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08060005 CITY OF CUPERTINO s = .cw+s' s.a<sm BUILDINC'DIV7SIOM PERMIT �'CONTRACTOR�INFORMATION ; BUILDING ADDRESS: PERMIT NO. 22023 BAXLEY CT SABA SATHYA 08060,005 OWNER'S NAME: PERMIT ISSUE DATE SABA SATHYA 22023 BAXLEY CT 06/02/2008 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEEA: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uop LICENSED CONTRACTOR'S DECLARATION Job Description iI 1 Wrens,affirm.that 1 am licensed under previsions of Chapter 9(commencing - p ^z1 with section 70M)efDivWon 3 ofthe Rumina and Professions Cado,and my licenau ADD SNK& 'BBQYIT OUTSIDE OF KTCHN in full fans and effect J z License Clan Lbe.6 r Dale Contractor ARCHITECTS DECLARATION y d 1 understand my plans still W used ss public mcnnis Jyp y0 Licensed professional 3 'i OWNER-BUILDER DECLARATION �M 1 bereby alTinn Nm al 1 am empt from tun Contractors t: a Ne •" Law far E p o following reason.(salon 10313,Business and Pmfestions Code:Any city or county $ which requires a .it m construct.a1W,improve.demnfish.or repair any swctum pricer to its issuaac,ttim mquiia lhcapplicam for such Permit o file a signed sueamm, that W is Bccnscd pursuant to the pmviaka ofmM Conuackr's Liccmma Law(ChapW9 Sq.Ft. Floor Area Valuation � (commencing with Section00) 90nf Division 3 of the Bushasoand Professions Code)or $10000 ERE$ that M is cumpt Oraefrom and the basis far the alleged camptiun.My violation of section 10313by myapplicaut Torr a permit subjects de applicant to a civil penalty ofNumber Occupancy not ream than five hundred dollars(ssoo). 3 5 6 0 6 0 2 2 .'l7'l?' Pane Y Type I.as owner of the property,or my employees with wages as their gale compensation, will do the work and the stinum Is our intended oraRered for sale(Sec.]Old,swearer add Padmslam Cade The Conmcmrs License Law does ret apply to an owtur of Required Inspections property who Wilds or imp ewes thereon,and who doessachworkhimselfer through his own employees.pruMded that each impro emrnu are,not intended oroRered fasale IL however,tae Wilding m ireprommet is sold within arc year of cempletion.the owty- lailder will have th WIdUI of proving that k did ret Wild at improve for purpose of ale.). ,a owner of the property,am eaclunwly contracting with licensed contractors m 1tthe project(Sae.71)44.Business and Rofessiom Code:)The Comm cmrs U. come Law dos not apply in an owlW of property who Wilds or improves thereon.and who contracts for such projects with acentrxrtor(s)licensed pursuant to the Contmadn s License Law. ' ❑lam. ,under See B k PCfa``r Nislesson Data �b Owner TbTPENS DECLARATION 40 1 hereby affirm under penally of paddy,We,of the following declarations I ham and will munafn a CertificateofCedwam m self--io orae forWorkere Compcn- , sation,as provided for by Section 3100 of the Labor Code.for the performance of the f work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,Is,required by Section 370(1 of the Lata Code,for the,perfammace of the work for which this permit is Wood ' My WoM1sh compnuadan lased.carrier em Policy number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORXERS' COMPENSATION INSURANCE Trek it.need col W completed if the permit is rmaahundmG da g.(5100) or kee) I totally Not in the performance W the,work far which this permit is issued.1 shall not employ any person in any mennersok mea jec the Worimn'Compamttion Laws of Califomia. c Applicant -- r NOTICE TO APP LICAN-f:If,after making this Cr is aaemp7 lion,you should hecwne subjm N the Workers Compensation previsio of the V Wr Code,you must .J O foMwith comply with stah provi4mts ar this permit shall W doomed mvokcd. z y CONSTRUCTION LENDING AGENCY [+ Ihereby M.that them is a emennome lending agency far the pendma.dce tar 0.ai w>i the work for which this permit Is issued(Sec.3097,Civ.CJ W O Landers Name 7 z Lenders Addmv U Q 1 certify that 1 hese rend Nis application and sums that the above inramatim is D.Fcone IL 1 agme N nd comply with all City ad county eminences asuite laws Rlming in C)U building conswction,and hereby authorize repreacrusaws of this city m color upon Ne above-mentioned property for impaction purposes. F a (We)agree to ave,indemnify and hap harmless the City of Cupenina against res judgmcnis.ease,andmnifyPomur ad keep may insect wayty of agramest Cupertino id City (J,'Z in comcqueae of the granting of Nu permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU RE�G�"TIO —� 1 VEco — n Lime � Re-roofs SigSignatureUC / SmgnucelApplicunanlrmlo I/o HAZARDOUS MA ALS DISCLOSURE Type of Roof Will Ne applicant or future Wilding ocempant uom or handle baamom muerial as defined by the Cupertino Municipal Cade.Chapter 9.11.and thee Health and Safety Code.section 255320)? Dy. ItQNu All roofs shall be inspected prior to any roofing material being installed. Will tuna licant or future Wildin oeeu pat um a If a roof is installed without first obtainingan inspection,I agree to remove PP Y P a Air Qu or devices which omit hs>amnm air cunuminants u defined by the Bay Arca Air Quality Management all new materials for inspection. Disuicn I have mad the WramwsmauriJs retnikemenu under Chi puf6.95ofNe Califor- meHmlthikSafely Code,ScnionsUM5.25533 and 15534.1 understood NuiflW Wilding dun' comm curmnlly hem a knol,that it a my responsibility,m noury dm occupant or the re9uirements which must here priormi Lc afi C[mIKiLL'or GCNa . Signature of Applicant Date Owner o3authariradagent D, All roof coverings to be Class IW'or better CITY OF CUPERTINO • 4 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35606022 . 