08110028 CITY OF CUPERT
BUILDING DIVISION PERMIT �CONTRAC�,TUR�INEORMt�TION�`
BUILDING ADDRESS: PERMIT NO.
7495 PROSPECT RD TOMMY' S CONSTRUCTI
OWNER'S NAME: PERMIT ISSUE DATE
9NE: A CONTROL NO.
(408) 206-4109
ARCHI'IECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PU1MB MECH
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
4 U F 1 Mrtby from Nat 1 un licensed under provisions of Chapter 9(commencing p
with Section 7M)ofDivWon 3 of NC Business and
Prurient..Code.md my licen¢u
: H infull force and effect BATH RMDL, NON—STRCTRL, CHNG ALL FXTRS INCLDNG
Dow�m�a't CCmu,aaar TOILT, BTHRUB& SNKS
ARCHITECTS DECLARATION
U I undraseand my places shall he used u public records
g G to Licensed P ntesumal
3 ' OWNER-BUILDER DECLARATION
Conum0N
COO Wneonaffirm Nali am.Bmsefrom
an Ne Cssions Coas de: ense my
for tW
COO O following maw..Permit
t 7M 1.3,Butlness and Professions Cake My city or county
5$� which requires a permit to consuucL alter.Wprove,demoiLsh.or repair any swnuro
_zm prior 0 its issuance,also requtms An applicant for such permit to file a signed simmcm
p <
that Mislicensed Purwanttothe Provisions afthe Consonant's UcenseLaw(Chapter 9 Sq.Ft. Floor Area Valuation
y�s (commencing with Section 7000)of Division 3 of the Business and Profusions Code)or
Nat W u exempt Noefrom and dm basis for N4 alleged exemption.My violin of $3000
Section 7031.5 by arty applWm for a permit subjects the applicant to•Civil penalty of APN Number Occupancy Type
not mane that five hundred dollars(SSW). 36615053 . 00
1,uo ofdkpWmy,mmyemPloyrrawithwageunoirwlccmpenution.
willdo the work and dmtwcwm u rot intended oronered forsak(Sec.70th,Business
and Pwressions Cade:The Conbwmrs L''-^s•law dues nos apply m an owner of Required Inspections
present,who Wilds orimpvvesrWanon,andwbo desesauchwarkhiuselforOuovgh his
own employee.proMded that such improvements art Out mended..Rood for sale.U,
harever.the building or impwwxum is sold wuhus arc Isar of completion.Ne owner-
Wilder will have use Marden of paving Nu he did not build or improve for Purpose of
tale.).
IQ 1,u usurer of the prolmrty w cacionvely convecting with licensed contractors in
combat Ne Project(Sec.7044.Business and Professions Cade:)The Conbwrers Li-
ccvsu taw does not apply ban owns of property who Wilds or improves Neuron.and,
who contract for such projects win anownsuar(s)lianxd pursuant in an,Convactots
License law.
I am eacmpt under Sec ' ,BkPCf Nis retort
WORKER'S COMPENSATION DECLARATION -
I Wreby,affirm order pao aby of perjury aro of the following declando.c -
]ham vrro wlll!for by a tical Sam a An Labor
Ter Wokers Compm
'on,r movidW for by Section 37W of Ne Mbar Cade.(m the psfonnana of the
soak for which this permit is iaucQ
❑1 have eM will maintain Workers Comp e..ad.I..u ralared by Section
37W M Ne Labor Cade.fa the per(...of Ne work for which hat permit is issaN
My Work .Compensation huwvta camior W Policy number sm:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crhu saslae need notbecouplered if the permit Is fame,hundred"Wer($I00)
Or lest)
1 cordfy that in we performance of the work for which this Permit u issned.I shall not
employ any pawn in any manns u twme wbjwtw Newmken'Compcuathat
Laws of Califmmia Da¢ D
AppOcwt Oe-L.• 0 NOTICE TO APPOIC P L�ma mg Nu w0um of Exemption,you Nwld
become subject N the Work 3 Compensation provisions of the Labor Code,you must
�Z foMwidi comply with such provisions or this permit Nall W domed revoked.
