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09010102 CFTY OF CUPERTINO f r TMANX BUILDING DIVISION PERT NII PERMIT NO. BUILDING ADDRESS: PERMIT ISSUE DATE OWNER'S NAME: Sq CONTROL NO. .r10 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH REMODEL BATHROOM NON— loo LICENSED CONTRACTOR'S DECLARATION STRUCTURAL CHANGE TWQobDescription i U jI Eby 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 H in full force and effect. j Z License Class Lie.N t- Dam Contractor ARCHrfECrS DECLARATION 1 understand my plans shall be used as public records )WU .in Licensed Professional 0 OWNER-BUILDER DECLARATION ' 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following mason.(Section 7031.5,Business and Professions Code:Any city or county e'_V� which requires a permit to construct,alter,improve,demolish,or repair any structuren'•W ior w its issuance,also requires the applicant for such permit to file a signed statement prFt.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S q t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 rive hundred dollars($500). ❑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(Sec.7044•Business Required Inspections and Professions Code:The Conuactoes 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.). &„eks 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 conuactor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATIO DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sadon,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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code•for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF 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.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 A P CAM:]f,atter making this Certificate of Exemption•you should become subject to the Worker's Compensation provisions of the Labor Code•you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z h CONSTRUCTION LENDING AGENCY F~•h►�. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See.3097,Civ.C.) W 0 Lenders Name Z Lcndees Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes In. (We)agree to save,indemnify and keep harmless the City of Cupertino against ff Hto liabilities,judgments,costs and expenses which may in any way accrue against said City / S U Z in consequence of the granting of this permit. Date ►. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applican o ter Dam T Of Roof H RDOUS 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 Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ya 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. Districr7 / ❑Yes putt I 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 does not currently have a tenant,that it is my responsibility to notify dho occupant of the requirements whickmust be met p'r issuance of a cetiruatc of Oc m ncy. Signature of Applicant Date aDam All roof coverings to be Class"�''or better Owner Authorized agent Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPE�TINO Building Department JOB ADDRESS: PERMIT # ? L(q S Rot 0 ��-'. OWNER'S NAME: 1 OAopmw PHONE # j1 p-S_ �41 Se GENERAL CONTRACTOR: Leis FAX # 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 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36615053 . 00 DATE ISSUED. . . . . . . : 01/23/2009 RECEIPT # . . . . . . • • • : BS000007027 REFERENCE ID # . . . : 09010102 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 ZSR,iI7VRIODHYA GOPALAINC # 30377 CONTRACTOR . . . . . . ,p COMPANY AZTEKA BUILDERS ADDRESS . 105 STIRLING DR CITY/STATE/ZIP . . . : VA A)I3L0,0A 95687 TELEPHONE FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- __NEW-BAL- ---------- ------ 0 .00 1 . 00 0 .0 1BCBSC VALUATION 3 , 00020000 16 .032 0 . 00 16 . 32 0 .00 1BPFIXTURE NO OF FIXTURE 40 .79 0 . 00 1BREMRECEP NO. OUTLETS 1 .00 40 .79 0 .00 0 .50 0 . 00 1BSEISMICR VALUATION 3 , 000 .00 0 . 50 0 .00 1 .00 245 . 00 0 . 00 245 . 00 1DOORNONST EACH 0 .00 lEPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 .00 1 .00 40 .79 0 . 00 40 . 79 0 .00 1PPERMITFE FLAT RATE 1STPLNCK HOURS 1 .00 122 . 00 0 .00 122 . 00 0 . 0 1 . 00 40 .79 0 . 00 40 .79 0 .00 1TRAVDOC FLAT RATE ---------- TOTAL PERMIT 547 . 98 0 .00 547 . 98 0 .00 REFERENCE NUMBER AMOUNT -_ METHOD OF PAYMENT _________ _ --------------- CREDIT CARD 547 . 98 AMERCIAN EXPRESS --------------- TOTAL RECEIPT 547 . 98 CITY OF CUPERTINO CITYCUPEf�TINO GENERAL BUILDING PERMIT APPLICATION FORM A6100 2-4 APN# Date: ,3 Lp - 65-W I Building Address: -74-gs PROSp&cl RD Gv pC(Z't 1 N U, Carr '9 SDI 4 Mailing Address (if different from building address): Owner's Name: SR1V (�"p� �b Phone#: Contractor: Phone: 707_310 _ O377 p�zT�xf� t�v►�� Fax: Contractor License#: Cupertino Business License#: �j U 3�� Contact: SRS V"Iy1R Gb"PJ°n Phone: o- r7 ,-g L&g- Fax: Residential ❑ Commercial 6P,-TtRMjA R D{I— N �–W Sl►1Tc f-'� Job Description: bpN-STRQ L- 0?AL► GlkPfN6 - -Tvv v �f X Tu RE J Nom( (S1FCl OU7U�T �v � - CHfrN&E Building Permit Info: Bldg Elect B— Plumb 3--. Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B EK (2-– Valuation: -,30 a0, O-D 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 hel , contact Build it Green at www.buflditgreen.org Revised 01/07/09 S1,11 ,11-Z CITY OF CUPERTINO CITY of GENERAL BUILDING APPLICATION CUPERTINO 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 1 MPERMITFEE Mechanical Permit Fee M / IPPERMITFEE Plumbing Permit Fee P I ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK 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 1 BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B J 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B P0W ncin S'arUfci ,::!r j /;prr- T 2 �Lvrn �;l'L�- ��w�vCeJ 5of5 11 7 Pr✓ o> woR lc; Cl4T� : r � �o c .�c- - _ No TI C -}IVI,� 0 G, _ MavE7 - -new, �r l out tiCATEFL 0 15 ` rsmm N', .z i i y AC,CURQANCE WITH fliE CI1Y l'/J J - ORL?INP►NCE` , UPERTINO CODES A 2 0 3, c - ATE —�� - - tins MU . i his set nd it is ur, - - )e-keP'- 1 alteration' Cr - awful to andn;ssion_iron - nsame w r mo. iie Decification - -. - he stamp r = ;r,�s:�r to be of - - - . HPr jSI Of the uvula i.n ut any provim, _ n e nr sLAtP M