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04090030 CITY OF CUPERTINO - � � •' `"•' .,,, BudmNG DIVISION PERMIT CONTRACTOR INF,URMATION �.�.c•;;,.:. ._.... .. .„fit.,> . , -,.I: axe _ BUILDING ADDRESS: PERMIT NO04090030 4090030 OWNER'S NAME: PERMIT ISSUE DATE VARA SPINIVASAN 04 NE: SANITARY NO. CONTROL NO. ARCHITECUENGINEER: B M EL E MECH moo LICENSED CONTRACTOR'S DECLARATION ryoo� W, hereby eby Affirm that I am licensed under provisions or Chapter 9(commencing Job Description< L O i wiNSmimagpd IIur Division Sofdm Eusinevaand Pmfcuiom CoM,end myliccnsc is mrmlrotengdcttga / S/ L ELECTRICAL SERVICE UPGRADE p�z LMan!Cl < -/O Lick nt_O Date x Gy Cmimctor E..,.�iz F/.Yr. 200 AMP ra -�A1tllls e ARCHITECTS DECEMIA119N 9/8/4 ENERGIZE LECTRIC PD ENERGIZE LECTRIC PD BiJ X11[[ Yz „LurMcrsmnJ my plain aballbeuacd as puM1ba rtmrus W Licensed Professional O OWNER-BUILDER DECLARATION <q 1 berehy affirm Net 1 am exempt from dm Contractors License law for the Q O following moan.(Section 7031.5,Business and Pofewiom Code:Any city or county L29 which ou,toms a permit m construct,¢Iter,imporm,demolish,or repair any structum Ziprior in its issuaam.al¢m requires the.,icamforsuch pesmiuofile asignedsutemenl that he is licensed pursuant to the pmvisiov Of the Contrnchn's llsnw Law(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Section 7")of Division Sof the Business and Pofessioa Code)or i $ that her Is exempt therafmm and the boo for dm alleged exemption.Any violadon of $2200 Section 7031.5 by any applicmt for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type not mom than Eve hundred dollar MIND. ❑I,as owner of the property,or my employees with wages as their mlc compenvtion, will do the work,and the surmount is not intended or offend forsalc(Sec.7014.Business and Professions Code:The Contractors Licum law diner not apply to an owner of Required Inspections progeny who buildsmrimyrows Thereon,and who does such work himself or through his awn employees.provided that such improvements art 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 moving Nat he did not Wild or impmw for purpose of sale.). CD I,as owner of the pmperty,am exclusively contracting with licensed contractors m consumer the project(Sec.7W,Business and Professions Code:)The Cmntraems's Li. come law docs not apply in an owner of property who builds Or improves themon,and who contracts for such pojcns with acomsacros(s)lianxd pummunuo the Conuactola License law. em elempa Under Sec. .B&P C for this moan Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under mewty of perjury arc of the following dimarations: I have and will maintain a Certificate of Consent to self-insure for Worlum'sCompen- sation,as provided for by Section 3700 of the labor Codefor me Ndovoance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,a retained by Smdon 370E of the Labor Cock,for the performance of dm work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cart�r'1 Policy. o� CERTIFICATE 11 EXEMPTION At rI WORKERS' COMPENSATION INSURANCE (TTiascaion need not bccomplemd if the permit is for one hundred dollaa giIOB) or lase.) I mnlfy that in the performance Of me work for which this Permit is!wood,I Nall not employanypea0ninany an �s�own beoomesubjecuothe Worteri Compevadon laws of Calif a.Dam-X,La3L� Applicant NOTICE TO APPLICANT:If,after making this CeniIMate of Exemption,you should became subject o Our Worker's Compensation previsions of the tabor Code,you must QZ foMwi th comply with such mrnvoions or this perm i,dall be deemed¢voted. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of 0: the work fur which this permit is issued(Sec.3097,Co,C.) Bd 0 tondo's Namc 4 Lender's Addreas 7Z U Q I certify that 1 have read this application and sure Net theand above information is C) cortdingcorcemcomply and with all city and coumyouitimi or and sum laws trefining Me QU ithomngcnioned construction,and herebyin,mchonprcpraenutivrsofmiscirymenmrupon the r aM1ove-mentioned I.rove for imn ify an Purposes (We)agree m cow,indemnify and tech harmless be City of against id City UN inconsou,sudgmcnu.gratsing expcnscsmit. may in my way accrue against cold City Uz APPLICANTeof the UNDERSTANDS lag of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. >'a------ /s`fZ4/roti Re-roofs \: tont of ApplianUCommcmr !— Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building occupant store or handle harudous material u defined by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety Code,Section 25532(.)? All roofs shall be inspected prior to an roofing material beim Yea RRm p p y g g installed. 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 t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. trio] ❑Yes 21V 1 have mad Ne henardnus mnterinlsmyviremcna under Chapter 6.95 of the Glifor- nio Health&Salary Cade.Sccdom 25505.25533 md25534.1 un&n=d Nat if the building doe nor curr555e,,,ntly lout a tenant,that it is my msWmibility m nodly the occupant of thc MquirtmenL mch "iscmelpnmmiwmncemfaceImam o(Ce empamy. Signature of Applicant Date ��� Owner or agent ue All roof coverings to be Class "B"or better amhoriacd CITY OF CUPERTINO 2 of 2 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rug: Sub: Blk: Lot: APN . . . . . . . . : 32630120.00 DATE ISSUED. . . . . . . : 09/08/2004 RECEIPT #. . . . . . . . . : 26958 REFERENCE ID # . . . : 04090030 SITE ADDRESS . . . . . : 20832 FARGO DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VARA SPINIVASAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ERNEST AARSEN CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . . TELEPHONE . . . . . . . . : OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL ___ _ - ---------- ---------- ---------- BENERGY PERMIT FEE 83 .16 39.92 0.00 39.92 0.00 BELEC200 METERS 1.00 0.00 0.00 0.00 0.00 BPERMFEE VALUATION 2,200.00 83.16 0.00 83 .16 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BREMPOWER POWER UNITS 1.00 47.96 0. 00 47.96 0.00 BSEISMICRE VALUATION 2,200.00 0.50 0.00 0.50 0.00 --- ---------- --------- __--- TOTAL PERMIT 209.91 0.00 209.91 0.00 METHOD OF PAYMENT AMOUNT NUMBER __ _ _------_- CHECK 549.25 508 TOTAL RECEIPT 549.25 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL ft . CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM �c�09dD36 APN # Date: o Building AddrN: Mailing Address (if different from building address): ,10 'd 3 2 -�, /J! C7_d e Owner's Name: Phone#: V�,-^ S v Vo P, 2 5 . O 8 Contractor: License #: C - /p Contact: g�rl1fi74Phone: Cupertino Business License#: B i - 7 o i z_ Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description 12 Residential Residential Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box i ❑ 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> 1M 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 I of 3 .(!,t,31al", CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMIvIM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME 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 clin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > 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 CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Li ting 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 ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 Is Community Development x 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building Department JOB ADDR PERMIT # z oy9 L OWNER'S NAME ,; PHONE #� 2 ' 7 ° gr Scl GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing ectrical ` J 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 /Contractor Signature til Date