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07050167 CITY OF CUPERTINO ' BUILDiNGDIVIStON PERMIT BUILTI( DRESS: PERMIT NO. � NOVEMBER DR APS ROOTER 07050167 OWNER'S NAME: PERMIT LSSUE DATE KHULLAR, SANJAY 1725 LOCKSLEY PARK DR 05/17/2007 )NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO REPLAC'' WATER SERVICE, WATER BLDG ELECT PLUMB MECH ig 0 D D D 0 0 LICENSED CONTRACTOR'S DECLARATION T ,ry Job Description V♦= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)or Division 3 of the Business and Professions Code,and my license is h w is full force and effe ? License Class Lic.tY F w Date Contractor ARCHITECTS DECLARATION 7 < 1 understand my plans shall he used as public records )A. U.y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the bo following reason.(Section 7031.5,Business and Professions Code:Any city or county S. which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior in its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN 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 Ins eCt1011S and Professions Code:The Contractor's License Law does not apply to an owner of 9 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.). ❑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. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insurc for Worker's Compen- sation,as provided for by Section 3700 of the Tabor 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 Policy number arc: Carrier. ` licy No.:aV My"--_� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for ane 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY Ems-+Eel 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 0,M Lender's Address U 0 1 certify that I have read this application and state that the above information is (y correct.I agree to comply with all city and county ordinances and state laws relating to rJ J building construction.and hereby authorize representatives of this city to triter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against L��&�.Date liabilities,judgments,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. SOURCE�,F�ULATI / �'�i!/ Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of]Roof 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 io 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes VN. 1 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 currently have a tenant,that it is my responsibility to notify the occupant of the requirementss' h'ch must nor to issuance of a Certificate of Occupancy. Signature of Applicant Date yA� - All roof coverings to be Class"B" or better Owner of authori"zcd agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bl:c: Lot : APN . . . . . . . . : 36.216022 .00 DATE ISSUED. . . . . . . : 05 /17/2007 RECEIPT #. . . . . . . . . BS )00001365 REFERENCE ID # . . . 07 )50167 SITE ADDRESS . . . . . : 1035 NOVEMBER DR SUBDIVISION . . . . . . CITY CU?ERTINO IMPACT AREA . . . . . . OWNER KH'JLLAR, SANJAY ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CU?ERTINO CA, 95014-4129 RECEIVED FROM . . . . : KI:3N VO CONTRACTOR . . . . . . . : KI.3N T. VO LIC # 26535 COMPANY AP,3 ROOTER ADDRESS 17.25 LOCKSLEY PARK DR CITY/STATE/ZIP . . . : SKI JOSE, CA 95132 TELEPHONE . . . . . . . . : (4 )8) 274-5277 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- --- ------ ---------- ---------- BENERGY PERMIT FEE 1 .00 34 . 86 0 .00 34 . 86 0.00 BPFIXTURE UNITS 6 .00 54 . 00 0. 00 54 . 00 0.00 BPWHEATER PER HEATER 1 .00 10. 79 0 .00 10.79 0.00 BSEISMICRE VALUATION 5, 300 .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 215 .36 0 . 00 215 .36 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------------. CREDIT CARD 215.36 VISA --------------- TOTAL RECEIPT 215 .36 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF C UPERTINO �1rr0F PERMIT APPLICATION FORM CUPEk INO _PN # Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: License#: Contact: Phone: ��%3� Cupertino Business License#: Fax: Building Permit Info: rl/ Cy �•C�'i�Ce/ !d//GL/may �°�� j� OT �; S Plumb Ili Mech ❑ Bldg ❑ Elect ❑ Job Description: Residential Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 00 p a Occupancy Group Type of Construction: Please check this box if the project is a second-story addition: El eroject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID .Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo:ler<= 100,000 Btu MECHANICAL BBOILER2 Boile-> 104K to SOOK Btu MECHANICAL BBOILER3 Boil-,r> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/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 <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD l�nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF CUPERTINO a OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID IW Description Fee Group BMISCELL M iscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,-,w Comm Plumb PLUMBING BOVERTIME Inmection Overtime BUILDING _ BPBA�KFT,OViT Atriosplieric �Vacziuni PT - --- _ - - - -- - -- --- - _ ---- -- _- BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Pla-i Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rei i e Of Fixtures PLUMBING BPSEWAGE �ewa a Disposal . PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A.t of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER NN ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI .appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT :-ighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel) Furnace> l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL gREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pc le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R-,pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL of 3 CITY OF C'UPERTINO l C11 ,0 ,0 PERMIT APPLICATION FORM CUPERTINO quantity Fee ID lee Description Fee Group BREMSIGNAD Rmc.l Signs Add Branch ELECTRICAL BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S.6 Specific Plan BUILDING _BSETSMICOAI -- - SeiSnii C C:0 n_ rn,erC ra.T BUILDI BSEISMICRE ;seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T�m orary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC I?lectrical sq foot ELECTRICAL EPERMITFEE Elf c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meoh Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 Community Development 10300 Torre Avenue CupertinoCA 95014 7 Telephone(408)777-3228-3228 CITY OF Fax(408)777-3333 `:UPEkTINO Building Department JOB ADDRESS: PERNIIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ,fps' - FAX# I am not using any subcontractors: /��/ 6 a7- Signature Date Please check applicable subcontractors and complete the following information 21 SUBCONTRACTOR BUSI14ESS 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