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06020032e3e0jLC0CLy�P�� t�R 00 y pz UO OF U CITY OF CUPERTINO� �^ .� b •d," NFURMATIO! BUILDING DIVISION PERMIT .CONT.RACTOR BUILDING ADDRESS: PERMIT NO.06020032 10291 DE ANZA BLVD R'S NAME: PERMISSUE DATE IT KEN PATEL WN 02/07/2006 NE: SANITARY NO. CONTROL NO. ARCH=IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm Nat I am licensod under provisions of Chapter 9 (commencing P with Section 70(10) of Division 3M` Ne Business and Forced.. Code. and my limine is in full fora and effxt ADDING 3RD ELECTRIC, SERVICE LEG. 200 AMP SERVI License Class Lic. At Dm Comr Dau LANIER ELECTRIC IS THE CONTRACTOR - PAID AT THE ARCHI'IECrS DECLARATION SAME TIME AS PULLING THE PERMIT. I undcaund my plans shall be used As public records Licensed Profeuienal OWNER -BUILDER DECLARATION 1 hereby affirm that I em exempt room the Conuamars License Law for the fallowing mason. (Section 703 L5, Business and Professions Code: Any city or county which inquires • permit as emWmel Alun improve, demolish, u rural, any auuctum prior as its issuance, iso requite the applicant foroch permit to rile a signed aatenumn Contractor's Lleeme L.aw(Chspmr9 Sq. Ft. Floor Area Valuation dist he is licensed pursuant to the provisions of the (commencing with Section 7000) of Division 3 of rima Business and Profesfi ns Cade) or $3000 dist he u exempt wesefrom and the buts for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by my applicant for a permit objects the Applicant o a civil penalty of out more than five hundred dollen ($50D), Q 1, u Manu of the property, ar my coployces with ages As their ole comp unfon, will do the work, and Ne structure is act Intended a offend for ule(Sm. 7014, Business Required Inspections e and Prefesslons Code: The Contractors Llame Law don not apply u an owner of 9 P popertymo buildsc rimpra cni ft... AM aha dausuch wmk himself u Waugh his awn employee, provided thsloeh Mperovemenu un nainunded iso@red lunatic. if, however, the Wilding or Improvement it old within atm your ofcompledon. the owner. builder will haw tiro burden of proving that be did not build or Improve for purpose of �� p, ,{7 A ,9p p.� h sale.). ^' Q 1, a Manor of see property, am exclusively contracting with licensed comanon he construct dm project (Sec. 7044, Business and Professions Co*:) The Common' U. Y.(d'�^ 4.a cense Law docs not apply as an wmar of l eopertYwho builds or improves theteu, and, " who contacts for such projects with a eonmeto (s) licensed pursuant he see Conuauoes License Law. j f y ❑ I am exempt under See. . B k P C for this reason Dam /j(,y1.i/ �f} 'g * y j� WORKER'S COMPENSATION DECLARATION IF 1 heaby affirm under penally of perjury one of we following decimdau: v ❑ I haw and will maintain a Certlricam of Consent to self -mom for Workeh Compen. "y Milan, u pmvidcd for by Section 37M of the labor Cade, for the performance of Ne work fee which this permit is iuued. ❑ 1 haw and will maintain Worker's Compensation Insurance, As required by Section 37W of tha labor Coe, for the performance of the work for which this permit is issued. My Workees CMmpeuW on Imummse curia And Policy number am: ' Carrier: Policy No,: CERTIFICATE OF E%EMMON FROM WORKERS' COMPENSATION INSURANCE (Thtsxection recd not becompleud lithe permit s forone hundreddollan ($IfgO ' Or lest) I certify dot in the performance of rite .,it for which this permit Is iasad, I she)[ not employ any person in any mannero As to bccomaobject to tiro WorYca' CanpensMon Law, of California. Data Applicant NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should become object to see Worker's Compensation provisions of she labor Code. you mut forthwith comply with such provisions "is permit shut he damed booked. CONSTRUCTION LENDING AGENCY 1 hereby grim Net More is a construction lending agency 1'or dme performance of the work for which this permit B Issued (Sm. 3097, Civ. C.) Lenders Mama , Lender's Address I aNfy Nal I have mad this application and saw Out the above information is Correct. 