03040042 (3) CITY OF CUPERTINO =
BUILDING DIVISION PERMIT79
•" `�
BUILDING ADDRESS: PERMIT NO.
22681 SAN JUAN RD DUSITYANT PANDYA 03040042
OWNER'S NAME: PERMIT ISSUE DATE
DUSITYANT PANDYA 04/07/2003
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO BLHCr- PLO O
o o LICENSED CONTRACTOR'S DECLARATION
I hereby aafmt that lam licensed under provismiu of LTaper 9(commencing Job Description
z wiNSceflon 70(10)of DiAsion 3ofWC Business and Prafculom Code.and my license 13 p
< m eBmnamdarceeL DECK REPLA
DECEMENT F8 ALE
S�? Lkenn Clus Lk.
t Dem Contractor
5
ARCHITECTS DECLARATION
Ni I endemend-my plans shall he used as public mcnNa MAY 12 2004
iQ Licensed Professional
OWNER-BUILDER DECLARATION
f 1 hereby affirm that I.am exempt from the Consu ctofs License Lew for the BUILDING
�B e9® A' �wA�
00 following moon.(Section 7031.5,Business and Profession Code:Any city or county B{SEB. D A�
lv which requires a permit to construct,alter,improve,demolish.or repair any structure
y,�s^ prior to its issuance,also requires the applicant for such permit to file a signed statement
g < dust he Is licensed pursuant to the provisions nfOnContractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
a $ (commencing with Section 7000)of Division 3 of the Business and Profusions Code)ur .$20000
Out he is enmpI thtvefrom and the bub for the alleged exemption.Any vialsdon of ppb p�''Dyt,f.
RAcdon 7031.5 by em applicant for a permit objects the applicant a civil penalty of 3-4 L17 o'"IY� 0 0 P Y ZYP
.I mom than Eve hundred dollars 5500 Occupancy e
will❑J,u owner of the property.m my empleyeu with wage u their axle 044,Business cation, -
anddothewmk,and the ao Careteris s temledLivens Lawroffered
epply 7l an owmao �.d*
and property
who
Code:The Contractor's Llama Law dors not apply to an owns of 101 — FOUND Y4•JiW Inspections
pmpemploy b.lumiilds rimpmvuchhopemdwho doe amehwded oroel(or thmugb his 102 — PIERS
eveneer,the employ=.building
or i prsuchimprowmmuamneUnmMedoroffemd forces.man If.
however,the huildinpmbnpmwment4wm within one year o(mmpledon,me owner- 103 — UI'']-S'R
bull.dcr
r will haw the Ionian of pmvmg Nat he did not build or improve for purpose bf 104 — REBAR
❑h as owner of On property,on aelualvely contracting with licensed convectors td 105 — ANCHOR BOLTS
construct the project(Sec.7W,Business and Professions Cade:)The Comractoes LI- lO6 — SEWER & WATER
came law does not apply to ow
an ur of property who builds or improv themon,and,
wocontracts for such projects with eemtncmr(q licensed puneant to the Convector's 202 - UNDERFLOOR PLUMBING
nalaw.
I
areuamptum rsee. B&P C lea thia aaapn 203 - UNDERFLOOR MECHANICAL
ny,(�� $yy�DA 64/07/03 204 - UNDERFLOOR FRAME
WORKER'SCOMPENSATIONDECLARATON 205 - UNDERFLOOR INSULATION
Ihereby area under penalty of pedury ore of the follows clantmne: 301 — ROUGH PLUMBING
end will..].We a Cenifrnm of Consent in fmWmkers Cornier, 302 TUB & OR, SHOWER
u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this Permit is Issued. 303 - ROUGH MECHANICAL
111 have and will maintain Workers Compensation imursnee,as required by Section 304 — ROUGH ELECTRICAL
3700 of the labor Code.for the pedarmance of the won for which this permit is issued. f 305 — FRAME
Workers Compeuation Insurance carrier and Polity number arc:
Carrier. Policy No.; 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE
(Thvaectlen need net uncompkmdlnhe rcrmRhmrone hundred dollara(g1ffi) 308 — SHEETROCK
ser lees.) 309 - EXTERIOR LATH
I eenify Nat rformena of the work for which this permit B issued,I shell not 310 - INTERIOR LATH
Laws of Cali Ie.Da¢y mmmfs9ubbec rp`sobjcclmlhc Workers compensation 311 _ SCRATCH COAT
At
11cam�A �44^.�0077 A C 313 - ROOF NAIL
�TOcttothe AN Works'Compensation
thisvisisate O LabrOon.dc, should 501 — FINAL ELECTRICAL ENERGY
subJen m the Worker's Compenution provisions of Ne Labor Cnde,you mut
Z fo with amply with such provisions or this permit shall be deemed revoked.
