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04040059 (2) CITY OF CUPEW11NO BUILDING DIVISION PERMIT iCONTRACTOR INF�ORMATION f a BUILDING ADDRESS: - I K' S CONSTRUCTION PERMIT N004 04 0 OS9 10312 RICHWOOD DR OWNER'S NAME: PERMIT ISSUE DATE RAJAGOPAL MURALIDARAN P.O.BOX 75 04 109 2004 .ONE: SANITARY NO, CONTROL NO. (408) 480-8048 ARCHITLCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECfI X00 LICENSED CONTRACTOR'S DECLARATION Job Description0 O O O iC I hereby spore that 1 am licensed under previsions of Chapter 9(com mencing n<n with Scc�t�'on]]IXM))nf Division Sof the Ousin sa JPrufcainm Cnde,endmyliccnuis it,full Rox erten _ 0 UPGRADE ELECT PANEL . q z Licenu Cox �FpD CO dour RCIIITECTS RAT I undcraun,my plans shall he uerd a public records /` fa. o Liccnud Pnlfcssinncl 3/ S OWNER BUILDER DECLARATION E 2 0 1 Maso affirm that 1 ore exempt from the Contractor's o License Law lar the E o o fallowing rosin.(Scctiun]51]15,Business and improve, Code:Any city or county rd: which requires a e,alsm re quires((be alter,rat for e,h Permit ermi 11,fi repatrial any strutateme2 _zy pdrnoiuissmnoursuarequires parvisapplis(if forsuch Law £ 81 Roo tcommencKml he is ingsN orstion70nt to hc m ivision3oheCnmsiness and Cha ¢r9 S Ft. Floor Area y�O (cat he commencing ithharfro7afnd th buti�frth alleged exempt Professions Codc)or q' Valuation y that io Is exempt tang applicant li and the basis for be alleged applicant to Any l Penalty of Section 7031.5 byanyapddoll.forapermit subjecuthe epplicanuoaeivilpenaltyof I�SxkMerOO nm mare than rw nrnared aalHrs(5500). 3 H'VRIIAI Occupancy Type 0 1,as owner of the reopen,or my employees with wages as their axle compensation, will do the work,and the structure is not intended or offered for sale(Sec.7014,Business and Professions Code:The Contractor's License Law does not apply to in owner of Required Inspections progeny who builds or improves thereon,and who docs such work himself of through his own employees,provided that such ireprawmenu are nut imcnded oroRered for sale.If. however,the building or impmwmenl is wild within one year of completion,the owner. builder will have the burden of proving that he did nal build or improve for purpose of sale.). 0 h as owner of the property,am exclusively contracting with licensed contractors to construct LOU project(sec.7 044,Business and Professions Code:)The Contractor's Li. cense law does not apply to an owner of progeny who builds or improves theeon,and who contracts for such pmjecu with a contractar(s)licensed pursuant o the Commences ta law. em exempt under Sec. ,B&PC for thisreaon Owner Date Am WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of pe jury one of the following daelaratirns: 1 how and will maintain a Ci nificUe of Conserv Ir amf-imum for Worker's Compere ation,as provided for by Section 37M of the labor Code.for the perfmmanee of the work for which this permit is issued. 0 1 have and will maintain Worker's Compcnatinn Insurance,as requited by Section 37W of the labor Cade,for Use performance of the work for which this permit is issued. My Worker's Compensation Insurance artier and Policy number arc: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not he completed if the permil is forone hundred dollars n]0O) or las.) I ccnify that int5¢pyftf mounce of the work for which this permit is issued.)shall nut employ any peso ray mann rut m acorea subjectto the Workers'Compensation V of Calif e.Data A poi on N E TO APPA Jr,after makin this Ceniliatc of Eac numn,you should become subject to the Worker Compensation provisions of the lahm Code,you must .JO forthwith comply with such previsions or this permit shell he domed rawdtd. ��• r CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency l Or the performance of LU LU the work for which this parrot Is issued(Scc.3097.Civ.C.) Lender's Name 6r z 1<nderi Address a " Q I ccnify tem 1 have with this application and sura that the above Information ad2tiun is 0 F bonen.]agree to comply with all city and aunty ordinances and Cute laws relating to pU building construction. hembyamhrrim repreumatiwsof this City to enter upon the G>) abovomemidned pmpedy fordexpenses penes purposes a (we)agree to save,indemnify and keep harmless the City of Cupertino against flabiN in graining cx penusmit. may in anyway eccmc against said City Uz in coacqucnce of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINi Issued by: Date SOURCE REGULATIONS. ° Re-roofs In c pplicaHUConRD0U5 MATERIAI3 DISCLOSU Date Type of Roof Will be applicant or forum building accupam nme or handle heaudom material Us defined by the Cupenion Municipal Code.Chapter 9.12,and the Health and Safety .ndc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ym �Nu Will the appliwnl or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove III haeardnus air crnuminan6 a darned by the Day Area Air Quality Management all new materials for inspection. iuricl? ,,,ttt OYca fUNo I have read the buvamommmamfialsrequimant under Chopurh95 of the Califor- nia Health 5 Safny Cndc,Sector 259)5,25533 aM 25534.1 Understood thatifthe hate ing does no,currently have a¢rens that it is my rte Mihility m nnul'y the necupant of the rcyvirem whim be ormiauanreof.CareremeofOcga r. Signature of Applicant Date D o All roof coverings to be Class 'B" or better cr ser amhrrir m .3t.,. . ,. .. .� Community Development 10300 Torre Avenue 1 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPERTINO Building Department JOB ADDRS l� PERMI Z so� tl�7a n.P 1 0 qD. C90 OWNER'S N PHONE r GENERAL CONTRACTO FAX# 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 Electrical3 uc do 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 tactor Signature— ate '(fid- CITY OF CUPERTINO rr°F PERMIT APPLICATION FORM 6 v 0 C� -7 CUPEkTINO APN # Date: � : 0$ 02-0 o Building Address: Mailing Addres �ijf ifferent from building address): r9 A oo (' 2-l" rriJ l�D� Owner's Name: Pho e #: 4 0 Con rac or• Licen e, : v✓J rl d . Contact: Phone: �f�8 P-9,,14, Cupertino Business License#: K` (-e Fax: Building 15ermit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: / e / Residential Q �/e �v.��.0 .� Hrf .Commercial ❑ Sq.Ft. Floor Are $/Sq.Ft.: Cost of Pro ct: �1 e _ Occupancy Gro Type of onstruction: Please chec this b x if the ject is a second-story a Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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 1 of 3 �J 7, 7 7 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BNUCOM1vIE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME 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 e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLUUTAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENU URN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance I ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 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 2of3 - II. ` CITY OF CUPERTINO F PERMIT APPLICATION FORM CUPEkTINO uanti Fee ID Fee Descri tion Fee Group 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 Inspection BUILDING Bsv;im 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 Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee afoot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3