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09010033 CITY OF CUPERTINO BUILDING DIVISION PERMITT � � � ' BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE A 0 9 CONTROL NO. 707) 310-0377 ABUILDING PERMIT INFO RCH17ECf/ENGINEER: BLDG ELECT PLUMB MECH i p C LICENSED CONTRACTOR'S DECLARATION Job Description 11I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is s�y in full force and effect. RPLCE 6 WNDWS LIKE4LIKE IN LVNG RM & FAM RM i vg Z License Clan Lic•ff t— Dam Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records )W U �C Licensed Professional y OWNER-BUILDER DECLARATION �yI 1 hereby affirm that I am exempt from the Contractor's License Law for the i00 following mason.(Section 7031.5,Business and Professions Code:Any city or county <m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure u`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 at—In $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 O O 0 y .. 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($500). 36615053 . 00 ❑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 for sale(See.7(X4,Business Required Inspections and Professions Code:The Conuacwes License Law docs not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his awn 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.). �as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors 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. 0 1 am exempt under SecB&P q for 9fis mason '43Owner A44.•✓ dwikoge Date awl XW RKER'S COMPENSATM91WECILARAMON11 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-inswe for Worker's Compen- .aon,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: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed it the permit is for one hundred dollars(S 100) or Iesa) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manntr ect to the Workers'Compensation Laws of California.Dec Applicant NOTICE TO APPLI r m g s Cc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code.you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Fr i�r I hereby affirm that then:is a construction lending agency for the performance of �tthe work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 134 ►7 z Lender's Address V 0 1 certify that I have read this application and state that the above information is LL►' corccL I 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 toter upon the W above-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against fn liabilities,judgments,costs and expenses which may in any way steric against said City V Z in consequence of the granting of this permit. r't APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS.- /� .4-P, 4e4-1— n1 ff�/ v�� Re-roofs — Signature of A 'cant/Contractor Dam Type of Roof HAZARDOUS MATERIALS ISCLOSURE Will the applicant or future building occupant stare 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 Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which it hazardous air contaminants as dcftncd by the Bay Area Air Quality Management all new materials for inspection. strict? 0 Yes 0401 I have mad 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 does not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which t�ortoi ofacertifcate�[OcSignature of Applicant Date All roof coverings to be Class'�ror better Date Owner or aut� agcnl CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36615053 . 00 DATE ISSUED. . . . . . . : 01/08/2009 RECEIPT #. . . . . . . . . . BS000006932 REFERENCE ID # . . . : 09010033 SITE ADDRESS . . . . . : 7495 PROSPECT RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SRIVIDHYA GOPALAN ADDRESS 7495 PROSPECT RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SRIVIDHYA GOPALAN CONTRACTOR LAURO MEJIA LIC # 30377 COMPANY AZTEKA BUILDERS ADDRESS 105 STIRLING DR CITY/STATE/ZIP . . . : VACAVILLE, CA 95687 TELEPHONE (707) 310-0377 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 368 . 50 0 . 00 368 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 368. 50 AMEX --------------- TOTAL RECEIPT 368 . 50 C) CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# / I 3 03 Date: SI,, vo 9 Building Address: 7 .cis ARO-!;�cr CuPFd<>r/BYO, CA Mailing Address (if different from building address): Owner's Name: �,R�vl-DHVA 6CPA c Phone#: Seo--�579 r 96�,9> Contractor: Phone: 707- 3/0 - 0377 Fax: Contractor License#: Cupertino Business License#: Contact: LA vfz&AI Phone: 707-310- 03-77 /0UA--1a Fax: Residential Commercial El Job Description: � Building Permit Info: Bldg L.(YPElect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ I1/1II B, IV-HT,V-B Valuation: �400a- OD Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditg reen.or Revised 01/07/09 S,_K4� CITYOF CUPERTINO OF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B / door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 s� IV x �:c Ell vEf) '1 JAN 0 8 2000 Coll BY:-___ C> X, LJ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -7UPEIQTIN0 Building Department JOB ADDRESS: 7 S- PR ps j�E /Z� . PERMIT # CU/�F�'rl/IlD CA _ e? OWNER'S NAME: S' PVIPHt ,O DP PHONE#,.00-- 6 GENERAL CONTRACTOR: X A- FAX # I am not using any subcontractors: ignature r 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 t g-�vb� Owner/Contractor Signature Date