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09070145 CITE'OF CUPERTINO BUILDING DIVISION PERMIT Cd) II QCT I� 1TIQ�IY BUILDING ADDRESS: PERMIT NO. 22216 CUPERTINO RD PROVISIDN DEVELOPMENT, OWNER'S NAME: PERMIT ISSUE DATE gT rnT____T L_1?n ��n3282 KIPER RD STE 297 .ONE: S A CONTROL NO. (408) 245-0991 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH chi O p LICENSED CONTRACTOR'S DECLARATION m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000)of Division 3 of the Business and Professions Co and my license is 7=y in full force and effect 7J. DEMO EXISTN TRIM, DEMO, GUARDRAIL, NEW STUCCO j a? License Cl a �� Lic.x +F o Date t Contractor 12 100 1 LW./TRIM, NEW FLASHING, NEW GUARDRAIL & NEW PAINT W CHITECI'S DECLA ATION 7 I understand my plans shall he used as public records �yU 4 o H Licensed Professional n rn OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the i O O following reason.(Section 7031.5,Business and Professions Code:Any city or county K m Pi which requires a permit to construct.alter.improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement x that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation v t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $26500 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(5500). 32650001 . 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 docs 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 arc 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 does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑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-insum for Workces Compen. sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. nk I have and will maintain Worker's Compensation Insurance,as required by Section L*T7OO 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 am: Carrier. JMfL '9 Policy No.: CERnFqCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z "' CONSTRUCTION LENDING AGENCY [moi ice+ I hereby affirm that there is a constructinn lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) 0 Lendees Name Z Lenders Address U 0 I certify that I have read this application and state that the above information is GL r" correct I agree to comply with all city and county ordinances and state laws relating to 0 building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the CitgoCu` against liabilities,judgments,costs and expenses which marirt lufj wNAecrgFagaiinst said City V Z in consequence of the granting of�1_t' APPLICANT UNDE9S•TAN6SY WITH ALL N N-POINT Issued by: Date r -�J�$ SOURCERF ANIONS. o �7 Z/ d Re-roofs / ignatum of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOS RE Type of Roof f Will the applicant or future building occupant store or handle hazardous materi as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:;hall be inspected prior to any roofing material being installed. C]Yes - 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 have read the hazardousIn[crisis requuiiT der Chapter 6.95 of the Califor- / nia Health&Safety Code,Sections 25505, 3 534.1understand that ifthc building does not currently have a tenant,,�Z�'c pon ibih'ty to notify the occupant of the requirements which must�e+rri t once oCa Certificate of cup cy. Sigfi ure of Applicant Date -71.?-11 All roof coverings to be Class'`'or better Owne ut orizcd agent D CITY OF CUPERTINO 4 ITEMS OF 4 PERMI`C RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . : 32650001 . 00 DATE ISSUED. . . . . . . : 07121/2009 RECEIPT # . . . . . . . . . : BS000008232 REFERENCE ID # . . . : 09170145 SITE ADDRESS . . . . . : 22216 CUPERTINO RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUNIL BALIGA ADDRESS . . . . . . . . . . : 12138 KIFER RD CITY/STATE/ZIP . . . : SUITNYVALE, CA 95014 RECEIVED FROM . . . . : JOHN T HA CONTRACTOR . . . . . . . : JOHN HA LIC # 29054 COMPANY . . . . . . . . . : PROVISION DEVELOPMENT, INC. ADDRESS . . . . . . . . . . : 1288 KIFER RD STE 207 CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 245-0991 FEE ID UNIT QUANTITY 1NOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 26, 500 .00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 26, 500 . 00 2 . 70 0 . 00 2 . 70 0 . 00 1DECKRAIL EACH 1 . 00 443 . 00 0 .00 443 . 00 0 . 00 1STUCOAPP SQ FEET 2, 800 . 00 635 . 00 0 . 00 635 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1082 . 70 0 . 00 1082 . 70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 082 .70 VISA --------------- TOTAL RECEIPT 1, 082 .70 OV070 I �s CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: 2zZ%b k w pc-Po V0 CO E kc-4 0 . CA e1tD I Mailing Address if difTerent from bulldin ress): '� o i T�yo ��NN N� = CA o I Are Hazardousl Materials being used asp rt of this project? Yes No HOA: Exterior work only) Yes ❑ No ® If yes, provide letter from HOA Owner's Name: Phone#: S vr4 ►L_ (�A k 6 4 OV 44- zO$ Contractor: Phone: (C{�� ?—�S—V w )S ID rlb Ey i KC Fax: Contractor License#: a S:1 -?I Cupertino Business License#., Contact: I Phone: 2 �Vti,4 �t rA- Fax: Residential Commercial Job Description: DVy10, 'r,-X��.P6 k M r V f Ars-VI ,W r-) ow p �l ti Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ I /lII/V-A ❑ II/III B, IV-HT, W lam- 3 Valuation: Square Footage: Project Size: Express [L,,-<taandard ❑ Large J] 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.buildj=!en.or Revised 07/14/09 CITY OF CUPERTINO C U CITY OF O GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B oadditional stucco application 1 WINREP Replacem ent windows/sliding glass B door (ea 3 windows) 1WINMEWSTR 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 I ELCPLNCK Stand Alone Electric Pin Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pin Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pin Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourl -st and alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic F.esidential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B e� RA) L_ 5 of 5 2 Hr "� z3 s e 3 ` — -�$' t -�'-to-xs-�•" .y,, c .r-u` '�-y - ,M�x ,:�..�: --h;;.� - -�_ =;- � �" -,7r 3.: 1 �� :--2- �x �z-�,' t ..... �.. •+�- �-y mw.,' ,.£,z�yam. S_ - Assessor's Parcel Number: Name of owner. S VN i r7AU(6A _ Project address. 222 ��b ` Cis —( cel D �-9, C� eG 6-4 y Contact person. Phone. V� Fx: D Q Net square footage of lot-"L--- Existing ot: Existing Proposed Square footage: First floor: _ Second floor: _ Garage: _ TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the gar P . SH .La privacy protection planting required for the project? ,, EET On what floor(s)is work being done? JrrBrief description owork. N )'�, �� i I�k�i fi Z i l 6 64' Vu c o4 AI b tK d -" APJ ¢" G Ar PAIL S� Code editions: (Y-N)2008 CFC N)2008 CMC (Y-N) 2008 CPC (Y-N)2008 NEC (Y- 1) Effective 1/1/08 y: P a *� -x QJc Z O a Z QU Orz W ' hW 2 v' ani E — c� Z Ir - 4 G �3 G •,, it y <p G ��= Q R Plan Review Process Work Book Page-B-Revised 1/1/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,;UPEI�TINO Building Department JOB ADDPESS: PERMIT # OWNER'S NAME. SU N r ,� ,�- _ PHONE # 0 -s GENERAL CONTRACTOR: 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 er/Contractor Signature &ate