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03080025
CITY OF CUPERTINO BUILDING DIVISION PERMIT ,CONTRACTQR�INFORMATIONa BUILDING ADDRESS: PERMIT"03080025 O.3 0 8 0 02 5 OWNRRIAGH 2L ER' NAME: PERMITISUEDATE 17V cleippt)ATT4Y E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO �fiTmi BELECT -PLUMB MEOCH 100 LICENSED CONTRACTOR'S DECLARATION rr]�}J'DEgCfI I £m 1 heecby affirm that 1 em licensed under previsions or Chapter 9(commencing - I p neun with Section70M)of ndeffecDivision Sof NC Bulinus and Pmfcssinns COJc,and myliccnwis {v i in full Tome and effectgzLiuna.clas, Lie.« ADD 497 SQp Da¢ GdnDELLARCHITECTS DECLARATIONI undcrsunJ my pinsshell W used as puhlic mcnrds 7c0 Licensed Profcasienal 1 6/7✓ OWNER BUILDER DECLARATION 2 M 1 hereby affirm that I em exempt from the Contractors License Law for the 00 following reason.(Section 7030,Business and Profusions Code:Any city nr county <$ which requires a permit to Construct,alcor.improve,demolish,or repair any structure Yprior I.its issuane..alsu rrquireaft. plicam rm WCh permitto Blc uigoodflacmcnt Mthat he is licensed Poerhano 10 the Provisions lua visionsOftheContractor'sLicenseLaw(Chapter9 Sq. Ft. Floor Area Vation (commencing with Section 7000)of Divamn 3 of the B usiness and Professions Code)or $ that he is exempt therefrom and the basis for d¢alleged exemption.Any violation of 35906050 . 00 Section 70713 by anyapplicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy , not more than five hundred dollars MOD). — --- p YTye p ---- I,ses owner of the property,or my employees with cages u their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.70 .Business std Professional Code:The Cmeracmri License Law does not apply to an owner of d Inspections property who builds or improves themon,and whodas such work himselfor trough his 102 - PIERS own employces,provided that such improwmenu are not inumded or offered for sale.If. lO3 — UFER however,the building or improvement Is sold within one year of completion,lie owner. builder will ban be burden of proving that W did not Wild or improve for purpose of 104 - REBAR m.). 105 - ANCHOR BOLTS %�L]y� 1.as owner of the property,am exclusively contracting with licensed comom m swet to pmject(See.7Ba4,Business and Professions Code:)The Conuacmra Li. 106 — SEWER & WATER cents Law does not apply to an owner of property who Wilds or ire prove lhemon,and, 2O2 — UNDERFLOOR PLUMBING who contracts for such projects wit a contracmrp)licensed pursuant to the Contractor's Lin the Law. 203 - UNDERFLOOR MECHANICAL ❑len exempt ser e. ,BesPcrrthi, asnh 204 - UNDERFLOOR FRAME r WORKEWSCOMPENSAT1 f ECL RATION 205 - UNDERFLOOR INSULATION I hereby a M.under Penalty of perju neuritic following declarations: 301 — ROUGH PLUMBING an and will mainuina Cenificamaf Cmmem loselGinsum for WorkeM1 Compcn. 302 — TUB & OR SHOWER n,as provided for by Section 37M of the labor Code,for the Performance of the - 3 03 — ROUGH MECHANICAL works whichdid. maintain issued. 304 - ROUGH ELECTRICAL J©1/ ❑1 have and will maintain WorkersarocofheCompensation Imuvnce,as him con ,i Section / JTM of the labor Codc,for the performance of the work for which this permit is issaJ. 3 05 — FRAME My Worker's Compensation Insurance carrier and Policy number are: 3O6 — HOEDOWNS, Canter. Policy No.; _ CERTIFICATE OF EX EMPION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (Thissectim need not Wcumplcied if the permit is for one hundred dollars(SIM) 309 - EXTERIOR LATH renify 310 - INTERIOR LATH employ that in the nanymanneof to work for which this fermis is issued,1 shall not 311 SCRATCH COAT Law. California.ninany mennersnum Wcomesvbjuuo the Wprkefi ComPcnsetlan Laws of CalifoData Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.IF.after making his CcniOcnc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject the Worker's ro Coons or this previsions of the Labor Code,you most 502 - FINAL PLUMBING ENERGY D ,7.' become cube t t with such rker's ompens to 1prmhshall W he Lab rCodes., ?O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there its communion lending apenry for the perfmmahce of Y> theworkfur which this permit isissued(Sec.7097,Civ.C.) 504 - FINAL BUILDING ENERGY LenName 505 - FINAL ELECTRICAL tr7 Q jz Lnder's r'aAdd '!a 506 - GAS TEST J 1 unify that 1 haft read this application and sum that the above infom,atiun is 507 - FINAL PLUMBING F corset.l agree to comply with all city and county