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09070001 CITY OF 1-UPERT,INO BUII_r!NG DIVISION PERMIT � , � � � ' BUILDING ADDRESS: PERMIT NO. 22017 SAN FERNANDO CT CJ SULLIVAN EL 09070001 OWNER'S NAME: PERMIT ISSUE DATE cRF.FNIVAgT NTTCWnTj A,1)N ..JNE: S A CONTROL NO. (650) 954-5043 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u o 0p LICENSED CONTRACTOR'S DECLARATION Job Description W C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z<w with Sccdon 7000)of Division 3 of the Business and Professions Code,and my license is 'oy in full force and effecL 200A ELECT SVC UPGRADE - CJ SULLIVAN ELECTRIC ? License Class Lic.#1 t-o DateContractor RENWD B;J S L I C ARCHITECTS DECLARATION C< I understand my plans shall be used as public records D,U k W InLicensed Professional n r0 OWNER-BUILDER DECLARATION t 1 hereby affirm that 1 am exempt from the Contractor's License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county e 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 =c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y.t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1500 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). 35712005 . 01 ❑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 ns 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.). I,as owner of the property,am exclusively contracting with licensed contractors to tnrct 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. ❑I am B&P C for this on --nen Date WORKER'S-COfAPENSA71ON 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 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars($100) or less.) 1 rerti(that in the performance f the work for this permit is issued,1 shall not employ any person in an bec c subject to the Workers'Compensation Laws of California. Applicant NOTICE TO APPLICANT:If,after-making this crlificate of Exemption,you should become subject to the Worker's Compensation pibvisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z '. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of LYr the work for which this permit is issued(Sec.3097,Civ.C.) WtI,Q Lender's Name Z)z Lender's Address V C) 1 certify that 1 have read this application and state that the above information is VL"' correct.I agree to comply with all city and county ordinances and state laws relating to p V 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 City of Cupertino against rA liabilities,judgments•costs and expenses which may in any way accrue against said City V Z in consequence of the grantingof this rmit. Date �4 t" APPLICA STANDS WILL COMPLY WITH ALL NON-P INT Issued by: SOU LA CO'7Re-roofs Sfgnatu scan ontractor f Datfi HAZARDOUS MATERIALS DISCLOSURE Type of R)of 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 monde,Section 25532(a)? �._.c All roofs.,hall be inspected prior to any roofing material being installed. ❑Yes o 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 Area Air Quality Management all new materials for inspection. District? ❑YestR Nu 1 have read the haza ms materials requirements under Chapter 6.95 of the Califor- nia Health&Safety C ,Sections 15505,25533 and 25534.1 understand that if the building does not curte a a tenant•that' y respomsibilily to notify the occupant of the requirennmust e '--to issuance of a Certificate of Oc pan . Signature A Applicant Date Owner or authorized agent Dare All roof coverings to be Class'%!."or better CITY OF CUPERTINO BUILDING DIVISION PERMIT NF BUILDING ADDRESS: PERMIT NO. 22017 SAN FERNANDO CT CJ SULLIVAN ELECTRIC o9n7noni OWNER'S NAME: PERMIT ISSUE DATE cRREENIVA.2I VI.2iAATAP14 >< VNE: S A CONTROL NO. (650) 951-5043 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a p C LICENSED CONTRACTOR'S DECLARATION Iv U with SeI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description _Z w Section 7000)of Division 3 of thc Business and Professions Codc,and my license is 7=y in full force and effect. 9-V 8—CT 6 2 200A ELECT SVC UPGRADE - CJ SULLIVAN ELECTRIC D 2g? License Class Lic.M Date - t 4 1 Contractor L— 1 J 2—T f ve- f RENWD B,J S L I C �—ARCHITECTS DECLARATION 1 understand my plans shall be used as public records �ulU 4 0�, Licensed Professional �,� OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct.alter,improve,demolish,or repair any structure 4;- prior to its issuance,also requires the applicant for such permit to file a signed statement _G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation Y. H$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1500 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 35712005 . 01 ❑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 Contractor's License Law docs not apply to an owner of q 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.). [11.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. ❑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: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .,ation,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 Workees Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc 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 7 as become subject to the Workers'Compensation Laws of California.Date 7 1 d P Applicant CA, r t—�i I—y. 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 [~-r I hereby affirm that there is a construction lending agency for the performance of Ix•� the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address V 0 I certify that I have read this application and state that the above information is LL►'� corecL 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 enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL C MP LY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS.' l/l� � .1,44 `71( Ad I Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R)of 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:hall be inspected prior to any roofing material being installed. ❑Yes taJJro 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 t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .strict? ❑Yes QDie, 1 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 ave a tenant.that it is my responsibility to notify the occupant of the requirements w c m be..t prior s� �c of a Certificate of Occupancy. Signature A Applicant Date -7/( r O S All roof coverings to be Class"n"or better Owner or authorized agent Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 35712005 . 01 DATE ISSUED. . . . . . . : 07/01/2009 RECEIPT #. . . . . . . . . : BSC00008088 REFERENCE ID # . . . : 09C70001 SITE ADDRESS . . . . . : 22C17 SAN FERNANDO CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SREENIVASI VISWANADHA ADDRESS . . . . . . . . . . : 324 RIESLING ST CITY/STATE/ZIP . . . : CLCVERDALE, CA 95425 RECEIVED FROM . . . . : CHRISTOPHER JOHN SU CONTRACTOR . . . . . . . : CHRIS SULLIVAN LIC # 28443 COMPANY . . . . . . . . . . : CJ SULLIVAN ELECTRIC ADDRESS . . . . . . . . . . : 1177 FERNSIDE ST CITY/STATE/ZIP . . . : REEWOOD CITY, CA 94061 TELEPHONE . . . . . . . . : (650) 954-5043 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 .00 1 . 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 1, 500 .00 0 .50 0 . 00 0 .50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 241 .50 0 . 00 241 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 241 .50 #1643 --------------- TOTAL RECEIPT 241 .50 _ CITY OF (,UPERTINO CITY OF CUPEkTINO GENERAI. BUILDING PERMIT APPLICATION FORM APN# 5 00 o ( Date: 7 / / Q S Building Address: Z Zo i � Mailing Address (if different from building address): I Z 4 (Z-i(!�5 I S f _ 1,01 2s v�a�,t_. C� 19 S 4 Z sr Owner's Name: �,`� �� Phone# S r e e.n i V< k s i U s w HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone: ��, S-b) � Y-4 . � 4 3 Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential Commercial ❑ Job Description: Building Permit Info: Bldg ❑ Elect ©r 'lumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B./L],-" R--2 Valuation: �.-� n �- Square Footage: i Project Size: Express [Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion c,f 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.builditgre-n.or Revised 02/05/09 CITY OF (--.'UPERTINO CITY OF GENERAL BUILDING APPLICATION CUPE(�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 3 windows) 1 WINMEWSTR New Window-structural shear B wall/masc my(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 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 ?Ian Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B 1 BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business :-icense B Community Development ` 10300 Torre Avenue i:., Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4;UPEI�TINO Building Department JOB ADDRESS: PERMIT # 0 OWNER'S NAME: S.�,,,,i �s'� v i S� a.�a. PHONE # S-'° 4 GENERAL CONTRACTOR: Sv i I Y c-.r�_ FAX # (70--?) 6 6 S -o s~d o c Q cC- I am not using any subcontractors: - 7 / o Si;nature 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 7 � Z6 Owner/Contractor Signature Date