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07020038 CITY OF CUPERTINO BUILDIN-G,DIVISION PERMITTT��IC1RMATIf��t*', PERMIT NO. BUILDI61 ADDRESS: MIKE COUNCIL PLUMBING INC 07020038 1U�44 NORTHSEAL SQ PERMIT ISSUE DATE OWNER'S NAME: DEEPA SUBRAMANIAN 1977 O'TOOL AVE 02/07/2007 NO.NO. CONTROL NO. 'NE: (408) 272-4900 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECTPLUMB MECH (� E (� j p LICENSED CONTRACTOR'S DECLARATION Job DesCrlptlOn Aa W.1 P I hereby affirm that I am licensed under provisions of Chapter 9(commencing U�d with Section 7000)of Division 3 of the Business and Profc 'ons C nd my license is GAS LINE TO COOK RANGE I'<v in full force and j n Z Licengg,C1 s J Lic.N L_ Contractor F w Datc ARCHITECTS DECLARATION Q`�S/yU t j a< I understand my plans shall be used as public recordsTj LQ a. ;ort„ Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 0.rZ which requires a permit to construct,alter,improve.dcmalLeh,or repair any structure Valuation m n prior its issuance,also requires the applicant for such permit to file a signed statement LS Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $1098 e.F (commencing with Section 7000)of Division 3 of the Business and Professions Calc)or i 5 F that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3164002-7 . Number ParaC y Type not more than five hundred dollars(5500). 0 I,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 Required Inspections and Professions Code:The Contractor's 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 that 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.). 'DECEIVED 0 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. F[I�D O n O who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's [ / License Law. 0 I am exempt under Sec. B&P C for this reason RV Owner Date A.0 A WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �I I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work Cor which this permit is issued. 0 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 War r s Compens on Inssuce cam il nu : Carrier. Z7u '3o`y r CERTIFICATE OF EXEMPTION FROM WORKER ' COMPENSATION INSURANCE (This section need not be completed if the permit is far one hundred dollars($100) or less.) I certify that in the performance 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 Workers'Compensation Laws of California.Date 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) Ora Q Lender's Name Z Lender's Address V C I certify that I have read this application and state that the above inform GL correct.I agree to comply with all city and county ordinances and state laws relating to O V building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. OWr (We)agree to save,indemnify and keep harmless the City of Cupertino against _.._ rF rA liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date r �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roof: Signature of Applicant/Contractor Dare T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munici I Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof s shall be inspected prior to an roofing material being installed. 0Yes n If a roof is installed ithout first fairing inspection,I agree to remove Will the applicant or f tore building occupant use equipment or devices which -mit hazardous air contaminants defined by the Bay Area Air Quality Management all new materials f r i spection. District? Cl Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor - 7 - nia Health&Safety Code,Sections 25505,25533 and 25534.I understand thatif the building CCC��� does not currently have a tenant,that it is my responsibility to notify the occupant mf the Date requirements which must be met prior to issuance of a Certificate of Occupancy. lgnatu"e Of App Kant All roof coverings to be Class"B" or better Owner or authorized agent Datc CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 31E40027. 00 DATE ISSUED. . . . . . . : 02/07/2007 RECEIVED RECEIPT #. • . . . . . . . : BSC00000413 REFERENCE ID # . . . : 0 7 C 2 0 0 3 8 FEB 0 7 2007 SITE ADDRESS . . . . . : 10S,44 NORTHSEAL SQ BY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DEEPA SUBRAMANIAN -. ADDRESS . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 0530 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MIKE COUNCIL LIC # 23033 COMPANY . . . . . . . . . . : MI]CE COUNCIL PLUMBING INC ADDRESS . . . . . . . . . . : 1977 O'TOOL AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 272-4900 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 BPGAS OULETS 1.00 5.40 0 .00 5 .40 0.00 BSEISMICRE VALUATION 1, 098 .00 0.50 0 .00 0 .50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107. 00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0 .00 -----38_37 ------0_00 ---------- ---------- TOTAL PERMIT 186 .13 0 .00 186 .13 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CHECK 186 .13 16206 --------------- TOTAL RECEIPT 186.13 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO ��naF PERMIT APPLICATION FORM CUPE TII�10 k .PN# // P Date:3 & Building Address: Flailing Address (if different from building address): logm �l Owner's Name: Phone#: 96;� r_ornOn - l Z 5 - Contractor: License#: ►1 t � M,0(0, Phone: Cupertino Business Lice C� Fax: t nse#CE D Contact: S36-I& / _Z 3n-3-3 j IVE Building Permit Info: 906 z V -4-m(r FEB 0 7 200 Elect ❑ Plumb � Mech Bldg ❑ / Job Description: �; Cl,`�&inmercial El Residential S Sq.Ft. Floor Area: Sq.Ft.: Occupanc Cost of Project: �771 �. Please check this box if theproject is a Type of Construction: second-storyaddition: roject Size: Standard, Large ❑ Ma-or ❑ Quantity Fee ID Fee Description Fee Group AL BAPPLOTHER ether Appliances MECHANIC BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILE2 Boiler> 100K to SOOK Btu MECHANICAL R 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 BELEC 1000 E lee 600V<= l OOOA 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 oto:_ CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTiNO roup Quantity Fee ID Fee Descri tion Fee DIN BMISCELL Miscellaneous Fee BUILDING BMITIGATC Co m. Housing Mit. Fee BUILDING n BNUCOMME I1ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME nspection Overtime BUILDING BPBACKFLOW �_tmospheric 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 P Ian Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap _ _ PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER In;tall/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECTReinspection Fee BUILDING BREMACOVER AJC Unit> 10,000 cfm MECHANICAL BREMAIRHAN Ai C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN 'Zelocation of Furnace MECHANICAL BREMFURNOV Belo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP R-_m 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 F_emodel Res Appliance ELECTRICAL 2 of 3 -UPERTINO CITY OF C CITY OF PERMIT APPLICATION FORM CUPEkTiNO Quanti Fee ID Fee Description Fee Group BREMSIGNAD Rmd. 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 S-,b Specific Plan BUILDING BSEISMICOM Sei!;mic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S-..)ecial Inspection BUILDING BSWIM :>wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM TeTj)orary BIPermit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL PPERMITFEE PlumbinE Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3