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07050213 - PUB (D N Li Yl' n, ai' sZD n- N' �_ Ncl OL om; u u°- 4 U v° o' LO z ex X11; " e m� �R 5 w s z Q 0 a� o Q ykD o LO o ua J H 1 LLI f O 1 cv O v p Z ,H o v Z i4t, J = w �I s 0 Z r LO: U a 1 M E- O ),N p i(.Zf a Z N cc i CD a a y Y�Y U7 cr) LU W W H N d- G C3 ,m m. ,.�,., w 1 x N N Z N J co ' 3: (D ' Q M < U " z, 111 � iz 'l I Q � �o . {y gpg4 l s o 0 - { 16 16 P o f ��Lu z i i( f( 5 rr) n 6 a IDL Q7 O O OO w y a�lo! o i mY r � T r C'll I LO CD -r' 4.Yi � ?.I . CL W f U. LU w 'I -v f,:mz LU OCZ O LU u O O N ^e O J ,J Cc O raY r i-^ y4 Z.. W - 1;,J U N f ( N o v r_ 1" � ❑ i o "� ]L R—" x 0 as �O a x �, +v n x o OL ID 0 z 22 32 LU CD � .� _ «� it © a ca4r �. 'G ,u N ._ � '� - � a+ N S1 N dCL M � iv LOo CLOL 0 CL. 4) a w 1i CITY OF CUPERTINO BUILDING DIVISION PERMIT � � BUIL(),IT�Qi4DESJPERMIT NO. OLLYMAN .LN LOT 2 TBD — TO BE DETERMINED 07050213 OWNER'S`NNAlME: PERMIT ISSUE DATE GUPTA, DIPESH 06/21/2007 PHONE: SANITARY NO. CONTROL NO. ARCHiTECT/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT. PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description Cm(= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z7 W with Section 7000)of Division 3 of the Business and Professions Code,and my license is REVISION-TRUSS CALC S OR I G PERMIT 06100074 NO NEW <s in full force and effect z Licensc Class Lic.p PERMIT. t„W Date Contractor ARCHITECTS DECLARATION uai< I understand my plans shall be used as public records yU IL Licensed Professional y OWNER-BUILDER DECLARATION <f 1 hereby Affirm that I am exempt from the Contractors License Law for the p Opr 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 Z y prior to its issuance.also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor AreaO Valuation t=-$ (commencing with Section 70DO)of Division 3 of the Business and Professions Code)or 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 Number Occupancy Type not more than rive hundred dollars($500). 35922061 ❑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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Conuactors License Law docs not apply to an owner of �l 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.). V1 1,as owner of the property,am exclusively contracting with licensed contractors to construct 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 Contractors License Law. ❑1 am exempt under Sec .H&P C for this on -IfOwner Date O WO ER' C MPENSATION DECLARATION zI reby affirm under penalty of perjury orie of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for WorkersCompen- 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 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 arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(SIOD) 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 manners u t come tab m the Workers'Compensation Laws of California.Date O Applicant NOTICE TO APP CANT:If,after grifing this Ccnificatc of Exemption,you should become subject id the Workers Com nation provisions of the Labor Code,you must �Z forthwith comply with such provision or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY —t I hereby affirm that there is a constructinn lending agency for the performance of _ Y.> the work fur which this�j�!it is ssue�!(Scc.3097,€iv.C.) L)Q Lender's Name Rr�� z, Lenders Address J 0 1 certify that I have read this application and state that the above information Is i— correct 1 agree to comply with all city and county ordinances and state laws relating to D building construction,and hereby authorize representatives of this city to crier upon the U above-mcrtioned property for inspection purposes. y a (We)agree to save,indemnify and keep harmless the City of Cupertino against (t) liabilities,judgments,costs and expenses which may in any way accrue against said City J Z in consequence of the granting of this permit '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE ULgT1 S. o Re-roofs % Signa m of ApplicanUC tract Da US MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as damned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? —�/ All roofs shall be inspected prior to any roofing material being installed. ❑Ye: fro 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 decd by the Bay Arca Air Quality Management all new materials for inspection. District? 13 Yes El No I have read the hazardous materials requirements undcrChapter 6.95 of the Califor- nia Health&Safety Code,Section 25505.25533 and 25534.1 understand that if Ute building docs not currently have a tenant that it is my responsibility to notify the occupant of the reyuiremc iscitm car: nrtl»amanuefaCertificate nfOccupancy. Signature of Applicant Date Ul Wncrorauthorizsdagcnt Date C All roof coverings to be Class "B" or better ncr CITY OF CUPERTINO ll� 01-07050-213 cuPE�TIiNo PERMIT APPLICATION FORM ku4t- # 0 6 1 0 0 0 -f4 APN# 359 -a� -Qbl cop-) ate: O.S-I21loq Building Address: 1 Mailing Address (if different from building address): ofzy- Lx,, e - Lot z Owner's Name: 'ko xokA-L4 L-1- L Phone#: 40s 62i 30 9 � Contractor: © � C License#: Contact: PESN CtU�,p Phone: 419 6?) .3og4 Cupertino Business License#: Fax: X M Building Permit Info: Bldg ® 1 QkkS-'tS Elect ❑ Plumb ❑ Mech ❑ Job Description: `T-ku44.t4ift si` It tm�I-E] utk4Residential K U Sq.Ft. Floor Area: 2; y Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3