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06060154ciry aF CUPEkTINO CITY OF CUPERTINC D(QW0I54- PERMIT APPLICATION FORM APN # 3S� Date: I J 6� h Building Address: g 13�nn p Mailing Address (if different from building address): Owner's Name: 2 d V\C1 Phone Contractor: D License #: Contact•-. MP-V\Q S e p Phone: 4 V g `3'13 02 '` Fax: , Cupertino Business License#: Building Permit Info: V �A A,% � 6 n �'`�o anA al) on, o7/CC Bldgs Elect ❑' Plumb a Mech 2" Job Description/ 16 42- S . T+ 6%8 Residential Commercial ❑prr Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: f G Q 0 Occupancy Group: . Type of Construction: �� Please check this box if the project is a second -story addition: ❑ Project Size: Standard Large ❑ Major ❑ BELEC1001 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I 00 to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDI]vG BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDI]vG 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 Investiization fee BUILDING 1 of 3 -(f =- ITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW BPCESSPOOL Atmospheric Vacuum Cesspool PLUMBING PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 ,-� CITY OF CUPERTIN( CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING LZ ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL L2, ro MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING 2.Z F—d PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING 3 PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 i -.g s <G Fqo�wggq�qsl1 fW� .p� �pC 3zE 4 W U CITY OF CUPERTINO IONTRAC.T;nRTN.�'ORMATIO.OIY,F ;� - °�•'"""' 'f" a'a�A`� BUILDING DIVISION PERMIT BUILDING ADDRESS: MEDHA S. DEO PEBMITN°'06060154 10138 BONNY D WS NAME: PERMIT ISSUE DATE MEDHA S. DEO 'PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUITDING PERMIT INFO PLO 0 o l� LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby afRrm that I am IksNed under Provisions of Chapter 9 (Commencing with Section 70t)(1) of Divine. 2 of the Busiress and Profassimms Code, aW my [team is ADDITION 6381-BEDROOM/DINING/LIVING RM in full forte and cfrm Li,...Clw Lie.0 REMODEL 16421-REROOF ENTIRE HOUSE/REPLACE ALL Dam. Contrmtar ARCHITECTS DECLARATION WINDOWS & DOORS/STUCCO ENTIRE HOUSE I max erstand my plans shall he used as public Words Licensed Professional OW NER.BUILDER DECLARATION I Immay IT,. that 1 am exempt from me Conbacm's Liccr m Law for ftfollowing mason. (Section 7tB 1.5. Business and Prufessioas Code: Any city or county which requires a permit m ..slrueL alms improve, demolbh, ler repolr my ..at.. prior to its issuance. elm requires elm applicant for such petea t or Bk a signed Comment Law 9 Sq. Ft. Floor Area Valuation me, W is licesucd pursuant to lW provisions Of the Consmme'Lacme (Chapter (commencing with Section 7000) of Division 3 of the Business no Professioas Cade) or $302200 that he is exempt therefrom and Ne basis far the alleged uamptlan. Any violation of Section 7031.5 by any applicant for a permit Objects rime appliesnt to a civil penalty of APN Number Occupancy Type not seam man Ove hundred dollars OiSM ❑ Las owner of the property, or ney easPloytm with "gas as Ihelr role tamprssation, will da Ne work. andlhe somrnumkantuuWW maRerW fm tale l5ce.70ss,Busirmss Required Inspections 9 P and Prefesaloas Cade: The Contractors License law does Out APPly 0 m awes r of property who builds or im proves thereon. and who docs such woM1 himself w through his awn employees, provided Not such Improvements are natimmrlded aroReted far We. If. however. the building or improvement is mid within ass yam of completion. the owner. builder will haw the burden of proving that he did ant build or improve for purpose or sale.). ❑ 1, ss awuer of the property ane cmdusiwly cConsrting with licensed mnuanms o ....tree the Profen (Sas:. 7064. Business am Professional Code:) The Contractors U. cense raw time Out apply w m owner of property who builds ar improve ammo., art, who contracts for such prejecs with a contractor(s) licensed pu"a, to the Cmtrmtoh Lice. Law. ❑ 1 em exempt ond���ec . B B P C fee this mason r n/]f'lA/"' ,vis' Date Ate• WORKERI COMPENSATION DECLARATION I hereby efrinn order poultry of perjury arm of Ne following declarations: ❑ I hart and ill ..Iowa a Certificate of ctwomm self-iueum far Workers Compere Wm, as provided for by Secuan 7700 of the labor Code. fm the ilmlermammm Of de work for which this permit is issued. ❑ I haw and will maintain Workers Compensation Insurance, as required by Section 3700 of the labor Code, far the performance of me worts forwMch this permit is issued. My Workers Campemauon hum. eartier and Policy number one: Currier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (nds merlon seed not he eom p1emJ 0 the permit Is for anc hundred dollars (S I dB or less) I certify that In the performamu of the wary fm which this Nemlt Is issued. I shall not employ any person in any muse, eta stobem esu Jmtua/Omen C. pemWm laws of California. Dau Applicant NOTICE TO APPLICANT: If. after making this CeniOmu a ^ mmpllon, you should become subject to me Wahars Compmwtian provisions of Ne labor Cadeyen must > forthwith Comply with such provillam m this permit Nall be deemed revoked. CONSTRUCTION LENDING AGENCY I Wroby,Riese mar there ts a c.utroetim lending agaany for the performance of > dm work for which Nis permit Is imand (Sec. 3097. Civ, C.) Lendces Name Lenders Addsesr L 1 certify Nat I have lead this applicaum snd rum that the above infomutiun Is ¢tem. [agree to comply with all city and cmmy ordimnas and sum laws elating to nd hereby or oris city tocnmrupon lht 3. ahovc-mentioned property for inspection purposes. building canswee and eprcaenutivese (We) agree ts, cost, indemnify end kap harmless Nc City of Cupcnst against to law. AinconsesJWeofthecaaramd expenses which may in any way same against mid City Z of tiro granting of sets � APPLICANT Uffffff111111ggqqqqERSIANDS AND WILL COMPLY WITH ALL NON -POINT A APPLICANT D WILL SOURCE REC R 111-4, ' Issued by: Date Re -roofs Signuum of Appl ontmctor imof HAZARDOUS MATERIALS DISCLOSURE Type Roof WE mo applic nt m forum Wilding Occupant nam or han lk hautdous mamr(al dWred by else Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Sit 25l32U)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yeses (allo If a roof is installed without first obtaining an inspection, I agree to remove Wdl the applicant or future Wilding aaupant use equipment u dcvias which crit hamodaw air commumms as dcaned by time Bay Arms Air Quality Management all new materials for inspection. DW*17 C] Yet PONo I have mW the haurdous materials mquimmcns under Chapter 6.95 ofd the Califon lei. Health &SafalyCcem,Seedoas 2550.525533 and 25534.1 understand that ifdm Wading does set rtcnlly have a mnanL dot Its my responsibility to notify the Occupant of me Date mqui n wkh mus be"1 prior to Wallace Or a Comiscate of Occupancy. Signature of Applicant 813.16 6 • All roof coverings to be Class "B" or better owner ser amhoruad agent _ _ DOW CITY OF CUPERTINU BUILDING DIVISION FERMI BUILDING ADDRESS: 10138 BONNY DR OWNER'S NAME: MEDHA S. DEO PHONE: ARCHITECT/ENGINEER: Z 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is d in full force and effect. ? License Class Lie, 9 p Date Contractor Lu ARCHITECTS DECLARATION I understand my plans shall be used as public records 'U ti Licensed Professional ' OWNER -BUILDER DECLARATION J � I hereby affirm that I am exempt from the Contractors License Law for the 00 following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish• or repair any structure } prior to its issuance, also requires the applicant forsuch permit to file a signed statement • < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 m(commencing with Section 70D0) 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 not more than five hundred dollars (S500). ❑ 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 and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided Nat 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.). ❑ 1, 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 eontracior(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt undef'Sec. . B & Pf C for thismason Owner �1 Atmel AM Date -'B s rD � WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers 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 Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 so as to become su 'ect to orkeri' Compensation Laws of Califomia. Date Applicant RIM 'IV NOTICE TO APPLICANT: If, after making this Certificate oftxcmption. you should be,comc subject to the workers Compensation provisions of the Labor Code, you must Z forthwith comply with such provisions or this permit shall be deemed revoked. 0 4CONSTRUCTION LENDING AGENCY i hereby afrum that there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 30917, Civ. C.) 0 Lenders Name Z Lender's Address 1 O 1 certify that 1 have read this application and state that the above informaUen is Pcorrect. I agree to comply with all city and county ordinances and state laws relating to U building conswcuon, and hereby awhorim rcprcscmauves of this city to enter upon the CI-) aho�c-mentioned pruperty for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against r v) liabilities, judgments. toss and expenses which may to an way accrue against said Cit t� J g fx Y� Y Y g Y I Z in consequence of the granting of this permit. APPLICANT LI ERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCERE NS. _ V� �) 06 . Signature of Appli nt/ontractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle bwArdous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes ANo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes No 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 docs notgrcnuly have a tenant, that it is my responsibility to notify the occupant of the requi ch must be mel prior to issuance of a Certificate of Occupancy. 8 131a 6, Owner or authorised azcnt Dau: S. DEO , PERMIT NO. 06060154 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. Job Description BUILDING PERMIT INFO ELECT PLUMB ADDITION 638'-BEDROOM/DINING/LIVING RM REMODEL 1642'-REROOF ENTIRE HOUSE/REPLACE ALL WINDOWS & DOORS/STUCCO ENTIRE HOUSE Sq. Ft. Floor Area Valuation $302200 APN Number Occupancy Type Required Inspections Issued by: Re -roofs Type of Roof Date e�' 3 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. Signature of Applicant Date All roof coverings to be Class "B" or better / a CITY OF CUPEkTINO TO: Medha S. Deo FROM: City of Cupertino DATE: 01/18/2007 RE: Address: 10138 Bonny Dr. Permit: 06060154 City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: (408) 777-3228 FAX: (408) 777-3333 BUILDING DEPARTMENT With the length of time it takes for PG & E to provide gas and electric to a project we are allowing both utilities to be released prior to finals. This is allowed only if the inspector agrees and feels it is safe to do so. The owner and contractor need to sign this form stating that they understand they can- not move into the residence until they have received all of the required finals and the City has given a certificate of occupancy. If both do not sign this form, the inspections will be incomplete and the utilities not released until we have a signed form. Owner(s)/ Builder - Medha S. Deo Contractor - NewHome Construction: Nhat Nguyen Printed on Recycled Paper CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: /O 1-3.F PERMIT # O ,6' 0,6 01S- 1S-OWNER'S OWNER'SNAME: eo f PHONE # 40 QJ'oe GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heatingf'� Insulation Landscaping P g Lathing, Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering !; Plumbing D 0O 3 7Y Roofing r 1 Septic Tank Sheet Metal Sheet Rock Tile er/Contractor Signature d3lrS-4)-- Date