ordinances and sutelaws relating to 7 V Wilding construction,and hamby authorim representatives of this city 10 chief upon the FIN MECjWN CAL N U.1 above-mentioned property for inspection Purposes. / ti 6, (we)egrte m save,indemnify and keep harmless the City of Cupertinu against O 9 FI �^] h liabilities,Judgments,c.stsand expenses which may in any way.,cme a gains aid City 5 I 4Date APPLICA in nceoNDERSTr to 'ngof the WILL COMPLY WITH ALL NON.POI Issued bSOURCE E CATIONS, y'S WORK 0 Re-roofs tgnat ecf pp iceHA21ARD0US A ERIALS DISCLOSURE Dare Type of Roof Will the epplicam or return W - gacupant It..or handl.ha,sohous material as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety dkCode,Section 25572(,)? No All roofs shall be inspected prior to any roofing material being installed. ❑Yea M Will the aPPlicam or fuwre building occupant use equipment Pr devices which If a roof is installed without first obtaining an inspection, I agree to remove avardous air emtamimnu as defined by the Bay Area Air Quality Management all new materials for inspection. mI? ❑Yes OLINu In reW to ha,aNuusmamdals requirements under ChaPrr 6.Y5 of the Califory nia Health ffi Safety Code,Secdom 25505.2557]mJ 25574.1 undcrswd thw if the huilding Jou not cunenJy an tenant 1hol liamymspmmibilitymnndfyfixon, anI fthe mquire cn whi no met pct issuanceor.CcnificstcpfQcupancy,_ Signature of Applicant Date ow fmramt vadegent D,r All roof coverings to be Class "B"or better i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7743 CARRIAGE CL CONTRACTOR: PERMIT NO:03080025 OWNER'S NAME: VK SREEPATHY VK SREEPATHY DATE ISSUED:09/10/2003 OWNER'S PHONE: 4082537828 PHONE NO:(408)893-7693 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RES SIDENTIAL COMMERCIAL License Class Lic.# ADD 497 SQ.FT. Contractor Date REVISION#1-REVISION TO PLANS FOUNDATION ADD I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my.license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Flo n'6a: Valuation:$65000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35906050.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct,I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the , granting of this permit. Additionally,the applicant understands and will comply Issued by: Date. ' L� e with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by S,cction 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: S'-1 '7-2 UL permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. ` I Signature_ Y _Date I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7743 CARRIAGE CL CONTRACTOR:TI31D="I6 B Vi=m PERMIT NO:03080025 ,DETERMINE-13— OWNER'S NAME: VK SREEPATHY � � DATE ISSUED:09/10/2003 OWNER'S PHONE: 4082537828 ,-6 r,� d�[ PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: SIDENTIALCOMMERCIALS - License Class Lie.# 7 K O ADD 497 SQFT zo� Ch `��D cam` 2 REVISION#1-REVISION TO PLANS FOUNDATION ADD Contractor _ _ I hereby of am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$65000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35906050.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAVS F OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of thej,�Vr granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date S o--t 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 all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se s 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authori Date permit is issued. ed ager : : 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date I E i CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7743 CARRIAGE CIR DATE: 05/15/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY S F D or Dulex PENTAMATION USE: p PERMIT TYPE: WORK REVISE- FOUNDATION PLANS SCOPE i,Iech.Plan Check phwlb. Plait Check Elec.Plan Cheep kfech. Permit Fee: Phmxh, Pe»nit Fce: Flee. Permit rm: Other Alech, Insp, Other P111mb hasp, Other Elec.Imp, Ll L ilech.hasp,Fee: Phimb. hisp. rce: Elec,Imp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prelindna information available and are onl an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: (j) Reg. OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: � A61111inisiralive Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 Trcwel Docinnentolion Fees': Strong Motion Fee: $0.00 1 # Revisions Bldg Stds Commission Fee: $0.00 $666.00 IREVRESADD Addition � SUBTOTALS: $0.00 $666.00 TOTAL FEE: $666.00 Revised: 04/29/2013