08120134 CITY OF CUPERTINO
BUILDING DIVISION PERMIT TOR INF'ORM�kTION
'td.Ya 2.'Wm- Z4 fass.,i Nk.eF .
BUILDING ADDRESS: PERMIT NO.
7423 PROSPECT TBD — TQ BE
OWNER'S NAME: PERMIT 13UEDATE
O - SA CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
REPLACE FURNACE
u0, LICENSED CONTRACTOR'S DECLARATION
m 1 Watch,,(film that 1 an licensed unsed under provlof Chapter 9(commerming lob Description
-z with section 701111)of Diviaon 3 ofdte Rufiness and Professions Cade.aM my laccase is
io mea forts andLa '^
Edo J2
Licenc 1.2 __L L/��4` Lic.g
p,❑ r
- Dam 1-2 DM - wn.,- I_
aHr/ Iq-"CHITECTS DECLA N —
1 understand my plans shall be used u public meords
Slzas
u.N Licensed Professional
ym3 OWNER-BUILDER DECLARATION
I hereby,Tines that I am exempt[mm the Contractors License Law for the
i.
no fallowing mason.(section 703 1.5,Business and Pro(mom.Coda:Any city ar county
which requites a permit m..sister,Jere improve,demolish,as¢Noir any swctum
prior w is ismarim.also requires the applicant for such permit to file a signed statement
-�< that he is licensed pursuant to the provisions of Be Conunctor's License Law(Chapter 9 Sq. Ft.Floor Area Valuation
(coS
Lt-$ that hes ing exemthereion rom and
basis foion 3r
of the Business anion.Any
C.de)of
that he u exempt therefrom and Ne bwu far Be alleged exemption.Any violation of
Section 7031.5 by airy applicant for s permit subjects the applicant to a civil penalty of APN Number Occupancy Type
.at mom than firs hundred dollars(5500).
Q I,u aw.r of tiie property,army employees with wages u then sele compensadon,
and dothework.anddiehe Consumer
License
Law
cotarsale(sec.]014,Owner
and ertywhmm Code:The Conmcmr.Lionho law does trot apply lf an owmr e( Required Inspections
own ertywho builds kimltats thereon,and who doessuintended mtionalhmugh his
own ver.th Wilding
ithatsuchimpm mid
art not intended icidmied for sale t-
Wilderq the building ar improvement inti halt within nm Wild or completion,the owner-
builder wiB have the burden of proving that he did Out build or improve for Purpose of
sale.).
Q L.as owner or the property w conclusively containing with handed mnuactms to
cansimcl the project(Sec.1044.Business and Prefeesi ms Code:)The CantrsetnYa Li.
come law don not apply in an owner of property who builds or improves themon,and
who canaacu for such Projects with a contractai licensed pursuant in me Concussors
License law.
Q lamnemptumin See .BBPCfmdd,..
OwnerDECLARDau
41 WORKER'S COMPENSATION ATION
i hemby afftam under penalty of perjury one of du following declarations:
Q 1 ha+e arW will maintain a Cutifnta ofCorsent to sslf-iNurt fun WmkcfiCompen-
sadon.as provided for by Sayan 37M of me Labor Cade.for the Performance of me
work for which this permit is issued.
❑I haus and will maintain Workers Compensation Insurance.as required by section
3100 of dm tabor Code,fm Ne perfo.....f the woh for which this permit is issued
My Warks�r�yy//C pcnsadon yytsffulluntt artier and Poliry/n'u Im'ber tee: o
Cartier: KP f111�� Policy No.:4�+Olodsg]I.I_ 8
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbu seedom need wt be completed Ilthe permit is rnrone hundred dollars($100)
or less)
1 canify that in the performance of the work for which this permit is lamed.l mail net
employ any person in any manncru as in become subject to the Workers'Compemadan
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of me labor Code,you mute
.J O forthwith comply with such provisoes or this permit shall be demand revalued.
z CONSTRUCTION LENDING AGENCY
(-i I hereby xRnn that thcrt is a construction lending agency for the performance of
p: the work for which dills permit Is issued(Sec.3097,Cl,C.)
