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07010037 CITY OF CUPERTINO �'�t BUILDING 1.� � T�R� BUfLDIN �� * PERMIT BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: n nrm T m T nnT-r rTn PERMIT UE DATE KIRTI KANDADE 1712 ETONE AVE 01/05/2007 ONE: SANITARY NO. CONTROL NO. (408) 253-4717 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 O O LICENSED CONTRACTOR'S DECLARATION Job Description e V I hereby affirm that I am licensed under provisions of Chapter 9(commencing =z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE FURNACE Z y in full force and e t M? License C a Lic,ff 3 t-o Date - :=: -1 ALf;t274[ C A HITECTs DEC RA7 tC U I understand my plans shall be used as public records a 4 G H Licensed Professional .1 OWNER-BUILDER DECLARATION X I hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county .e vo ff which requires a permit to construct,alter,improve,demolish•or repair any structure y Z> prior m its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 3 O O 0 t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars(5500). 32648034 . V V ❑1,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 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 Mild 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 Contractors License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Conscnt 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. ❑I 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 Insurance carrier and Policy number am: Cartier. L Policy No:b�R1 raCEC ,14 44 �j C EXEMP170N FRO 0 RS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for anc hundred dollars($100) or less.) 1 certity 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY (~t C/3 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Lcndees Address V 0 I certify that I have read this application and state that the above information is Vm t" correct.1 agree to comply with all city and county ordinances and state laws relating to CUbuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against cp) liabilities,judgments•costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. "4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued br': Date SOU E REGU NS. V/ D Re-roofs Si of plicant/ ontracto Date HAZARDO11,13 MATERIALS DISCLOSURE 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 roof: shall be inspected prior to any roofing material being installed. ❑yes Will the applicant ytubuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. District? ❑Yes o 1 have read the haza tus materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCode,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the re nlrc n rich mast be met prier w issuance of a certificate of Occupancy. Signature;of Applicant Date d'Wncr'or aulhorizcd ent Dare_ All roof coverings to be Class"B"or better Community Development 'a A 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ':UPEkTINO Building Department JOB ADDRESS: PERMIT # -7 le-70 `3 ? OWNER'S NAME: PHONE # y - 2ZJE GENERAL CONTRACTOR: FAX # I am not using any subcontractors: A2 92 p c-ignat&e 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 (.UPERTINO C170100,30q f E FURN.A CE/AC .UPEkTINO PERMIT APPLICATION FORM APN# Jf Date: �� _a Building Address: Owner's Name: Phone#: Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Afr Plumb [!T � Mech Job Descriptio : Residential Commercial ❑ ForR ential Inst llations: Attic s' floor W 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (:tructural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type offs ction: Occupancy group: Strapped El On Platform Bonded EY Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if A licable Fee ID Fee Description Fee Group BENERGY E.nergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER VC Unit> 10,000 cfin MECHANICAL BREMAIRHAN VC Units<= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING