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08010023- PUB f LU V C (D a C Q a G �0 L-1mL) u- �'I �j� d� d = U' U O LO d i � t 3 +0 a) 7 p�7 ❑ LO d m a U H Q H L3 7 H O LO O .7, m O7 py O O a LO r- 0 J O a- v a W J 0 Q M CO J = O V H a- F UC"l CD -� O 0 J Lf) U Lo cD O 0 O � R l0 = r F- LOO _ ay w may H W F- LO � FE E a_ f. W O H Lo a- u O R c: _ _ 3 W f U m a- d rt' E xy Z to ❑ a) to d a- O n AD LL c c p a) 0 n n � t.L 2 _O -h V ~_ h 1� ❑ IV co Idl IC I CL z_? d d Q O O O J W �' c Icsl o f - ILU J w V p Q1 p � O O d OZ `0 a O W ° n }- ❑ z � J W 'Ll L ❑ z o mo 0 o rn d � > w w a) CD �CD CD CD o � CE 0- Lf) co CD CD m CD CD0m o _ ❑ O a5 Q1 Q1 aJ N ~ _ L d x x x d Q, a- io n� E E xN F- Z (D n ° � W o L 4 � � o o a) a) a) ❑ OC p CD U- N Z to +p A A Q1 d "' a) V a) c7lui CL -� a+ a- (i) a- d d U U U a_ E t L'� - a) .c CITY OF CUPERTINO BUILDING DIVISION PERMIT � ►Cfl Z ��Q � BUILI�1)�O�.RT' UGGLE PL ALL SEASONS REMODELING P08010023 OWNER'S NAME: PERMIT ISSUE DATE . HARI GOPINATHAN 1 219 DEMPSEY RD 01/29/2008 PHONE: SANITARY NO. CONTROL NO. (408) 946-4744 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION O 0 0 0 v m)= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description a a with Section 70W)ofDivsion3ofthe Business and Professions Code,and mylicense is ADD 13 ' 9"X14 ' SUNROOM 175 ' , ROOF NOT INCLUDED =- in full force and e :)n4 License Class 710 Lic.tri T 3 t-in Datc I Contractor .u'a ARCHrrECTS DECLATATION Ca I understand my plans shall be used as public records iyU iH Licensed Professional M OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the q O following reason.(Section 7031.5,Business and Professions Code:Any city or county K (L which requires a permit to construct,alter,improve,demolish,or repair any structure'a Z} prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y1-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or yS�1 O O O O y that he is exempt therefrom and the basis for the alleged exemption.Any violation or Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy T e not more than rive hundred dollars($50a). 3753406,5A P Y YP ❑1,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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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 safe.). ❑I,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 who contracts for such pmjecs with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker'sCompen- salion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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 Worker's Compensation Ins u nce carrier and Policy number am•� �/p�/�/��Q Cartier. 'N � Policy No.:Ap�ub)�„,,� "” o CERTIFICATE O EXEMP ION FROM WORKERS' COMPENSATION INSURANCE . (Phis section need not be completed if the permit is formic hundred dollars(5100) or less.) I certify that in the performance of the work for which this permit is issued.1 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:1(,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 0 CONSTRUCTION LENDING AGENCY [--h�-•+ I hereby affirm that there is a eorstruciinn lending agency for the performance of (Y. the work for which this permit is issued(Sec.3097,Civ.C.) RWi 0 Lender's Name a Z Lender's Address U Q 1 certify that I have read this application and state that the above information is 4. correcL 1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against hF'y L41 liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit — APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR E EG TION �� !1 ) a Gni Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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. ❑Yes (❑ryfvo 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 Area Air Quality Management all new materials for inspection. District? ❑Yes Nu 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requi�jm(n�s whkc oat be met nor mice f cnificate ofOC;upaney. Signature of Applicant Date , � 1` ate Owner or authorized agent Date All roof coverings to be Class"B"or better ate- CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINo PERMIT APPLICATION FORM APN# Date: lJ�c� (�5, o0 lJ Building Address: c_..x r o — Mailing Address (if different from buildi ddress): Owner' N e: Phone# ft Contractor: Phone 2j Fax #: C1'Z 5 t�7/f . j Contractor License#: Cupertino Business License#: 01 Contact: //11 Phone#:q Z c5 , I-IS �Gj•3 &1U S Fax Building Permit Info: Bldg. Elect. Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition(adding sq footage): 1 c What is being remodeled? Remodel Includes Re-Roof: Yes ❑ No..' If yes list number of squares Remodel Includes Structural: Yes ❑ No Square Footage: _ Addition: Porch: Deck: Garage: Detached Attached S_ Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N Valuation: Please check this box if the project is a v second-story addition ❑ Green Building Check list must be completed and Green Building Points Achieved: attached to the plans. ***For Office Use Only*** Over-the-Counter ❑ r r . CITY OF CUPERTINO ' ADDITION/REMOD]EL CUPER INO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS IF:3SFDADD PLLONGRNGR Long Range PL Planning/Residential 5i 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat. B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HlNSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside B plan check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn P Sprinkler/Backflow 1BPWSVCS Main Water Service P 1 1BSEISMICRE SeismicResidential B DECKS I.R31,3FDADD OR IR3SFDREM 1DECKWOOD Deck(Wood)-Each B (Each) 1DECKRAIL Deck Railing-Each B (Each) h Community Development 10300 Torre Avenue wF Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # C�ZI T�� (�I�r.G� 0&x( 0023 OWNER'S NAME: M b (,ylGtr-(? O-tl PHONE # "C-j `1 j GENERAL CONTRACTOR: ' �- FAX # 0Zri -4,r)4f-I 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile - Coy Owner/Contractor Signature Date