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07080084 CITY OF CU-PERTINO g �t BUILDING DIVISION PERMIT Y V" 1NFO� �� PERMIT NO. BUILDING ADDRESS: 20150 PEACHTREE LN AMERICAV TECHNOLOGIES, INC 07080084 l PERMIT ISSUE DATE OWNER'S NAME: NARENDRA SANTHANAM 30911 WIEGAAM RD SA AR N CONTROL NO. (510) 429-5000 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing %I with Section 70(X))of Division 3 of the Business and Profession%Qpdc,and my license is IRE REPAIR DAMAGE TO KITCHEN DUE TO FIRE , in full force and effect. is''l 4 License Class `� ` Lic•p EPAIR Date n%_05, Contractor ARCHITECTS DECLARATION DRYWALL & KITCHEN (LIKE FOR LIKE) I understand my plans shall be used as public records :J Licensed Professional a OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the O following reason.(Section 7031.5,Business and Professions Code:Any city or county fi 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 rile a signed statement S Ft. Floor Area Valuation 0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q" $6500 (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 �,pN Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316 3 3 0 5 8: 0 0 Number not more than five hundred dollars(3500). 0 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 ProfessionsCode:The Contractor's License Law does not apply to an owner of property who Builds or improves thereon,and who dotes 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 contratting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors 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. 0 I am exempt under Sec. ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I herby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for whieh.lhis permit is issued. 0 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 are: �� Cartier. 0.C V� Policy No.:W r CERTIFICATE OF EXEMPnON 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. C) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work far which this permit is issued(Sec.3097,Civ.C.) Lender's Name Z Lender's Address 1 certify that I have read this application and state that the above information is 0 correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the ahovc-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. Date r G" ►- APPLICANT„UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bJ SOURCE REGUL TIONS. _ `), a O� ( Re-roofs Signature ti ApplicanNConlractor Dale Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP 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 roof is installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new I laterials for inspection. District? 0 Yes XNu 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 tenant,that it is my responsibility to notify the occupant of the Date cyvircm ch must be met 'or to issuan oC a Ccrifnc Oceupanry. S ignatur;of Applicant �Q,(,�t'� `09 All roof coverings to be Class"B”or better Owner or authorized agent Date CITY OF C'UPERTINO c� f PERMIT APPL][CATION FORM CUPERTfNO CPN# '� Date: _ 0 Building Address: Mailing Address (if different from building address): D-0 \S�) Owner's Name: ` Phone#: 6,111 Contractor: _ � \n l � Licences e Contact: Ph e�'lv�� 9�"U� Cupertino Business License#: Fax Building Permit Info: Bldg D< Elect Et"' Plumb ❑ Mech ❑ Job Description: R��,?�� ..� � Yvk t-r-U�*- ; Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: `� ,da Occupancy Group: Type of Construction: Please check this box if the project is a S � second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boil,;r> I M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Llec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 yµ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CIT$OF Fax(408)777-3333 r'J PEkTINO Building Department JOB ADDRES `c - PERMIT # O l S 6 boa OWNER'S NAME: LNQ-4 A, S�.�J /.�'� PHONE # Ctp — r? GENERAL CONTRACTOR: N(*-(C VC&i t FAX # I am not using any subcontractors: Signature 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 5 ITEMS OF 5 PERMIT' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl]:: Lot: APN 31633058. 00 DATE ISSUED. . . . . . . : 08,'09/2007 RECEIPT #. . . . . . . . . . BS000002319 REFERENCE ID # . . . : 07080084 SITE ADDRESS . . . . . : 20:_50 PEACHTREE LN SUBDIVISION . . . . . . . CITY CU:?ERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NA]2ENDRA SANTHANAM ADDRESS . . . . . . . . . . : 20150 PEACHTREE LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JKYLE PICKET CONTRACTOR . . . . . . . : GARY MOORE LIC # 26199 COMPANY . . . . . . . . . . : AM:-.RICAN TECHNOLOGIES, INC ADDRESS . . . . . . . . . . : 30')11 WIEGMAN RD CITY/STATE/ZIP . . . : HAtWARD, CA 94544 TELEPHONE . . . . . . . . : (5L0) 429-5000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 6, 500. 00 137 .16 0. 00 137 .16 0. 00 BREMFIXT NO. FIXTURES 1.00 1 .20 0. 00 1.20 0. 00 BREMRECEPT NO. OUTLETS 10. 00 12 . 00 0. 00 12 .00 0. 00 BSEISMICRE VALUATION 6, 500. 00 0.70 0. 00 0.70 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 189 .43 0. 00 189 .43 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 189 .43 MC --------------- TOTAL RECEIPT 189 .43