06100108 CITY OF CUPERTINO
BUILDIrr DIVISION PERMIT C.O
BUILDING ADDRESS: PERMIT NO.
06100108
10648 GASCOTGNE DRIVE
OWNER'S NAME:
PERMTT ISSUE DATE
KUMAR, VARINDER in
)NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
O p LICENSED CONTRACTOR'S DECLARATION
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z uJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is
!=y L eneClassdeffect �1� REROUTING ELECTRICAL WIRING FOR TWO NEW CIRCUIT
License Class Lic•M
Dale Contractorr;;K iLDF_"
t ARCHITECTS DECLARATION
oI understand my plans shall be used as public records
U
a
C in Licensed Professional
�fz1 OWNER-BUILDER DECLARATION
j 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
*CC following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolLsh,or repair any structure
?Z y prior to its issuance.also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
t- (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 r. 0 0 Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages at 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 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 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.
Q 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:
Q 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.
❑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 s+WorkeesC�ompen_sation Insurance carrier and Policy number are:
Carrier. 51 401 C16— D Policy No.:
CERTIFICATE F 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,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 Workces 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
1 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 QLendces Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
v. O' correct.I agree to comply with all city and county ordinances and state laws relating to
CU building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tE'y(A 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
►+ APPLICANT UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Conaw or Dam
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 )�No
Will the applicant or future building occupant use equipment or devices which If a roof is 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 materials for inspection.
District?
Yes 1 No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements ichtmust be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date
I aI 12 I C b All roof coverings to be Class"B"or better
Owner or author zed agent ' '/ ate
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*TPEkTINO
Building Department
JOB ADDRESS: PERMIT #
t06C?0KC,01gN c nn . L�c�Ert-rt Ago ck D 610 0 ,/ o &--
OWNER'S NAME: *t Aa(P SER ku M W(2- PHONE !(VO) S-01-7?n.f
GENERAL CONTRACTOR: K. 1C. �; 1,&z S FAX # 51v 7S-1- 344 6
I am not using any subcontractors:
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
n 1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 37522019.00
DATE ISSUED. . . . . . . : 10/13/2006
RECEIPT #- - - - - - - - - : 36436
REFERENCE ID # . . - : 06100108
SITE ADDRESS . . . . . : 10648 GASCOIGNE DRIVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : KUMAR, VARINDER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : VARINDER KUMAR
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
eEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BREMMISC FLAT RATE 2.00 27.58 0.00 27.58 0.00
BSEISMICRE VALUATION 800.00 0.50 0.00 0.50 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 171.45 0.00 171.45 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 171.45 M/C
TOTAL RECEIPT 171.45
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
CITY OF CUPERTINO
C!fYOF PERMIT APPLICATION FORM
CUPERTINO dC 1001be
APN# /9 Date: I (7 106
Building Address: Mailing Address (if different from building address):
(N 49 (44,SC0/6NF_ CU OZ11NO, CA qS-01q
Owner's Name: Phone #
'JA9,1tW A kung. (409) ao -gto;.
Contractor: License#: QC 36 10
k K 9)0,L 0 VLS
Contact: Phone:(SI SZI- 33p� Cupertino Business�icense#:
kt+AL1� KftK 4A-IC, Fax: S o 151=344(7
Building Permit Info: CCU_�V,"� wi(11.,� -40 b ��,u.A
Bldg ❑ Elect P Plumb ❑ Mech ❑
Job Description: �z n r -�`u-•� a�2c`r�c�:.� ws�i� c W ,.� A-W 0 c
Residential R] Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: IROccupancy roup:,3
Type of Constructio Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity 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 IM 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
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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