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07060165 CITY OF CUPERTINO BUILDING DIVISION PERMIT CQI�'�'R��TQR I�1�C}RM�TT�N BUIL�I�Ct..PJ�IaRI`ONG DOWN RD SANDIUM PERMIT 7 0 6 016 5 OWNER'S NAME: PERMIT ISSUE DATE DINESH ARORA 4223 VERDIGRIS CIR 06/19/2007 .ONE: (408) 804-9072SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !cc LICENSED CONTRACTOR'S DECLARATION Job Description Up I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)of Division 3 of the Business and Pr ons Codc,and my license is ADD AC 1M REPLACE FURNACE. r<a in full force and cIfec `` j ? OV License Clan �" Lic.# F Date #V Contractor ' AITCHII EC I S DECLARATI N Z a 1 understand my plans shall be used as public records )yU oH Licensed Professional H OWNER-BUILDER DECLARATION ' 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure —y prior to its issuance,also requires the applicant for such permit to file a signed statement -z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area6 8 O O Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 3 4 2 4 0 0 02 . Number Occupancy Type not more than five hundred dollars(6500). ❑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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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 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. ❑1 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: ❑I have and will maintain a Certificate of Consent to self-insure for Workcr's 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 C mpensation In nee carticr and Polity be Blare: .136 ,2� Carrier: Policy No.:91�—1 7� CERTIFICATE OF XEMPTION 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,t 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z '" CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of pC the work for which this permit is issued(See.3097,Civ.C.) Gun Q Lendcr's Name Z Lender's Address U C) 1 certify that I have read this application and state that the above information is V> r" correct.I agree to comply with all city and county ordinances and state laws relating to C U building construction,and hereby authorize representatives or this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree io save,indemnify and keep harmless the City of Cupertino against F" c/) liabilities,judgmcnis,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. �^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 -f 5!- G SOURCE REGULATIONS. _——n�• (b At I t•7 Re-roofs Signature of Applicant/Comractor Data HAZARDOUS MATERIALS DISCLOSURE Type of R sof Will the applicant or future building accupantstorc or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs:;hall be inspected prior to any roofing material being installed. Cl Yes 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 Arca Air Quality Management all new m iterials for inspection. District? ❑Yes �Nu 1 have read the hazardous materials requirements under Chaptcr 6.95 of the Califor- nia Health&Safcly Codc,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 require whicItmust me 'or to issuance of aCcrufrc�eZupancy— Signature of Applicant Date - (� i` All roof coverings to be Class"B" or better Owner or authorize agent Date CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 34240002 .00 DATE ISSUED. . . . . .. : 06,'19/2007 RECEIPT #. . . . . . . . . : BS000001700 REFERENCE ID # . . . : 07060165 SITE ADDRESS . . . . . : 22891 LONG DOWN RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DINESH ARORA ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2651 RECEIVED FROM . . . . : YIIJ-HANG LEE CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867 COMPANY SAI dDIUM ADDRESS . . . . . . . . . . : 4223 VERDIGRIS CIR CITY/STATE/ZIP SAI7 JOSE, CA 95134 TELEPHONE . . . . . . . . : (408) 894-9072 FEE ID UNIT QUANTITY j'�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---=------- ---------- ---------- ---------- BENERGY PERMIT FEE 34.86 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 6, 800. 00 0.70 0. 00 0.70 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 .44 0. 00 176.44 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 176.44 VISA --------------- TOTAL RECEIPT 176.44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF C UPERTINO C`706 o t �o S U NACE/AC CUP ERTINO PERMIT APPLI=CATION FORM APN# Date: g /6-7 Building Address: Z 2 Owner's Name: Phone#: Dtwet�% 4% 777 iS2`7 Contractor: CJGt - ---- --Phone:/ gg�i- X2'0? Z License�� -- c Contact: Phone: Cupertino Business License#: Building Permit Info: / Bldg ❑ Elect ®� Plumb E Mech C Job Description: Residential Commercial ❑ For Residential Installations: Attic ❑ 1St floor .9 2nd floor❑ Adhere to min set back requirement 9 For Commercial Installations: Zeplacement same weight E] Additional weight (sbuctural calcs) El Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: D0 Strapped ❑ On Platform Bonded Sq.Ft. Floor Area: New Location Replacement. 0� Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Fumace MECHANICAL BREMACOVER A,'C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A'C Units <= 10, 000 cfm MECHANICAL BREMRECEPT R;cptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE E:ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE B:dg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC B isiness License BUILDING