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04100092I 4 CITY OF CUPEWTINO G BUILDING DIVISION PERMIT �6CON�T,,RAC"TORIINFORM,XT-,ION UIL BUILDING UILDINGADDRESS: K DESIGNERS PERMIT N04 10 0 0 92 les 0621 TUr,,9 L_ 6-Al— OWNERS NAME: PERMIT ISSUE DATE HARI GOPINATHAN 11261 SUNRISE PARK DR 10/13/2004 ONE SANITARY NO, CONTROL NO. (916)631-9300 ARCHITECT/ENGINEER: BUILDING PERMIT INFO HIM ELECT PLUMS MECH I LICENSED CONTRACTORS DECLARATION Job Description I hereby air,. he, I tons licensed in"moisions of Chapter 9 (commencing wit rkiSecti?'. 7r)(10).fDiAsime 3.f dic Buq�PA and Professions Chile, and my license is in a and a ""' -VINYL -911w� Lit -a is, Date Aft.CITEA�' ARATION I understand my plans shall he used as politic records Licensed Prefcosima.] OWNER -BUILDER DECLARATION I hereby afflom that) am exempt from the Contractor's License Low for the r.11mving reason. (Section 7031.5, Business and Piorcesions Cods: Any city or county which mutation a permit in consexino, alter, improve, demolish, or repair any structure $11743 prior in its issuance, also requires the applicant for such Permit to rile a signed statement Thal he is lice tried pursuant 10 the provisions oft he Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 of she Business and Prorcirom Code) or Nal he is exempt therefrom and i1a, 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 be Occupancy Type not mom them five hundred d.11... (5500). 0 1. is owner of the paren any, of my employees with "gas as their role compensation. will do the work. end the miallilre I ... I intended or offered far see (Site 7044. 11trairim. Required Inspections .it Profession. Code: The Ciarisclins License Law it.s net apply in a. ..at, of property who builds or Improves thereon, and who does such work himself or throullb his own employees, provided that such Improvements sm not intended in offered for ale. If. however, the building or impmmmtnL is sold within one year of completion, the owner. builder will have the burden of proving that he did not Wild or improve for purpose of sale.). 0 1, as owner of the property am exclusively contacting with licensed contractors to construct the project (sec. 7044. Business and Professions Code:) The Contractor's Lt. came Law does not apply to an owner of property who Wilds or hormones domain, and who contracts for such projects with a contactors) licensed pursuant 10 be Contractor's License law. [-11 one exempt under See. ,B& P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby 'from under penalty of perjury one of the following declarations: I have and will maintain A Caoirlac of Consent to self -insure for Workin3Comrn. saner, as provided for by Section 3700 of Be Labor Code, for the performance or the work for which this permit is issued, C] I him and will maintain Worker's Compensation frourarma, as required by Sceflon 3700 of the Labor Code, for due Performance of ilic want for which this permit is broad, My Worker's Compensation Insurance carrier and Policy number Corti r.✓>45�policy No.: CIRTIFICATEOFEXEMPTION FROM W KERS' 7 COMPENSATION INSURANCE - (This section need nut Ncompleted if the permit Isfor one hundred dollars ($101)) or less.) I ciatry that in the performance or the work for which this permit is issued, I shot) not employ any Person in any manner anis to become subject to the Workers' Cont aamAdon Laws ofCalifornia. Data Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must fOnhWiLh Comply with such provisions or this parrall shall too deemed revoked, CONSTRUCTION LENDING AGENCY I hereby aMo. that them I. . troutioutdian leading .,one, I'm he rsafflurrivoc of do, work fur which this permit is issued (Sec. 3097, Civ. C.) Landers Name Lender's Address I cenify that I have mad this application and suma that the above information is Correct. I 19MC to Comply with all city and county ordinances and state laws relating to building construction. and hereby authorim representatives of this city to enter upon the abova-mcartioned imarsoly for inspection purposes. (We) agree to ran, indemnify and keep harmless the City of Cusanino against liabilities, judgments, costs and expenses which may in any way accanic against mid City in consequence of the granting of this permit. APPLI CNffERS . DS co ._WNT ASOUREG� DS WITH ALL NON P sue Da Wroofs (7 Type of Roof nature. 17AppWant/Con factor Da BOGUS MA /V HAZARDOUS ftRIALS DISCLOSURE L/ Will the applicant or future building occupant store or handle hummer nodonal as defined by the Cupertino Municipal Curb, Chapter 9. 12. and the Health and Safety .do. Section 25532(.)? 0 Y., ll�Nu 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants in defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 year .110 I have mad the Waindous materials requirements under Chapter 6.95 of the Califor. nia Health & Safety Code, Section 25505.25533 and 25534.1 inulconand that lids, Wilding does not currently him a lanams trial it is my maronsibility to notlly the .x.pano of e imine nen et nor ,iaaanm.nanifi,ete focc P Y.�P ture of Applicant Date f All roof coverings to be Class "B" or better her V er or auithorizzTagent an, �v r L C z— �i ]r UC OF �a U2 0 CITY OF CUPERTINO BUILDING DIVISION PER r"� "iCQNT"IQTOR D'b"QN ,i BUILDING ADDRESS: PERMIT N@41 0621 Tt)4,&L2 PL OWNER'S NAME: PERMIT ISSUE DATE HARI GOPINATHAN 11261 SUNRISE PARK DR 10/13/2004 ONE: SANITARY NO. CONTROL NO. (916)631-9300 ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed rovisions of Chapter 9 (commencing i Seni n]axHofpivinion 3rf the Bu.io.ead Professions Code. and mylicenm is incl VINYL SINGING eafder Lice lose" Date — Y Cuntri'l. RIAS D .ARATION ' I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Comracmis License Law for the following reason. (Seemm 703 1.5, Business and Porfcssions Code: Any city o, amty which requires a Permit to construct, altar. improve, demolish, or repair any structure $11743 room hl its issuance. also requites the applicant for such permit to file a signed matemcnt Sq. Ft. Floor Area Valuation that he is I ccnud purtumun the provisions of the Contractor's License Law (Charter 9 (commencing with Section ]000) of Division 3 of the Business and Professions Cuda) or that he is exempt Macaroon and the basis for Ne alleged exemption. Any violation of 57MA C Occupancy Type Section 7031,5 by any applicant for a permit Subjects me applicant o a civil penalty of not mart Nan five hundred dollars ($500). 0 I, as owner of the property, or my employees with wages ss their sale compensation, Required Inspections will do the work. and the swctum is not intended or offered for sale (Sec. ]We. Business and Professions Cada: The Centimeter's License Law crack not apply to an owner of formerly who builds or improves Motion, and whodoes such work himself orthrough his own employees, provided that such improvements are not intended orofferW for sale, If, however, the building or improvement is sold within one year of completion, Ne owner. builder will have the burden of proving Nat he did not build or improve (or purpose of / / K <� 01,sale.l ❑ 1, a owner of the property, exclusively convecting with m :)The Contractor's Business and ProfessionsConvenor's construct the project (See.o , B � nd an ds or imports McconsContra, send who Wildsorant ante Lawdoesfnotapplyjets ithaofproperty to whocontractsLa ts for such projects with o conmemr(s) licensed pursuant to dm Convenor's License Lew. I am exempt under Sec. . B & P C for this rumen Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury, me of the following fluctuations: ❑ 1 have and will maintain a Ccrtiremc of Consent to ml binsum far Worker. Compere kation, an provided for by Section 3700 of Ne Labm Code, for Ne Performance of me work for which this permti Is issued. ❑ 1 have and will maintain Workers Compensation Insunna, as required by Section 37M of Me labor Code. for the performance of the work far which this permit is Wood. My Worker's Co. pensaion Insurance carrier and Policy number rt: �— r - lJ cam r.S litl �JPoliayNo.: CERTIICATE OF EXEMPTION FROM WORKERS ' COMPENSATION INSURANCE (This union head not he mmplcmd if the Permit is forme hundred dollars (; IM) or less.) I emi(y that in the pc,fnmme. of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Wmherf Compc IALkin Laws of California. Doc Applicant NOMCE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compemetion provisions M the labor Code, you must forthwith comply with such provisions or this Permit shail W deemed revoked. I " CONSTRUCTION LENDING AGENCY . I hereby affirm that More its cotutrvctinn lending agency for the performance of We work for which this permit is issued (Su. 3Nn. Civ. C.) Lender's Name Lendcrb Add., j 1 certify that I have read this application and sum that the above in(omation is mmaL I agree to comply with all city and county ordinances and state laws rcluing to building construction.tioneard rescinvtivcs u(mis city menta upon the p or mquilho purposes for forimpactionkeeph. eMvo-(we)are to son, (we) egmc to ma, indemnify and keep may in an the Cum of Cupertino against j emuand may in any way varve agaimtmid City / _ a(Misaspamasmit. ineonseydencc Of the graining of mispermit. in coities,fudi, Ofth, APPLI UNDER; DS,ySN L COMPLY WITH ALL NON? NT DYS _sue by: Dat / SOU REG AT 5. 