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10050177 REV1CITY OF CUPERTINC BUILDING ADDRESS: 10040 PHAR LAP DR OWNER'S NAME: MEENAKSHI GUPTA OWNER'S PHONE: 4082532482 ❑ LICENSED CONTRACTOR'S DECLARATION J5 License Class 1 Lie. # .o 0 2 6 2 Contractor /4 w s ,i to newC J v Date y �a 1 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. 1 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. 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 permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 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 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 with all non -point source regulations per Cup ino Municipal Code, Section 9.18. Signature c9 Date ❑ OWNER- BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 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 permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is correct. 1 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 iify and keep harmless the City of Cupertino against liabilities, judgments, ind expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT CONTRACTOR: NA UTICA PERMIT NO: 10050177 CONSTRUCTION 1 282 LIME DR DATE ISSUED: 05/24/2010 S UNNYVALE, CA 94087 PHONE NO: (408) 667 -1586 B JILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL r— COMMERCIAL r JOB DESCRIPTION: REVISION #I- REVISE NEW CEILING BEAM AT KITCHEN. 0 0 DAW ,710 -- Sq. Ft Floor Area: Valuation: $24000 AI'N Number: 32618037.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is ins alled without first obtaining an inspection, 1 agree to remove all new materials for ins hection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I ha ve read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will ma ntain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 2553j(a) should I store or handle hazardous ma erial. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, a Owner or authorizet7 tigent:!' Date Qa<i / 0 CONSTRUCTION LENDING AGENCY I he -eby affirm that there is a construction lending agency for the performance of Ivor c's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION un-lerstand my plans shall be used as public records. ,ice nsed Professional A C, CUP-EkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # 3 2, — 1'9- 03-7 Date- 3, /0 Original Permit #: Building Address: /00 yo Pk -5tr- Mailing Address (if different from building address): Owner's Name: Phone I H-4g�e viol k V pfc�, -2- Contractor: �t CA0,14s4rjc,-k-0--V%1 Phone: -) a, U C-CN V%+O✓1 "o 6e--ti C-U ✓A Fax: Contractor License #: 700 Cupertino Business License Contact: Phone: ("Ps 0. y Fax: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Residential ❑ Commercial Job Description: Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-BE] II/III/V-A ❑ II/Ill B, IV-HT, V-B Valuation (cost of project): Project Size: Express F-1 Standard E] Large F-1 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.bui1ditgreen.org Revised 01/07/09 �_ CITY OF CUPERTINO CMOF REVISIONIDEFERRED CUPEI�TINO PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R -3 Inspection B IDS 1DEFPLNCK Deferred Submittal not R -3 Plan Check B IDS IDEFR3INSP Deferred Submittal Inspection B 1DSR3 1DEFR3PLNCK Deferred Submittal R -3 Plan Chk B 1DSR3 S 0 ��� -f lz6'