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07060255 CITE'OF CUPERTINO � TIf`TR IUMTN; BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 7626 KIRWIN LA KYM MECHANICAL CAL 07060255 PERMIT ISSUE DATE OWNER'S NAME: RAGINI SIVA 2815 FAI:2 OAKS AVE 06/27/2007 SANITARY NO. CONTROL NO. (650) 36. 6 -3190 BUILDING PERMIT INFO ARCHITECffENGINEER: BLDG ELECT PLUMB ME�CH ce C LICENSED CONTRACTOR'S DECLARATION Job Description l Vp I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is FURNACE. RE PLAC EMENT S, RELOCATION TO THE GARAGE & >>N in full fore and effect CLic.#License Class Z ADD AIR :OND I T I ONER. h�2 p Date Contractor ARCHITECTS DECLARATIO i < I understand my plans shall be used as public records )aU a Licensed Professional a OWNER-BUILDER DECLARATION }-3 from the Contractors License Law for the 1 hereby affirm that 1 am exempt 3 p o following reason.(Section 7031.5,Business and Professions Code:Any city or county Pi which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation rn prior to its issuance,also requires the applicant for such permit to file a signed statementF35 S�.Ft. Floor Area Zthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $8300 t- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of q. 61 pN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of2 2 016:U 6 not more than five hundred dollars($500). 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 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.). 0 1,as owner of the property,am exclusively contracting 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 Contractor's License Law. B&P C for this reason 0 1 am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: .tape and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,asprovided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. f 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 Workers Compensation Insurance carrier and Policy t encumber are: Carrier. 4�SA'f1 i' Policy No.::,tz I-0a,.�6s 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 Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F~.c ce) f hereby affirm that there is a construction tending agency for the performance of {Z!> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name Z Lcndees Address U C I certify that 1 have read this application and state that the'above information is correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against "H Col.) liabilitiu,judgments,costs and expenses which may in any way accrue against said City 1,Z in consequence of the granting of this permit. Date �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULAT I Re-roofs Signature of Ap can ontractor _ Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type will the applicant or future building occupant store or handle hazardotts material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cafe,Section 25532(a)? All roofs Shall be inspected prior to any roofing material being installed. 0Yes ®N° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which nazardous air contaminants as defined by the Bay Arca Air Quality Management all new rr aterials for inspection. uhstrict? 0Yes %No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safcty Codc Sections 25505,25533 and 25534.1 understand that if the building does not currently have tenant,that it is my responsibility to notify the occupant of the Date requircmcnts w' be met prior to issuance of a C 'fica cup Signature of Applicant All roof coverings to be Class"B" or better Owner o au riz agent Dae CITE'OF CUPERTINO y�t NDA T BUILDING DIVISION PERMIT }l ' ZEQ1rTl� a PERMIT NO. BUILD.(N):'t34p6ESS;_RISTA CT QUAN' S ELECTRICAL 07060267 l U `�2$ j� PERMIT ISSUE DATE OWNER'S NAME: GEE DAVID B AND JEANNE F 10628 RJINDY LN 06/29/2007 SANITARY NO. CONTROL NO. SNE: (408) 366-1823 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 Q LICENSED CONTRACTOR'S DECLARATION Job Description V1 hereby affirm that I am licensed under provisions of Chapter 9(commemcing U cUu with Section 7000)of Division 3 of the Business and Professions Codc,and my license is CHANGE FURNACE, ADD A/C o a. in full force and ec Q _ 4 t n i License CI Lam• t Q Dam Contractor — ARCHITECTS DEC RA i x a I un ,stand my plans shall be used as puhlic records iaU ti y Licensed Professional �< OWNER-BUILDER DECLARATION > 1 hereby affirm that I am exempt from the Contractors License Law for the n O following reason.(Section 7031.5,Business and Professions Calc:Any city or county e m which requires a permit to construct,alter,improve,demolish,or repair any structure a y prior to its issuance,also requires the applicant for such permit to file a signed statement r. Valuation z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area $5500 i F (commencing with Section 7000)of Division 3 of the Business and Professions Cade)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 of3424500,E ( Number Occupancy Type not more than five hundred dollars($500). ❑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 oroffered 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.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's u- ccnse Caw 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. ❑I 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: ❑1 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. ❑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 Workersomnsa iInsu ice carrier and Policy number d. Carrier. Policy 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 Z forthwith comply with such provisions or this permit shall be deemed revoked_ Z O CONSTRUCTION LENDING AGENCY Ha I hereby affirm that there is a construction lending agency for the performance of (� > the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name Z Lender's Address U O I certify that I have read this application and state that the above information is f~ correct.I agree to comply with all city and county ordinances and state laws relating to .J C, building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. C1. (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 n g U Z in consequence of the granting of this Permit. Date "L (—t-7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULAyt0yS. Re-roofs ' Signature of Applica i/Contractor Dare T of Roof HAZARDOUS 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. [:]Yes CPNO Will the applicant or future building occupant use equipment or devices which If a roof i;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 rr aterials for inspection. District? ❑Yes o 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 docs not curcnilfk� All t.that it is my responsibility to notify the occupant of the requirements wht prior to issuance of a Ccrtificate of l�rkyp Signature of Applicant Date _ roof coverings to be Class"B or better Owner or authorized agent are CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34215004 .00 DATE ISSUED. . . . . . . : 06/ 29/2007 RECEIPT #. . . . . . . . . : BSOD0001848 REFERENCE ID # . . . : 07050267 SITE ADDRESS 10398 KRISTA CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER GEE DAVID B AND JEANNE F ADDRESS 10398 KRISTA CR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 RECEIVED FROM . . . . : HIEN Q TRUONG CONTRACTOR . . . . . . . : HIEN Q TRUONG LIC # 23332 COMPANY . . . . . . . . . . : QUAN'S ELECTRICAL ADDRESS 10628 RANDY LN CITY/STATE/ZIP . . . : CUFERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 366-1823 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ------------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 5, 500. 00 0. 60 0. 00 0 .60 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 -- --------- ------ TOTAL PERMIT 176 .34 0. 00 176 .34 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------- CREDIT CARD 176. 34 VISA --------------- TOTAL RECEIPT 176. 34 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- - 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF C UPERTINO U �I CE/A . Ic F' PERMIT APPLICATION FORM 76 6-7 CUPEi�TINO APN# Date: Building Add r� C.�►• • C 1�(�r'rte v C' � - Owner's Name: Phone #: License #: Contira r: I hone: L(A 1�`S -C� C- r �y� C-�0 T -2 Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb Mech L5 Job Description: /l Residential Commercial ❑ For Residential Installations: Attic ❑ I" floor 2nd floor❑ Adhere to min set back requirement For Commercial Installations: .teplacement same weight ❑ Additional weight(stuctural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Projec : ,2"� Type of Construction: Occupancy oup: Strapped ❑ On Platform Bonded J Sq.Ft. Floor Area: New Location Replacement Qty. if Fee Group Applicable Fee ID Fee Description BENERGY E:iergy BUILDING BREMFURN Fizrnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A Units<-- 10, 000 cfin MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE S-,ismic Fee Res BUILDING BSEISMICOM S-.ismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE N[ech Permit Issuance MECHANICAL PPERMITFEE P[umbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK P[an Check Fee BUILDING BPGAS Gras Piping System Fee PLUMBING BUSLIC Fusiness License BUILDING Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *-,UPEKTINO Building Department JOB ADDRESS: PERM�� � o ���� � � k-?� � PHONE OWNERS NAME: V GENERAL CONTRAC OR: f (r '` ,v FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSII'--fESS 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