # . . . : 07020043 SITE ADDRESS . . . . . : 7770 OROGRANDE PL SUBDIVISION . . . . . . . CITY CLPERTINO IMPACT AREA . . . . . . . OWNER RPJANI BALARAM ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4144 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR MCGEE, PAT LIC # 18986 COMPANY WITER HEATERS ONLY ADDRESS 9/0 E. MAIN ST, SUITE 200 CITY/STATE/ZIP . . . : GFASS VALLEY, CA 95945 TELEPHONE . . . . . . . . : (E00) 835-5946 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0. 00 84 . 02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 84 . 02 MASTERCARD --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO WATER HEATER CUPEIZTINO PERMIT APPLICATION FORM APN# Date: J4C.�a 7 — "U Building Address:--7-7 -7o -7,7 -7o c rQ Grande- Owner's rarsde-Owner's Name: Phone#: V✓' v �r-u� �� W82n ni ZZs Z %3Z Con actor: � Phone: ��i License#: 3,7/ � /73 !.veer {�e«�efs �� Y r� 57 3 0- �7i- 3 Contact: Phone: Cupertino Business License#: Building Permit Info: Bld ❑ Elect IJ` Plumb Mech C9� Job Description: �l Cpcjs Residential 1K Commercial ❑ Cost of Project: R2 b Strapped On Platform Bonded 8 New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING