The URL can be used to link to this page

07010095 CITY OF CUPERTINO f3UILRIN(;DIVISION PERMIT 9�.. .. PERMIT NO. BUILDING ADDRESS: 1 355 FARALLONE DR A PERFE2 PERMIT ISSUE DATE OWNER'S NAME: RAJA & KATRINE BHADURY 10570 S DEANZA BLVD 01/17/2007 SANITARY NO. CONTROL NO. 'NE: (408) 86119545 BUILDING PERMIT INFO ARCHITEC IENGINEER: BLDG ELECT PLUMB MECH O a LICENSED CONTRACTOR'S DECLARATION Job Description 'WE E 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing REPLACE FURNACE AND ADD A/C e Z yr with Section 70(10)of Division 3 of the Business and Professions Code,and my license is Z)y in full Come and feg 3 tRZ License Cl s Li,g t- in Date — Contractor AR ITECI'S DECLARATION WU I understand my plans hall be used as public records a 4 O w Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the HO O following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,demolish,or repair any structure prior w 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 $9683 xH (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 3 6 9 31016 .`(•tl1',p� Number Occupancy Type not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself at through his own employees,provided that such improvements are not intended or offered for We.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.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's LL- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contactor(s)licensed pursuant to the Contractors License Law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby aflitm under penalty of perjury one of the following declarations: 0 1 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 Corch this permit is issued. d will maintain Worker's Compensation Insurance,as required by Section 3 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrierQelicy number am: ^ Cartier jicy No.: CE ATE OF EXEMPTION FROM PK S' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 ,J,Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY Hr-a I hereby affirm that there is a construction lending agency for the performance u! C4> the work for which this permit is issued(Sec.3097,Civ.Q W ALender's Name �z Lender's Address V 0 1 certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives or this city to enter upon the above-mentioned property for inspection purposes. W (We)agree to save,indemnify and keep harmless the City of Cupertino against HCW V) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date 0� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE ULATIONS. Re-roof:; Signature of Applicanantfactor Dare T of Roof AZARDOUS MATERIALS DISCLOSURE Type 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. 0 Yes Will the applicant or future building occupant use equipment or devices which If a room is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as do d by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes o 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of C Gcate of OccupajDcy. Signatu;e of Applicant Date � All roof coverings to be Class"B"or better Owner orauthorvedagent a Community Development :Y 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Buildin De artment JOB ADDRESS: PERMIT # ��35 ctic vie �r OWNER'S NAME: J. ' c, 1, ),r,v, PHONE 0S- ?-)3•l Q otic GENERAL CONTRACTOR:Tc per+ FAX# I am not using any subcontractors: Si gnature Date Please check apphcable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 wo m FURNACE/AC �UPEkTINO PERMIT APPLICATION FORM APN # Date: 4 3(�q 3 { vi co t 1 - Building Address: �aCGlJon� VJ� Owner's Name: � #: 2 a ho/ fr73•Idao Contrac7ec" ��n;: ' �S ys License#:� / C -�e ) Contact: Phone: Cupertino Business License#: Za 1�c��c' &'�3•l �a 0 Building ermit Info: Bld ❑ Elect ❑ Plumb ❑ Mech Job Description;: O 2 actA C Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor 2nd floor❑ Adhere to min set back requirement For Commercial Installations• Replacement same weight Additional weight (:,ructural calcs) El Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Constnic ion: Occupancy group: q� 9 1,Strapped O latform Bonded Sq.Ft. Floor Area: New LocatioPn Re lacemenJ2- if Qty. Applicable f Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10, 00 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 Pip ng System Fee PLUMBING BUSLIC Business License BUILDING