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07010142 CITY'OF CUPERTINO $UILDING DIVISION PERMIT C� iTIRATC'/R'I�1� RMTIQN: PERMIT NO. BUILDING ADDRESS: TE OWNER'S NAME: NATARAJAN & ROJA KANNAN 16142 TCURRAINE DR 01/23/2007 SANITARY NO. CONTROL NO. JNE: (510) 258-7506 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p a LICENSED CONTRACTOR'S DECLARATION Job Description 4 v 5 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing =U m with Section 7000)of Division 3 of the Business and rofessions Code and my license is 2 O 0AMP UPGRADE Z<H in full force aGA�Contractor ? License ClasLic.A E-ca Date ARCHITECTS DECLARATION 9 a-t 1 understand my plans shall be used as public records DWU U.N Licensed Professional OWNER-BUILDER DECLARATION 3 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $1000 xt- (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 o[ 375280: 9 . Number Occupancy Type not more than five hundred dollars(5500). ❑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 build or improve for purpose of sale.). ❑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. F-11 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: JJ I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. ❑1 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 arc: Cartier. Policy No.: CERTIFICATE OF EXEMFn0N FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) I certify that in the performance of ork for which this permit is issued,1 shall not employ any person in any manner as become subject to the Workers'Compensation Laws of Califo " ate Applicant NOTICE T LICANT:If, lcr making this Certificate of giremptidn,you should become subject to the Workers 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 r rA 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.) W Q Lender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is Iy t— correct.I agree to comply with all city and county ordinances and state laws relating to rJ- Ubuilding 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 grantiew it. Date ►-r APPLICANT UNDERSTAILL COMPLY WITH ALL NON-POINT Issued ty:SOURCE RE CATIONS Re-roof 3 sig fApplicandCon tort Oate Type of Roof HAZARDOUS MATERIALS DISCLOSUR 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 root's shall be inspected prior to any roofing material being installed. ❑Yes *0 Will the applicant or future building occupant use equipment or devices which If a zoo�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 materials for inspection. District? ❑Yes IRNu I 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 tena at it is my responsibility to notify the occupant of the requimInphWh must t 'or w issuance of a Certificate of Occupancy. Signature of Applicant Date ITY All roof coverings to be Class"B"or better Ow r author agcrV Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ^CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: A�L-L-- PERMIT # Q�O U OWNERS N r-0, �' �: PHONE # lC r OCG GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signakure Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI:4ESS 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 f -� Own r/Contractct Signature Date =` CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM D l - CUPERTINO CPN# S-1&- r1-��O-CP19. Date: ` Building Address: Mailing Address (if different from building address): t cc -S c ff rJ . v l'�� "� ( �' �E l�T I�ti'C C P O J Owner's Name: Phone#: ; 'ATA RA s� � i�NN�!�- - �,5�; KA,vri Contractor: y ems. License#: � ��J Contact: eaSjlbS 6yWt N hone: � Cupertino Business License#: Building Permit Info: 0 60@00 �S Bldg ❑ Elect Ig Plumb ❑ Mech ❑ Job Description: Residential � Y CC E- , .0 4t Commercial ❑ Sq.Ft. Floor Area: C Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: V Please check this box if the project is a ,i ,J second-story addition: ❑ Project Size: Standard n� Large ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BB01LERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boilcr> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In,i/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co istax—Resi/Mobile BUILDING BELEC1000 El--c 600V <= IOOOA 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 CIT OF PERMIT APPLICATION FORM CUPEkTINO Quanti Fee ID Fee Description Fee Group BREMSIGNAD Rm31 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th.-atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V-,ntilation Systems MECHANICAL BSCBLVD 3cb Specific Plan BUILDING _ BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL ")pecialInspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Idg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mach Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Co me/Multi-Fam PLANNING PLLONGRNGR Plannin ;Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3