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03070234 (2) CITY OF CUPERTINO BUILDING DIVISION PERMITCONTRACTOR INFORMATION , BUILDING ADDRESS: BOB GERE MASONRY PERMIT 03070234 '10714 LA gnT)A DR OWNER'S NAME: 480 CROSSLEES DR PEItMITLSSUEDATI! PARBHAKAR 07/31/2003 40,NE (408) 972-1285 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 10, LICENSED CONTRACTOR'S DECLARATION fesF 1 hereby Affirm that 1 am intimated ender provisions of Chapter 9(commencing Job Description <Z to wim Section 90f1U)ggff Diyyyyyyyysiony of me Busittc{yµPr Tessio— c.elicensc is ^jN in full force vn C/ CHIMNEY Rg�,g� ;�= Lieem 1 Lie.. f�1,A1�E ,nr®l..E® s„c. Da¢ Cumrac ARCHITECTS DE f,U dere yplansahallMa daspehlkreenNr SEP 0 5 2003 ti: 11 5 2003 e G t;; Licensed Professional g ' OWNER-BUILDER DECLARATION 1 hereby notion that 1 em exempt from the Commctor's License Law for the [BUILDING a� O O fallowing reason.(Section 8131.5,Business and Profes.0ons Code:Any city or county nprt(iV� g.gu�L�'�G' 5$ which requires a permit m construct.Alter,improve,demolish,or repair any tmctum v $2940 - zpoorm its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation 2tZtO (commencing with section 7WO)ofDivision3ofthe Business and ProfessionsCode)or 36934042 . 00 3 that he is exempt therefrom,And the basis for me Alleged exemption.Any violation of Section 703 1.5 by any applicanot for a Permit sultmis the Applicant to a civil Penalty of APN Number. Occupancy Type not me.than Eve hundred dollars ' I,u owner .and pmpeny,m is employees wim wgu u alei(ink cW,Business will do me work.end Ne strvcwrt is not intended or offered for sale(Sec. Business 10 — ]]pp�� p� pg��, And Professions Code:The Contractors License Law dors not Apply to an owner of 312 - CH I MNE AKp Cctl."'1'RAP.S' property who build,or impormi memon,and who does such work himselfor through his Own employees,provided that Such improvements are not ntended or Offered for sale.If, 514 — FINAL PUBLIC WORKS however,me building or improvement is sold within one yet of completion,the owner. builder will have the burden of proving mat he did not build or improve for purpose of sale) ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7046,Business and Professions Cmde:)The Contractors Li. cense law dues not apply to an owner of property who builds or improver demon,and who contracts for such projects with a contractor(s)licensed pursuant o the Contractah License taw. ❑I am aempt under Sm. ,B&PC for this mason Owner Data WORK ER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of me following declarations: - I hem and will maintain a Certificate of Consent to sal Nnsum for Workers Cumpem cation,a provided for by Section 3700 of me Labor Code,for me performanec of-the w for which this Permit is issued. ve and will maintain Workers Compensation Insurance,a required by Section J1M of me labor Code.for me performance of me work for which this permit is issued. My Workers Compensation Insu aacan/i/gr and Policy Cartier. // icy No.: v� LR FICA �OFEKEM ONFROMWORKERS' COMPENSATION INSURANCE (7 hbsectionneednothecompletedifticp mmitisforo hundmddollars(51D7) fir kis.) 1 certify that in me performance of the work for which this permit is issued,I shall nut employ any Person in any manner an As to hceamc xrouuo the Worked Compensation Laws of California.Dine Applicant NOTICE TO APPLICANT:U.after making this Cenificam of Exemption,you should become subject to the Worker's COmpenaation provisium of the Labor Code,you must � forthwith comply with such provisions or this Permit shall he deemed revoked. 2:0 CONSTRUCTION LENDING AGENCY - I tombs 4fOrm that there its construction lending agency for me performance of Ya me work(or which this permit is issued ism,3097.Civ,Cd YQ lavdcrs Name 3 z LcAders Address J Q I certify inn I have read this application uW role that the above information is J. F correct.I Agree to comply with all city And county onlimance,and sum laws(elating to 'U building construction,And hereby Authorize representatives of this City to enter upon me 1 ahovumcntioned pmperty for inspection purposes. (We)agree to ave,indemnify and keep harmless the City of CuPCnino against liabilities,jud mencosts and evpcnses which may in Any way accmc against said City J rrr��••• m conuy I I.A.@c gmmin of this permit. APPLI NT SAND WILL COMPLY W H A L NON-POINT Issued by: e SOUROE_ Re-roofs Sig um of Appli oro nor OA c DODS MATERIALS DISCLOSURE Type Of ROOF Will the applicant or future Wilding occupant store or handle hasardous material As defiocd by me Cupertino Monte al Code.Chapter 9.12,and the health and Safety otic.Sccuon 15532(x)? All roofs shall be inspected prior to any roofing material being installed. Ya o Will the applicant future building us"upon.tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove h It -,mea air exam n u as fined by the Bay Area Air Quality Management all new a rials for inspection. bier? Yes have mAd thchar nus materials reyuiremenu under Chapter 695 of the Califxr. ! A) nia Health Cwk cc ti ons 15505.25537 anJ25536.iundcrsmnd mtifthc building — 1. V docs not mood, am 'tirm res nsi hility m nnuly the w:cup t of the require cmuw ' It nssusncc cAf,mic ( upon . SI natureo Appli til Date 0 0 r ummi- deCim Doc All roof coverings to be Class"B"or better CITY OF CUPERTINO 03 � 702 3 CITY OF PERMIT APPLICATION FORM CUPEkTINQ 66 3 0 QPKPN # Date: /Q i Building Address: Mailing Address (if different from building address): o 64 Owner's Name: R / Phone#: Contractor: License#: ar, p) Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldgy Elect ❑ Plumb ❑ Mech ❑ Jo escription:� R sidential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Proj t: Occupancy Group: - Type of Co truction: Please check this box i the prgleet is a IML second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BB0ILER2 Boiler> I OOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> I OOOA 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 7 1of3 77. ,s 1 arto CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMNM New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFLYTURE 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING IRV BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Ligbting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group 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 BSCBLVD 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 • 3 of 3