O 502 - FINAL PLUMBING ENERGY
TT
CONRUCr10NLPNDINOAGENCY 503 - FINAL MECHANICAL ENERGY
[� Ihamhy aBirm Net Nert lit construction lending agency for the performance of
C> the work for which this permit aleaned(Sec.3W7,CN.O.) 504 - FINAL BUILDING ENERGY
W Q Lender's Name
a.z I4rZ'.Addr:Z 505 - FINAL ELECTRICAL
U O 1 aNfy that I have mad this application and mm that the above information is 506 - GAS TEST
Morsel.1 agree 10 comply with all city and county on inanms and state levee reading to
pU building construction.and hereby audodnmprcsenatvesofthis city to enter uponthe S 7 - FINAL PLUMBING
{l7 shove-memimedproperty for Inspectionpugwses. 0 - FIN L MEC ICAL
gy (We)agree to cave,indemnify and keep harmlw the City of Cupertino against
,.,V! liehllitiu,Judgmenu,cmuandexls;nsu which they In any my seem agein+tuld City 9 FI
U 7 in consequence of the granting of this p.t. 5 NG
r7 APPLICANT UNDERSTANDS AND WILL.CCCiQMPLY WITH ALL NON-POINT Issued by. Date
SOUgCE REC�1LA770N$. f a-kw0�/O��1
— C( �J —��.we Re-roofs
Slg rcof ApPliaHAZARator Dato
HAZARDOUS MATERIALS DISCLOSCLO UR Typo Of ROOF
WIII the n Curpent m(inure building e,Chapter
9A or handle Health a material
u dented a the 32(a)? o Municipal Code,Chapter 9.13,and Na Hae1N and Safety
Code,Sctyu 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya r
pplieane or(mum building occupant use equipment or Jevkes which
If a roof is installed without first obtainin an ins ection,I a ree to remove
mWill the ag P g
.zi,"ts air contaminants as defined by the Bey Ara Air Quality Management all new materials for inspection.
R
❑Yes �No
Ihe.mW the haaNaus materials roqulromcnts underChapter 6.95 of the Califon
me Health&Safety Cade,Sections 35505.25533 and 75534.1 understand that ifthe building
dors not currently hew a tenant Net It u my mapomihilby m notify the occupant M Ne
vim uwhkAmuilbcmelrlwinumeconfic\
Owncronuthoriyed agent amofocapancy. Signatu� re of Applicant Date
> � a O�� t D5 D5 All roof coveringor s to be Class"B" better
Oam d '
51Y �Y OF CUPERTINO
PERMIT APPLICATION FORM
CUPERTINO
N# �. ,Z Date:
Building Address: 22 O p��N Iucx-vi P, oaf N AO C"4 71aly
Owner's Name: D\A Phone#: ..10 5 9 c7 6 O 770
Contractor: �W�no License#:
Contact: Cupertino Business License#:
Building Permit Info:
B Elect ❑ Plumb ❑ _—Meph ❑
J ascription:
Residential ommercia
Sq.Ft. Flodr Area: / � $/Sq.Ft.:
/77
Cost of Project: I n _ ccupancy Group:
Type of Construction: �Q
r
•
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
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
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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ATY OF CUPERTINO �
CUPEYOF PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BMTTIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res 'MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTINM Inspection Overtime BUILDING
BPBACKFLOW Atmospheric 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 Plan Check Repeat Fee BUILDING
BPREPIPE Re i eOfFixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Stonn/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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CITY OF CUPERTINO
aClOF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BS BLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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