00 DATE ISSUED. . . . . . . : 06/02/2008 RECEIPT # . . . . . . . . . : BS000004959 REFERENCE ID # . . . : 08060005 SITE ADDRESS . . . . . : 22023 BAXLEY CT SUBDIVISION .. . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SABA SATHYA ADDRESS . . . . . . . . . . : 22023 BAXLEY CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4744 RECEIVED FROM . . . . : SABA CHOCKALINGAM CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : SABA SATHYA ADDRESS . . . . . . . . . . : 22023 BAXLEY CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4744 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 123 . 37 0 . 00 123 . 37 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 918. 87 DISCOVER --------------- TOTAL RECEIPT 918 , 87 • 0P) Dons CITY OF CUPERTINO CITY OF CU PERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # &5 61� ( U Date: © b102- 108- Building D2 /0Building Address: 2 20 .2- S A j° LE7 Y P—T C P C-_P_ I " a G4 So l Mailing Address (if different from building address): Owner's Name: Phone#: SA -r +09- 3g 3 - 1299 Contractor: Phone: O WNE�2 RFU I l_� E� Fax: Contractor License#: Cupertino Business License#: • Contact: Phone: Fax: Residential Commercial Job Description: 51 NK F, 9 g/ P ( T OUTS r b ( OF kTC (+e--tV Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Building Permit Info: Bldg 0/" Elect 0— Plumb B' Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, IV V-B [9' �3 Valuation: Square Footage: Project Size: Standard D'Large ❑ 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.builditgreen.orIZ CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 BTEMPPER Temporary Building Permit (good for B 30 days) 1 BBOILERI For the installation or relocation of ea M boiler/compressor to &including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw). 1 BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h 1BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to • & incl 1,000,000 Btu/h 1 BBOILER4 Installation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to &incl 1,750,000 Btu/h 1BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h IBAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. IELECINSP Other Electrical Inspections (per hour) E 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing& Gas Inspections P (per hour) ----t 1MEETINGIHR Application Meeting B CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/DuplexNew B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B ICHIMNEYR Chimney Repair B FENCES 41 1FENCE>6FT Non-masonry, over 6 ft in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS IFOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRIVPile Foundation Driven (steel,pre- B stressed concrete 3 of 5 San CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM RETAINING WALL(CONCRETE OR MASONRY) 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSPI0 Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 ft) 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft) SIDING 1SIDEST/BK Siding, Stone & Brick Veneer B (interior/exterior 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>1 OSF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 4of5 lul CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee r 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P r IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B • 5 of 5 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A. All the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed, 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ................................................................................................................................................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: Date: Job Address: 2202-3 W�A7- LE`/ CoyrL-T Permit# C;v P C-ra-1'I N 01� CA- `7 So /tom Any changes to the information provided on this form shall be submitted to the City of Cupertino Build • Department. q City of Cupertino Building Department• CITY OF 10300 Torre Avenue CU P E k I N® Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by,the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. . If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs, and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento, California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, • City of Cupertino . Printed an Recycied Paper Community Development 10300 Torre Avenue Cupertino CA 95014 E' J Telephone(408)777-3228 CITY OF Fax(408)777-3333 OUPER,TINO BuildingDepartment JOB ADDRESS: 2202 3 �/�x PERMIT # CiJ ��7 �No c 50 / 6��6 Laos OWNER'S NAME: SP,g PHONE # GENERAL CONTRACTOR: p W N E9- b y L. FAX # I am not using any subcontractors:�2 r�L. — p6�pL,�p q7- SignatureD' ate 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 • Owner/Contractor Signature Date