Qlenders Name
iD. z Lenders Address
U 0 1 certify mat I have read this application and sum this the above information is
F' enrram 1 agree to comply with all city add county ordinances and sum laws relating in
0(J building crosuuction,and hereby malmre apressnutives of this city to enter open the
r W show-creatianed pmpcny for inspection purposes.
(We)agree to says,indemnify and keep harmless the City of Cupertino against
iy liabilities judgments.costs and expenses which may to any way.coa.against said City
V? in r ICcUNDERSTANDS uenum of the Starting of r
ANs permit.
D ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REcQ"ATIONS.
1Z1ZZ�OS Re-roofs
Signature 0r inni/Gontaicror DomeHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant some in handle harallous materia
as dcftwd by the Cupertino Municipal Codc.Chapter 9.13,and the Health and Safety
Cacao.Section 2x532(,)? All roofs shall be inspected prior to any roofing material being installed.
QYn u
Will the applicant ar future building mcupant tax cyuipmcnr or devices whicM1 If a roof is installed without first obtaining an inspection,I agree to remove
Cali I mind us air contaminants u dcrined by the Bay Area Air Quality Management all new materials for inspection.
District?
Q yesNo
I have mad lie hmadous matariala requimments under Chapter 6.95 of the Cables-
nia Health h SdeiyCode,Sations 25505,25533 and 25534.1 understand tWt if me building
does not Connally haw a h mm,that it is my respansihility to notify thc occupant of me
rtyJmments most rent priormissua.c ora Ccrtirmam ora pmmy Signature of Applicant Date
U
2 ZL E All roof coverings to be Class'%Q"or better
Ownerma hoed,gemI Dam"
Community Development
r 10300 Torre Avenue
Cupertino CA 95014
^TM Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
711,?3 'bras c n z-ot3 Ll
OWNER'S NAME: n V, ,r g 1c 13 a r ' PHONE # (a 15cr SeC?O
GENERAL CONTRACTOR: /Zlqr qpr tnj,r; k FAX # 6
I am not using any subcontractors: l z Z Z 1O 8
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
12/7--
er/Contractor Signature Date
CITY OF CUPERTINO
0.7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36615045 . 00
DATE ISSUED. . . . . . . : 12/22/2008
RECEIPT # . . . . . . . : . : BS000006875
REFERENCE ID # . . . : 08120134
SITE ADDRESS . . . . . : 7423 PROSPECT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DUTTA VIVEK B AND MANJARI
ADDRESS . . . . . . . . . . : 7423 PROSPECT RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5241
RECEIVED FROM . . . . : RONALD MATRICI
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -----
1BSEISMICR VALUATION 2, 900 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 338 . 85 0 . 00 338 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CREDIT CARD 338. 85 visa
---------------
TOTAL RECEIPT 338. 85
VOICE ID . DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
• ���, CITY OF CUPERTINO
FURNACE/AC
CUPEIZTINO PERMIT APPLICATION FORM
00#_ 41/3/ /1P p
APN It n 'Ih- Date: I I D
Building Address:
Owner's Name: Phone #:
VIvek wffzL � - qll - 3SIoV
Contractor: n , Phone #:&/S S- I3 — 60 2-Da
P-M I Me(/ In (CA ( l/UVIf-YG{GfTr- Fax #: - 3-bel/ 1
Contractor License #: 8 3 ) 1/0V Cupertino Business License #:
Contact: Phone #: 0 n 3 — Ce )--Ob
M l K e P2 1z l &1 Vf-T Fax #: tB S-D- Ste'25- 9 I l 1
Building Permit Info:
Elect ❑ Plumb ❑ Mech
• Residential 4 Commercial ❑
Job Description:
f� epl � ce Fitvndce
For Residential Installations:
Attic ❑ 1" floor 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight [�� Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
q ), 0100
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ��
Project Size: I.ix rens ❑ Standard ❑ Large ❑ Major ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08