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09010002 CITY OF CUPERTINO �� � * BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: PERMIT ISSUE DATE OWNER'S NAME: PRE)SPEC-111 RE) A 8.2 e 0 9 CONTROL NO. _.7 T/0-r:TIT (408) 996-9797 BUILDING PERMIT INFO ARCHiTECTIENGiNEER: BLDG ELECT PLUMB MECH 0 0 Q p LICENSED CONTRACTOR'S DECLARATION Z Job Description in� I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is RMDL KTC HN,NON-STRUC TRL(14 0 S Q) , INC LUD ;'0 y in full force and effect. J y,3'.�� ;z License Class tie x �,, ,� (ELCT,LIGHTNG&PLUMBNG -F Datc ��f�—Contractor gg pCI�CI'S DECLARATION d< I understand my plans shall be used as public records �yU n,y Licensed Ptufessional O< OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 4$V which requires a permit to construct,alter,improve,demolish,or repair any structure y—y prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq E H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10000 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 35614033 . 00 ❑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.). ❑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 docs 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 e 7 t Qs F t^+ License Law. ' 3 C3 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: i have and will maintain a Certificate of Consent to self-insure for Worker's Compen- -don,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 Worker's Compensation insurance carrier and Policy number are: Carrier. S T H'7S — N ? Policy No.: �'0 0 2 3 C RIIMCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need shot be completed iC the permit is for one hundred dollars($100) or less.) 1 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 Workcrs'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 [� 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 ALender's Name 2 z Lender's Address U 0 1 certify that I have read this application and state that the above information is LL H corer.l agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize 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 rA liabilities,judgments,costs and expenses which may in any way accrue against said City vl V Z in consequence of the granting of this permit. Date /r --t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGU TIONS 1 Re-roofs Signature of Appl canUContractor Date 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 Cale,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes P(Nm 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 tit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes CFrN _ I 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 ft building I�avr t does not currently have a tenant,that it is my responsibility to notify the occupant of the Date requiremcns hick must be me prior to issuance of a Certificate of Occupancy. Signature Of Applicant ' All roof coverings to be Class"j"or better Owner or au horixed agent Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35614033 . 00 DATE ISSUED. . . . . . . : 01/05/2009 RECEIPT #. . . . . . . . . : BS000006892 REFERENCE ID # . . . : 09010002 SITE ADDRESS . . . . . : 21901 COLUMBUS AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VISHAG KRISHNAN & SABITHA KRIS ADDRESS 21901 COLUMBUS AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4714 RECEIVED FROM . . . . : FRANK S LIONG CONTRACTOR LIONG, FRANK LIC # 20090 COMPANY SANFORD ELECT ADDRESS . . . . . . . . . . : 20888 PROSPECT RD CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 996-9797 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1REMRESKIT SQ FEET 1 . 00 429 . 00 0 . 00 429 . 00 0 . 00 1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 666 . 00 0 . 00 666 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 666 . 00 VISA --------------- TOTAL RECEIPT 666. 00 Vishag Krishnan & Sabitha Krisha 12/16/2008 21901 Columbus Ave. 3. X2cAMPS c112eK.i! c�unTaQ t v Cupertino, CA 95014 SII TciH x-'#j 15f'/K , Ako z. oo c i3 G 200 c ALL S/7DX P is To I?9 A/ 128" C F' C� N o n t cZ�•$'a, c JAN 0 5 2009 DOW` r C7 Gni IK 11 n : C f Community Development 10300 Torre Avenue ;x ,,' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 :UPEkTINO Building Department JOB ADDRESS: PERMIT # qor CokufngUg A-VZ 2TC6 �02 OWNER'S NAME: gR 11 1,1 QV C PHONE # 4 o,'-R 6 6— ? 7 4 GENERAL CONTRACTOR: R D " e . FAX # �b I am not using any subcontractors: = Signatufe ate 7 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 C) CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM APN# �-- ( f Date: Building Address: a I o J Co L OM au-C A f Mailing Address (if different from building address): Owner's Name: Phone# V+s HAC k R iso( MWAJ & 5681-NA S iiA > Contractor: Phone#: 4-vE — -T 66--`? 7 AN-FORD b. C,( iz K- Fax #: 40k — -06— Y Contractor License#: C--/o C3 Z,4313,6qO Cupertino Business License#: �2 O®q C) Contact: Phone#: 7 6 6—9 7 9 7 ]FRIANIK LION6 LIONFax #: 7 Building Permit Info: Bldg. ❑ Elect. ET— Plumb. El— Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? ta p \J�1.z.h Remodel Includes Re-Roof. Yes ❑ No ❑ If yes list nuler of squares Remodel Includes Structural: Yes ❑ No ❑ Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen_ U Bath Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B El II/III/V-A El II/III B, IV-HT, V-B R Valuation: '%�/ 741©tcSywL� . Please check this box if the project is a second-story addition ❑ Project Size: Express [Standard ❑ Large ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Poin"chieved: include in plan set& the sheet index. Z> I . ***For Office Use Only*** Over-the-Counter ❑ Revised 10/01/08 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check) 1REMRESBAT Bath Remodel up to 300 B " SF 1 REMREOTH Other Remodel up to 300 B " SF 1 REMRES2 Remodel Residential B Greater than 1000 sq ft 1REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft f IBSEISMICRE Seismic Residential B I TRAVDOC Travel &Documentation B I BUSLIC Business License B 5TPNC ►, M.Indoor Air Ouality and Finishes 1.Use L -VOG PAW 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low%VOCAwes 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Sad Alla .W.Pa Webeasal or MDF 41AQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3,Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 S.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 ! Total Points Available: ('� 140 130 57 Total Points Project Received: `i 01 0 0 G:data/progs/greenbuildingguidelines/remodelers/greenpointsfina12.12.D4protectedxls