7 'so/ roofs Type of Roof oxidic o pp'.W(Comutor r Da HAZARDOUS M RIALS DISCLOSURE Will Nc applicant or fmurc building accupmt Wore or handle harardrus material as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Surety Code.Section 155714)? All roofs shall be inspected prior to any roofing material being Installed. Dyen epNr If a roof.is installed without first obtaining an inspection, I agree to remove Will the applicant or futuu building occupain use equipment or devices which :mit hazardous air contaminants as dcMcd by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes tl I have read me h:vati materials requicarrams under Chapmru.95 of the Califm. nix Uculmffi Safety Code, Secuuns 25X15,8511 anJ 15534.1 undcnund mot if the Wilding duce not timmo ly have a recant, mat it is my responsibility to four, the occupant I c r immc hick I met dnrniakdmren(acanlucamgfOcadp r r _Si ature of Applicant Date All roof coverings to be Class "B" or better tar dr.dmrdze agent ata 0 1 of 1 0 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN . 37534065.00 DATE ISSUED.......: 10/13/2004 RECEIPT #•••......: 27418 REFERENCE ID # ...: 04100092 SITE ADDRESS .....: 10621 TUGLE PL SUBDIVISION ...... CITY .............: IMPACT AREA ....... OWNER ............: HARI GOPINATHAN ADDRESS ..........: 10621 TUGLE PL CITY/STATE/ZIP ...: , P OPERATOR: conniew COPY # : 4 RECEIVED FROM ....: K DESIGNERS CONTRACTOR .......: LARRY JUDSON LIC # 23172 COMPANY ..........: K DESIGNERS ADDRESS ..........: 11261 SUNRISE PARK DR CITY/STATE/ZIP ...: RANCHO CORDOVA, CA 95742 TELEPHONE ........: (916)631-9300 OEE ID UNIT QUANTITY AMOUNT BENERGY PERMIT FEE 191.16 91.76 BPERMFEE VALUATION 11,743.00 191.16 BSEISMICRE VALUATION 11,743.00 1.20 BPLANCHK PERMIT FEE 191.16 255.10 TOTAL PERMIT : 539.22 METHOD OF PAYMENT --7 -------------- CHECK TOTAL RECEIPT AMOUNT ------------ 539.22 __---_539 22 PD -TO -DT THIS REC NEW BAL 0.00 91.76 0.00 0.00 191.16 0.00 0.00 1.20 0.00 0.00 255.10 0.00 ---------- ---------- 0.00 ---------- 539.22 0.00 NUMBER ------------------ 394821 CITY OF • CUPERTINO � r / CITY OF CUPERTINO PER.MtT APPLICATION FORM (( APN #3 Ste— 3 6 D Fee Fee ID BAPP_L_OTHER Date: Building Address: Owner's Name: —tea6l �I M Phone #: 1 I q Contractor: � �J � License#: Contact: Cupertino Business License#: Building Permit Info: MECHANICAL Bld ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: 'Residential 9 n , IciIn Commercial ❑ Sq.Ft. Floor Ar S/Sq.Ft.: Cost of Pr Iect: I1 —ICA 1)G- MECHANICAL Occupancy G ou l Type of Co tract o Construction Tax BUILDING �— BCONSTAX Ind/Off/Comm/Quasi • L, s 3� z Fee Fee ID BAPP_L_OTHER Fee Description Other Appliances Fee Group MECrtANTICAL� BBLDGFEE Bldg Permit sq. foot BUILDING BBOTLERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I 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 _ BCONSTAN Construction Tax BUILDING �— BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone —BUILDING BCONSTAXFI Hotel and Motel BUILDING BCONSTAXR BELEC1000 Constax — Resi/Mobile Elec 600V <= I OOOA BUILDING _J ELECTRICAL BELEC1001 El cc 600V > l O00A ELECTRICAL — BELEC200 BENERGY Elec Svcs 600V <= 200A Energy ELECTRICAL _ BUILDING _ BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC _ _ Comm. Housing Mit. Fee BUILDING L, s 3� z WITY OF CUPERTINOO CUPEI�TINO PERMIT APPLICATION FORM L-A 2 of 3 Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMNM 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 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLUMAN 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 I 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 L-A 2 of 3 aTo CUPRINO WITY OF CUPERTINO* PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Ligbting 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 Inection BUILDING BSW'M 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 I w z a O m 2 CL O O H U W 2 O z Z H W Y x I ccH ¢ ti O W H U. U O ¢ sx U O UO LL I w z a O m 2 CL O O H U W 2 O z Z H W Y