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06100083 CITY OF CUPERTINO RM �T�7 ,c (�1 , BUILD'!NG DIVISION PERMI l _ BUILDING ADDRESS: ALTAP ELECTRICAL PERMIT NO. 06100083 902 BLA PERMIT ISSUE DATE OWNER'S NAME: BALAKRI SHNAN SAT I SH 325 SANITARY NO. CONTROL NO. NE: (408) 309-8290 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(X0)of Division 3 of the Business and Professions Code,and license is 2 0 O AM P UPGRADE H in full farce and effect G y 2 7 License CI Lie.r� � t-p Date � Contractor ARCHITECTS DECLARATION i < I understand my plans shall be used as public records tyU o.H Licensed Professional 0'< OWNER-BUILDER DECLARATION > 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ,n o following reason.(Section 7031.5,Business and Professions Calc:Any city or county $ 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 file a signed statementValuation S Ft.Floor Area ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1400 a that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(5500). ❑1,as owner of the property.or my employees with wages as their sole compensation, — 369 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 docs 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 Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such pmjects with a contractor(s)licensed pursuant to the Contractor's License Law. E]f 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: n I have and will maintain a Certificate of Consent to self-insure for Worker'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 Worrkce Compe tion Insurance carrier and Policy nu^m-bber are: Cartier�'r� L�_�+ Policy No.: (y CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars 1$100) or less.) I certify that in the performance of the work for which this permit is issued,1 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 z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of py> the work for which this permit is issued(See.3097.Civ.C.) W Q Lender's Name 0 z Lender's Address I certify that I have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this City to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-r liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date f/ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R `CATIONS. � I X11 ��/ - l o 4111 Re-roofs Signature of Applicant/Contractor Date T e Of Roof HAZARDOUS MALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as derincd 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 rlNo 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 materials for inspection. District? ❑Yes C Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cock,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 requirements which must be met prior to iss icJ0a Cerufica of cupan Signature of Applicant Date �� s 7T?0 l�4 All roof coverings to be Class"Bir or better Owner or authorized agent c-' Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ,CITY OF Fax(408)777-3333 '^UPEkTINO Buildin De artment JOB ADDRESS: PERMI�jT #/ / G �,: .Z �' "� i� �//� C1 A e. C� /nc rfl' ria 0 b U OWNER'S NAME: ec 6�Nr S kvlei tA S a i S PHONE # �40 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: A ,n cc- CA E Signature 0 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 'm 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 36917016 . 00 DATE ISSUED. . . . . . . : 10/11/2006 RECEIPT # . . . . . . . . . 36407 REFERENCE ID # . . . : 06100083 SITE ADDRESS 902 BLAZINGWOOD AV SUBDIVISION . . . . . . . CITY . . . * . . . . ' ' : CUPERTINO IMPACT AREA . . . . . . . OWNER BALAKRISHNAN SATISH ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM BAHRAM MOSTAFAZADEH CONTRACTOR BAHRAM MOSTAFAZADEH LIC # 26282 COMPANY ALTAP ELECTRICAL ADDRESS . . . . . . . . . . : 325 LASSENPARK CIR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 309-8290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - -- - - --- - - ---- - ------ ----- ----- ---------- --------- BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 1, 400 . 00 0 . 50 0 . 00 0 . 50 0 . 00 - --------- ---------- -- -------- ---------- TOTAL PERMIT 103 . 16 0 . 00 103 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - ------ ----- --- ------------ ---------------- -- OTHER 103 . 16 MASTERCARD TOTAL RECEIPT 103 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL - RTINO OW10009S ��. J CITY OF CUPE On PERMIT APPLICATION FORM CUPEIkTINO APN# Date: f r Mailing Address if different from building address): Building Address:f7 / ., 1 MVag � Owner's,Name: T Phone#: 517 Contractor: j License#: Z � ' L.TA C-t r C ct Contact: n Phone: p)?_ -2 q Cupertino Business License#: C1 V� Fax: 0100M Building Permit Info: S r f ✓, � ��,/`'� r,:t 6 '� U � ��) ^ Bldg ❑ Elect LI Plumb ❑ Mech ❑ Job Description:/ Residential C� Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: / D Occupancy Group: (Z-3 Type of Constriction: Please check this box if the project is a T!� second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Qu_an_fity 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 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 Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= I OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL f BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3