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10070185 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 822 CANDLEWOOD DR CONTRACTOR:PARACHUR MANNARPERMIT NO: 10070185 OWNER'S NAME: PARACHUR MANNAR 822 CANDLEWOOD DR DATE ISSUED:07/28/2010 WNER'S PHONE: 4083934400 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL0 License Class Lic.# DEMO&PREP KITCHEN *SEE NOTES* Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36919031.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relatin,, WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is _ installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensatior,, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed c tc�tors'to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION lemnify and keep harmless the City of Cupertino against liabilities,judgments, sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. !��!''l�'� Signature � �� `.�,� d Date �� CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Bl:c: Lot : APN . . . . . . . . : 36319031 . 00 DATE ISSUED. . . . . . . : 07 /28/2010 RECEIPT #. . . . . . . . . : BS )00010993 REFERENCE ID # . . . : 10 )70185 SITE ADDRESS . . . . . : 82.2 CANDLEWOOD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PA'ZACHUR MANNAR ADDRESS . . . . . . . . . . : 82.2 CANDLEWOOD DR CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014 RECEIVED FROM . . . . : PA'ZACHUR MANNAR CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : PA:2ACHUR MANNAR ADDRESS . . . . . . . . . . : 82.2 CANDLEWOOD DR CITY/STATE/ZIP . . . CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 000 .00 0. 50 0 . 00 0 .50 0 . 00 1SUPPKFEE HOURS 1 .00 126 . 00 0 . 00 126 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0 . 00 127 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 . 50 me --------------- TOTAL RECEIPT 127 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO. CA 95014-3255 (408)777-3228• FAX(408)777-3333•;>uiidmoi�C�D2tTl IO.Di 0 CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in-/our name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ,Z r APN`7 / f BP# Z �SthCt 11 wL E'C� V 2,C —�- I OWNER NAME OWNER ADDR Y �.l'C..I.�i Y �lCt V1 V\'h7 .Z �-w CC'.'c G> DESCRIPTION OF WORK: ±L L e '' We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by hE,ving this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed, and returned this form to us at our official address indicat3d. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION DF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) kP--\1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held IiablE.and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully actirg as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ,fy}2. 1 understand building permits are not requirec to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contra(:tor to assume this responsibility. 0r/, 3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. Yr) A. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. t 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer'under state and federal law. 2� 6. 1 understand if I am considered an"employer"under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. yy_�,_7. 1 understand under California Contractors' Si ate License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with'he intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general 'building Contractor. Yf1 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any s ibsequent owner(s)that result from any latent construction defects in the workmanship or materials. Cgi',raerBuilderForm 2010.doc revised 04/14/10 CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$3,000 'PERMIT TYPE: Demolition Permit - PRIMARY SFD or Duplex DEMOLITION S APPLICATION 1 SFDWL-DEM USE: FLOOR AREA: f TYPE: , x as 00 3U FE:Z'ID NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resohr:ion 09-051 Eff' 7.1%Y)9) FEE QTY/FEE MISC ITEMS Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0--01hrs $0.00 .Jit..' ..._ Strong Motion Fee: IBSEISMICR $0.50 1.0 hrs Standard Hourly Rate Bldg Stds Commission Fee: IBCBSC $1.00 $126.00 SUBTOTALS: $1.50 $126.00 TOTAL FEE: $127.50 Revised: 7/27/2010 CITY OF CUPERTINO DEMO CUPEi�T1NO PERMIT APPLICATION FORM z&Z2`1_Q�5� APN# Date: Building Address: ( �� Mailing Address (if different from building addr-.ss): Owner's Name: Phone: Contractor: 0/� Phone Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Residential ] Sq FootageCommercial ❑ Sq Footage Job Description: Valuation: Project Size: Express Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Gree a Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee DE scription Fee Group_ Permit Type 1DEMORES Demo-REsidential B 1SFDWL-DEM 1DEMOPRES Pool Denio Residential B 1SFP00L-DEM- 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09