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07060161 CITY OF%UPERTINO +CC1 'R �`T+OR ITQ�1 BUILDING DIVISION PERMIT PERMIT NO. BUa.Dl11 1altES�ILLOWBROOK WY SANDIUM 07 0 6 0161 PERMTT ISSUE DATE OWNER'S NAME: 4223 VERDIGRIS CIR 06/19/2007 SAMEER NANDA SANITARY NO. CONTROL NO. jNE: (408) 89.1-9072 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 o o LICENSED CONTRACTOR'S DECLARATION Job Description 1 U(= I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions`Code,and my license is ADD AC AVD FURNACE REPLACEMENT. w in ful��CHrrECTS 923 v�Z LicenZip Lic.# Contract-- t t� Dam DECLARATION i a< 1 understand my plans shall he used as public records >yU 4.y Licensed Professional O a OWNER-BUILDER DECLARATION 3< I hereby alTirm 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 <m which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation ti prior w its issuance,also requires the applicant for such permit to Tile a signed statement S Ft.Floor Area $6 3 4 6 Z< that he is licensed pursuant to the provisions of the Conuacmr's License Law(Chapter 9 a tz- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that m is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 369220 4 3 AM Number not more than five hundred dollars($500). 0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an°wrier 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- ho who contracts for such projects with a contracLaw does not apply to an owner of tor(s)lbuildspursuantlicensed to the contraetOe License Law. ,B&P C for this reason 0 I am exempt under Sec. Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty Of perjury one of the following declarations: ❑I hsve and will maintain a Certificate of Consent to self-insure for Workers COmpen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the workfor which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Station 3700 oC the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy nubesare: Policy No.:Um�N t7 Carrier.. — CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for 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 Workers Compensation provisions of the Labor Code,you mast Qforthwith comply with such provisions or this permit shall be deemed revoked. Z►-� CONSTRUCTION LENDING AGENCY E~..r►�.. I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Namc L.cndees Addrcss z 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the nWi above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against /7 liabilities•judgments,costs and expenses which may in any way accrue against said City U Zin consequence of the granting of this permit. Date �-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGUL�T(O�iS. Re-roofs Signature ofApplican i—!- for ate Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C3 Yes "° 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 as defined by the Bay Arca Air Quality Management all new r iaterials for inspection. Lwncr YesO have read the hazardous materials requirements under Chapter 6.95 of the Califor- h&Safety Code,Sections 25505,25533 and 25534.1 understand"ifthe huik6ng currently have a tenant,that it is my responsibility to notify the occupant of the Date require Which must x rior to issuance of a Certificate o�x I�cY S ignatun:of Applicant 6 �t7 All roof coverings to be Class"B"or better r authorized agent Dam CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36922043 .00 DATE ISSUED. . . . . . . : 06/19/2007 RECEIPT #. . . . . . . . . : BS000001698 REFERENCE ID # . . . : 07060161 SITE ADDRESS . . . . . : 10846 WILLOWBROOK WY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . .CUPERTINC) IMPACT AREA . . . . . . OWNER SAFEER NANDA ADDRESS CITY/STATE/ZIP . . . : CUFERTINO CA, CA 95014-4541 RECEIVED FROM . . . . : YIL-HANG LEE CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867 COMPANY . . . . . . . . . . : SANDIUM' ADDRESS . . . . . . . . . . : 423 VERDIGRIS CIR CITY/STATE/ZIP . . . : SArf JOSE, CA 95134 TELEPHONE . . . . . . . . : (408) 894-9072 FEE ID UNIT QUANTITY 2,.MOUNT PD-TO-DT THIS REC NEW BAL __ ___ --------- ----- ------------- BENERGY PERMIT FEE 34. 86 34 .86 0. 00 34 . 86 0. 0 BREMACOVER NO UNITS 1. 00 17 .82 0. 00 17 .82 0. 00 BREMAIRHAN NO.UNITS 1.00 10.26 0. 00 10.26 0. 00 BREMFURN NO UNIT 1.00 14 .31 0. 00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1.00 1.20 0.00 1.20 0. 00 BSEISMICRE VALUATION 6, 346. 00 0.70 0. 00 0.70 0.00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38_37 ------0- ----- TOTAL PERMIT 194 .26 0. 00 194 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 194 .26 VISA --------------- TOTAL RECEIPT 194 .26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ____ _ -------- ------------------- -- ------------ 03 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 3 505 FINAL ELECTRICAL 508 FINAL MECHANICAL o-70c, 0c (,, 1 CITY OF CIUPERTINO `U N .CEfAC CUPEkTiNO PERMIT APPLICATION FORM APN# Date: 6/1 ( q Iv-7 Building Address: �D uG Phone Owner's Name: Q j- Z -- - ____----------- Phone: L'c,ense Contractor: ��4' qo?z- 19$810 Contact: 1' n Phone: � �Q Cupertino ir�ess License#: � Building Permit Info: Bldg ❑ Elect ICY P umb 0-' Mech Job Description: nt C Residential E; t' Commercial ❑ For Residential Installations: Attic ❑ 1St floor 19 2nd floor❑ Adhere to min set back requirement For Commercial Installations: replacement same weight ❑ Additional weight (st(jctural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Occu nc ou Cost of Project: �63�.6 Type of Cop�truc�tion: P y�.3 p' L;*j Strapped ❑ On Platform Bonded ❑ Sq.Ft. Floor Area: New Location OL Replacement Qty. if Fee Description Fee Group Applicable Fee ID BUILDING BENERGY E iergy EEBREMFURN F-irnace MECHANICAL E, BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL B 11 CEPT P ecptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE F1ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL � PLUMBING PPERMITFEE Plumbing Permit Issue BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BP AS Gas Pi ing System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ''UPEkTINO Buildirt De artment JOB ADD FESS: PERMIT # ��l jl OWNER'S NAME: SG~,9V- a.. PHONE # `{�E. �-7 z_ GENERAL CONTRACTOR S FAX # I am not using any subcontractors: l� a Signature Date Please check applicable subcontractors and complete the followin 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile �( 7 4�tg(oma Date owner/Contractor Signature