z O CONSTRUCTION LENDING AGENCY
(-r I hereby alRrm NU Nem u a caustrunian kndmilsin cy for Jan perfmmanecaf
a Ne work for which dds Permit is issued(Sec 709'1.Civ.a)
131 Q Landers Name
=,Z Lenders Address
U C) I anifY that 1 haw read this•ppfution Ad sat Nal the above infarmatian u
E camel I agree re comply with all city and county ordinances and stale laws relating a
0 Wilding constrwthorlae mpmxntatiwa of this city m enter upon the
uction,and hereby
Irl above-mentioned property for inspection purposes
(We)agree to saw,indemnify and kap harmlm Ne City of Cupertino against
fd'jy liabilities,Judgment,cote and eapeuu which may In soy way accrue against said City
U Z in consequence of the granting of this Permil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date `
SOURCE REGULATIONS. 1
P� #f i \ Ftp Re-roofs
Sitnaure ofA i envactor I Chun
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm appliant or return adding oceupantnom or handle hvallou malerial
u Mined!by the Cupertino Mumu WI Code.Chapter 9.12,and dm Health and Safety
Cade,Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yu 194.
40 V Ne applicant err fvmrc Wilding oreupani=Nulpment err drAm which If a roof is installed without first obtaining an inspection,I agree to remove
111%anrdne aircommairulnt u Mined by the Bay Arca Air Quality Management all new materials for inspection.
v et7
❑Yes M
L have mal rte h&7 Nom muerials requirement under Chvpmr6.95 of dm 6lifor-
.iaHulNkSdelyCc@,S 6..25505.25533am125534.luakntnddmifthe Wilding
Jou rant curtently hvw v NnanL Nu it t my respouiMlity m rwtify Ne occupant of Ne
mqulmmcnuwhkhmwLMMCtpiormiuuanaofaCemacamofOca Signature of Applicant Date
owner err an riv ascotDam All roof coverings to be Class'J¢"or better
CITY OF CUPERTINO
e 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36615053 . 00
DATE ISSUED. . . . . . . : 11/07/2008
RECEIPT # . . . . . . . . . : BS000006567
REFERENCE ID # . . . : 08110028
SITE ADDRESS . . . . . : 7495 PROSPECT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SRIVIDHYA GOPALAN
ADDRESS . . . . . . . . . . : 7495 PROSPECT RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SRIVIDHYA GOPALAN
CONTRACTOR . . . . . . . : TOMMY' S CONSTRUCTION LIC # 30307
COMPANY . . . . . . . . . . : TOMMY' S CONSTRUCTION
ADDRESS . . . . . . . . . . : 663 SCOTT BLVD
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 206-4109
eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1REMRESBAT SQ FEET 72 . 00 429 . 00 0 . 00 429 . 00 0 . 00
1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00
TOTAL PERMIT 551 . 50 0 . 00 551 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- -------- ----
CREDIT CARD 551. 50 AMEX
---------------
TOTAL RECEIPT 551 . 50
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CITY OF CUPERTINO
ADDITION/REMODEL
CITYCUPEI�TINO PERMIT APPLICATION FORM
APN # �j JD _6 0 Date:
Building Address: 7445 pkbSPecr fz-p�) G4,91-2TIND , cn
Mailing Address (if different from building address):
Owner's Name: c7, VID � �b Phone#ID � 79
Contractor: � i5 Phone#:.'�'`� s . CDXML0GT/ i✓ Fax #:
Contractor License #:
Cupertino Business License#: �3n 30_�
Contact: Phone#:
Fax #:
Building Permit Info:
Bldg, Elect.NQL/ Plumb. [5' Mech. ❑� Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)? ��T (Z_e110T>P7_) 9JUy S1KfK�17K A L
C Vy"cj•'1g- ftL'-- F)X -VZF5 f NCW9lW,% TblLVX, 18MV W +- ;91W "
Remodel Includes Re-Roof: Yes ❑ No ® If yes list number of squares
Remodel Includes Structural: Yes ❑ No M
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: `f Garage: Detached Attached
Remodel: Kitchen Bath �77� '� Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑�.
Valuation: 0300 O - 6b Please check this box if the project is a
second-story addition ❑
Project Size: Ex ress El-Standard E] Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points ieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 10/01/08
d� CITY OF CUPERTINO
ADDITION/REMODEL
CITY o
CUPERTINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R31NSP _ Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection •
1R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Mternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal S stem
1PRSEWER Sewers P
113PSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
1REROOFRES Residential Re-roof Each B
100 SF
DECKS 1R3SFDADD OR
1R3SFDREM •
1DECKWOOD Deck (Wood)-Each B
(Each)
1DECKRAIL Deck Railing-Each B
(Each)