1 agree to comply with all city and county ordinances and suis laws alsting N building constuNon, and hemby otharbs representatives of this ity to enmr upon the snow -mentioned Property for impeeuon pugweA (We) agree N sew, indemnify and kap harmless the CitY of CmXnMO Al liabllides, judgments, costs and expenses which may In any my acme against sub City in APPLLIICANT UNDEuence of Lhe RSTANDS Arentiof IND WILL COMPLY WITH ALL NON -POINT Issued by: az Date SOURCE REGULATIONS. Re -roofs Type of Roof Signsmra of ApplicaHAZAR ctor Dau HAZARDOUS MATERIALS DISCLOSURE Will the applicant form building occupant am or handle mamnst ofuture Heallom As de0ned by tiro o Municipal Code, Chapter 9.13, and time Health and Safety e, Me, Sorties sss3z(.)? 324)? All roofs shall be inspected prior to any roofing material being installed. Yes ONO If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or dcviccs which emit havatdou, it conumemants As defined by we Bay Area Air Quality Management all new materials for inspection. Daniel? Q Yes 0 N I have mal Ne haeAtws materials Mquimmcnts undcrChapwr 6,95 of the Califon nu Hcal" Safety Cade, Sectors 25505.25533 and 35334.1 underio nd use lithe building does not currently haw a wool hast it Is my mspomihilhy in Airy tiro coolant of the requirements which must the met prior u issuance of a Ccrificau of Occupumy. Signature Of Applicant Date All roof coverings to be Class "B" or better Owner at authoriaud agent Dam •em 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN 35917001.00 DATE ISSUED.......: 02/07/2006 RECEIPT #.........: 33098 REFERENCE ID # ...: 06020032 SITE ADDRESS .....: 10291 DE ANZA BLVD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: KEN PATEL ADDRESS ..........: CITY/STATE/ZIP .... CA RECEIVED FROM ....: LANIER ELECTRIC CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: OPERATOR: kiersaw COPY # : 2 is ' FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BSEISMICOM VALUATION 3,000.00 0.63 0.00 0.63 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00 TOTAL PERMIT __________ 208.29 __________ 0.00 __________ ---------- 208.29 ,0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ------------ CHECK 208.29 ________-_-_-_____ 4582 TOTAL RECEIPT 208.29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 63 t � CI OF �UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: D S 7)!?� ll PERMIT # 6ZW3Z OWNER'S NAME: PHONE # " r S/U2� GENERAL CONTRACTOR Con rAL4-lsFAX # (¢ g/ I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Date 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 Date UkX_ CITY OF CUPERTINO cITM•c PERMIT APPLICATION FORINT O(oc�a c�3o2 CUPERTINO W# 3S - K -/?'60 ( Date: 0_7I0e-o Building Address: Mailing Address (if different from building address): _ _ l UZ5 Owner's Name: Phone #: Contractor:- Lair) 1 Co, License #: -ID v z9 Z Contact•�/ Phone: � 8/3 lad Cupertino Business License#: rl G-llr�p� Fax: V-7ZR7061Z, Building Permit fo: deV)n S 3-e— e/ee. 15-e�vrG•e /e� 2csz7 &44-lp Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial Sq.Ft. Floor Area: q.Ft.: Boiler> 1M to 1,75141 Btu MECHANICAL Cost of Proi t:tl� Occupancy Crroup: Type of Construction: Please check this box if the project is a Construction Tax second -story addition: Iftject Size: Standard ❑ Laze ❑ Major ❑ Ind/Off/Comm/Quasi Quant ity Fee ID Fee Description Fee Group BAPPLOTHER OtherApphances MECHANICAL BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1,75141 Btu MECHANICAL BBOILERS Boiler>1.75MBtu 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 41 1 of 3 e CITY OF CUPERTINO •CuPE o PERMIT APPLICATION FORM QuantityFee 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 BNUCOM14P New Comm Plumb PLUMBING BOVERTUYIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg 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 rinklerBackflo 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 BRE=T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREM 1EA T Heater Installation MECHANICAL BREMINHOOD Installation of Hood NIECHAIVICAL 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 CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Mar uee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS I Ventilation Systems MECHANICAL BSCBLVD Seb 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 ELECTRIC Electrical sq foot ELECTRICAL EPERMTTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot I MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plambing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Ranee Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3