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04100111 CITY OF CUPEWI'INO BUILDING DIVISION PERMIT I, QNTRAC'TOR INF�ORMATIOO Nom"' BUILDING ADDRESS: PERMIT NO.,V 4 10 0111 '7513 HEATHERWOOD DR OWNER'S NAME: PERMIT ISSUE DATE NEHA DESAI 10 15 2004 ]ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH wO, LICENSED CONTRACTOR'SDECLARATION Job Description w❑ 1 hcreby affirm that I am licensed under provisions of Chapter 9(commencing iW with Section k)eDivisionJof the Business and Professions Cork,and myliccnn is �1 ■ mu Tome areanderred, GAS LINE FROM MAI trQr•T�` ER p ? License Class Lit.0 n r O Date Cunnacmr ARCHITECTS DECLARATION 'nt< l understand my plans shall he unit as public records51 �� G h Licensed Professional 2004 OWNER-BUILDER m DECLARATION ON <y 1 hereby afErm that I on exempt from the Canons Co License Law rut the O o following mason.(Scctiun llq L5,Business and vc,demolish. Code Any city or county K m 4 which requires a femme to construct.al¢r.improve,demullxh,or repair any structure 8360 m—'^ poor o its issuance,also requires the applicant for such permit to file aligned statement that he is licensed pursuant Io the provisions of the Contractor's License Lxw(Chapter Y Sq. Ft. Floor Area Valuation ,,l-" (commencing with Section 7WO)of Division J of the Business and Profeuions Cnde)ur 'd Nat he is exempt thenfrOm N and the basis far e alleged exemption.Any violation of Section 1071.5 by any applicant for a Permit subjects the applicant to a civil penalty of 0 Occupancy Type ort more than five hundred dollars($500). Q 1,as owner.(,he properly,or my employ.with wages as We]r sole compensation, will do the work.and dee swmuK is not intended or Critical for sale(See.104a,Business Required Inspections and Pmressions Code:The Conmcmrs License Law docs not apply to an owner of q P property who builds or improves thereon,and who docs such work himself or through his own cand.,ov,provided lha such improvements are not intended orotTered for sales if. - however.he building or improvement is sold within one year of completion.the owner- builder will have the burden of proving Nat he did not build or improve for puryose of salt.). 1,as owner of the property,am exclusively contracting with liecrtsed contractors to o street the project(Sec)Baa,Business and Professions Code:)no Contraemr's Li cove Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such pe,ccer with a comranor(s)licensed pursuant to the Contractor's License Law. Q l am exempt Ontler C. �_.B A P C far this reason O r _uz DaK -s KER' OMPENSATION DI-CLARAAK. 1 hereby affirm under penalty of perjury one of the following declarations: Q I ham and will maintain a Cenificate of Consent to self-insure far Worker's Cumpem station,as provided for by Section 37M of the labor Code,for the pe fmosnce of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 310B of dc labor Code,for the pedormanee of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEM ProON MOM WORKERS' COMPENSATION INSURANCE (Tbisaectitm need not becompleKd if ncic permit is foronc hundred dnllan(SIN)) or less.) 1 certify that in the performance of the work for which this Permit is issued.I shall not employ any Person in any manner so az to become subjeeuo the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Cemi0cam of Exemption.you should . become suhjcn to the Worker a Compensation provisions of the LaMar Code,you must .,Z forthwith comply with such provisions or this Permit shalt IN deemed revoked. zO C0N SrRUCT1 ON LENDING AGENCY j-+ I hereby affirm that there is a construction lending agency for the performance or 13' thc work for which this Permit is issued(Sec.301 Civ.C.) lel Q Under'Name = 2 Lender's Address U C) I certify that 1 have read this application and into that the above information is v Ow f"' correct 1 agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorier representatives of this city to enter upon the T f31 above-mentioned property for inspection purposes. (We)agree to an,indemnify and keep harmless Ile City of Cupcnino against Ir F'ra/1 lisbilitics,judgmcnts,eastsand cxpcvcs which may in any way accrue asxiam wid City Q U Z in consequence Orme granting of permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIIO �J inn G� 100 is 0 Re-roofs Si turcof Applican, onta for ��ate IIAyARDOUSMATERIALSDISCLOSUR Type of Roof Will be applicant or future building occupant store or handle hvuduus material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ewe,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes INO 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 mit haimilous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Dialrict? N Q Ycs I have mw the havanlousmaWriuls equinmemu under Chapmr 6 95 of the Cardin. ria HcalNKSafmyCwc,Scwmu 25N)5.255JJ and 2557x.1 understand that i(tM hudding dues not currently bac a tenant.Wal it is my responsibility lin nuufy the occupont of the requircommi bienmusthemet miasnoncpOra certificate oroecupumy Signature of Applicant Date �0�'r^" 1�/)su4 All roof coverings to be Class "B" or better Owner or awhi Cut agent Date Community Development 10300 Torre Avenue in ` 41Y' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADD S 13 , I e0..tk�ur0-04 Dr,, PERMIT # 0/ O O I I CA 1 OWNER'S NAhOaf 1\ 9 k-a.- .Degcu PHO iqO$ `1*-73 911 O 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 Electrical Excavation Fencing Flooring: Carpeting • Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing w-ozrc{1 PI u v�h Roofing Septic Tank Sheet Metal Sheet Rock Tile C ��`' J/ +0/5-105 Owner/Co or,Signature Date ( - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM z� l CUPEkTINO APN # Building Ad Mailing Address (if fferent from bu lding address): X513 RC--ATHter- O0o� DR C)PC- -Ti NO CA 0ISo1y Owner'sName'J 0 ,NA ;1DC !;.A I PI)VI #: C, II U Contractor:y Rev E O S w 0 01� QLU M C31 N �p License #: Contact: ��O S �5 Phone: Cupertino Business License#: g Fax: Building Permit Info: Bld t`4:�- Elect ❑ Plumb Mech ❑ Job Descriptio�n:o Pt 0. `-r pyo vrina v� aw Residential L7 - -FO 1 ommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: i Occupancy Group: Type of Construction: f Please check this box F olect is a Adlk l' second-story addition: ❑ Pro'ect Size: Standard ❑ _Lare ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 <= IOOOA 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 df J 6 � , ys� (d CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI�TINO 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 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 Nor BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHHAN A/C Units <= 10,000 cfrn 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 ApRliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc t1 Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 2of3 ffll 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 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 Insection 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 PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3