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07010131BUILDING DIVISION BUILDING ADDRESS: _ 7601 RAINBOW OWNER'S NAME: APARNA SATHYE iONE: ARCHITECT/ENGINEER: �z Z C Iia > ►� z UO wE OU her � Uz PERMIT I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70(X)) of Division 3 of the Business and Professions Code, and my license is in full force andfffc .0 License Cla,�s . ` �> Lic. # Date /4/ 'r J Contractor !awn -- ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Cade: Any city or county which requires a permit to conswct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 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 is not intended or offered for sale (Sec. 7044, Business 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 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 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. 0 I am exempt under Sec. B & P C for this reason Owner Dare WORKER'S COMPENSATION DECLARATION I hereby affirm 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 Compcn- sation, as provided for by Section 3700 of the tabor Code, for the performance of the work for which this permit is issued. I have and will maintain Workers Compensation Insurance, as required by Section 700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensati n Insurance Cartier and Policy number are: Carrier-4-4Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 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.) Lender's Name Lenders Address I certify that 1 have read this application and state that the above information is corccL 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT OURCE REGULATIONS. /1111x... o/ -11 -,: 9/— Sign ure of Appli t/Comractor Date HAZARDOUS MATERIALS DISCLOSURE 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)? 0 Yes �!..-building Will the applicant or occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes u I have read the hazardo s 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 requitpments )vhich must be met prior to issuance of a Certificate of Occupancy. h�. UG�'Z .4 -Jt')/ Owner or authorized aCcn Date nT\TTI T T fl- q T T\T(- 712 ST,)NE A PERMIT NO. SANITARY NO. CONTROL NO. OCATE FURNACE TO GARAGE BLDG Issued by: Re -roofs 3q. Ft. Floor Area Description Required Inspections BUILDING PERMIT INFO Valuation Occupancy Type Type of R )of All roofs :;hall be inspected prior to any roofing material being installed. If a roof i:; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better V1 m"n f3yW'4 ITI/y OVED -4 IN A( GORDANC WITH THE CITY 01 ;,UM TINO GOD) AND ORDINANCE SIGN SPPi his of P1 ov, /to me sfpfulio of the pi- n . L NOT be he':d to P--!- MitA9--, )val of the, violation of Pa o rirwwp. nr q6i�'x I/ I IA- (,, ��,�ly oQaN�� ,9,6, 49(4& e6l1leCe, 140 S7411?j -6 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS:z7*M AV&A PERMIT # SUBCONTRACTOR OWNER'S NAME: ,dO,CiL;d PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: l� c1l Signa e Date Please check armlicable subcontractors and complete the following information Owner/ Contractor Signature Date 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 F CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM 17701 b 1-31 APN # r Date: /n Building Address: BENERGY I BREMFURN Furnace Phone #: Owner's Name: a� S-_ j� L o 04 1,41- l �� Contractor: Phone: License #: �/ &,d�'/� /,P�U�/C ydt J'Y7i Cupertino Business License #: Contact: f Phone: _ o �v - BL E BSEISMICRE Building Permit Info: BUILDING �/ Bldg❑ Elect ©� Plumb E Mech Job Description: yo A, 3 EPERMITFEE � Residential [ Co ercial ❑ ELECTRICAL For Residential Installations: ❑ P ❑ ]✓Tech Permit Issuance 2nd floor 1St floor Attic PPERMITFEE Adhere to min set back requirement PLUMBING For Commercial Installations: Additional weight (structural calcs) -1 Bldg Permit Fees Replacement same weight ❑ ❑ BPLANCHK Structural Calculations required for new installation BUILDING New installation Plannin A royal Required ❑ Sas Piping System Fee Cost of Project: Type of CCoo�nst�ru-:tion: Occupancy group: - q Iep-p BUILDING Strapped ❑ On Platform/G--'' Bonded LF Sq.Ft. Floor Area: New Location 7: Re lacement Qty. if 'U-- T'% ---;"+inn Fee Grout/ A plicable ree ili Energy _ BUILDING BENERGY I BREMFURN Furnace MECHANICAL BREMACOVER EX Unit > 10,000 cfin MECHANICAL BREMAIRHAN X Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM ;seismic Commercial BUILID EPERMITFEE l?lec Permit Issuance ELECTRICAL MPERMITFEE ]✓Tech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK flan Check Fee BUILDING BPGAS Sas Piping System Fee PLUMBING BUSLIC Business License BUILDING