02020044CITY OF CUPERTINO
c PERMIT APPLICATION FORM
CUPERTINO ,
APN # Date:
B m�l
/V 0
Ph one 11�0-g
contractor: License
C f) t c : Phone #:
XIt'y 4— - p 5-/v et l 7�41 3
A,?plicant/Contractor:
1 of
Quantity
•
Fee Description
FeeGr up---
Other Appliances
fullmm.. ISH
1 BBLDGFEE__
Bld-g-P-ermit sq. foot
j
BUILDING
W4, 1
Boiler > 500K to IM Btu
BBOILER4
Boiler > 1M to 1.75 m- Btu
-,Boiler> 1.75M Btu
CAN
IM
BrOOK
Constraction Tax
e rte_
NOW04
G
Con. Tax for 22 zolle-
Constax — Resi[Mobile
lec
E _W0V_<= I OOOA
ELECTRICAL
mumigam
Elec 600V > 1000A
13ELEC200
li
Elec Svcs 600V <= 200A
U—ILDING
Ene��Add�Multi
BUILDING
Investigation fee
I I R I z
Comm. Housing�it. Fee
-iwjiojiijikLl
1 of
w0c nM7
)z
,ow
3i3;
fl
as
CFF OF CUPERTINO
BULDING DIVISION
7-7777��
PERMIT
BUILDING ADDRESS:
PERMIT NO.
i o
____QLmRuBiN_ OUI_ZQN_
02020044
OWNER'S NAME:
APPLICATION SUB DATE
MURUGESAN SINNASSAMY
2377 SHERMAN DR
02/12/2002
PHONE!
SANITARY NO. CONTROL NO.
(408)309-0822
ARCHIT',XTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=1 L__J
LICENSED CONTRACTOR'S DECLARATION
Job Description
-jereby affirm that I am licensed under provisions of Chapter 9 (commencing
.
with Section 7 000) of Division 3 of the Business and Professions Code. and my license
CARPORT (345 SQ.FT.)
,a lit full force and effect.
License ;,lass _ Lie. #
Date Contractor
ARCHITECT'S DECLARATION
1 uuidersismd my plans shall be used as public records
Licenseo Professional
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
followinf, reason. (Section 70333, Business and Professions Code; Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$7000
prior to vs issuance, also requires the applicant for such permit to file a signed"tement
Ft., Floor Ar
Valuation
that he i.�,Iicvasad pausuinit to the proAsions, of the Contractor's License Law (Chapter 9
!vision 3 of The Business and Professions C
ion 700b) of D. ode)
lccnnrn��omg wfthS�tt:
08-U54.,O'Or
or Vhat he is exempt therefrom and the basis for the alleged exemption. Any violation
of Socti,n 703-1.5-by my applicant for a permit subjects the applicaritio a civil penalty
ofnolm,iie than fin hundred dollars ($500).
AP Number
Occupancy 'Type
101 FOUNDATION
0I, as c crier ofibe property, or my employees with wages as their sole compensation,
In t" I'D
Required Inspections
103 UFER
d) dc he work, and the structure is not intended or-offered for sale (Sec. 7044,
ftusiAeas and Professions Code: The Contractor's License Law does not apply to an
owner os property Who builds or improves Thereon, and who does such work himself
or Through his own employees, provided that such improvements at not intended or
offered for sale. If, however, the building or improvement is sold within one year of
104- REBAR
comme6ort, the owner-builder will have the burden of proving that he did not build or
105 ANCHOR BOLTS
improve for purpose of sale. 1.
106 SEWER. &...WATER-
0, 1, as —elloftbe property, am exclusively contracting with licensed contractors to
construct the project (Sec, 7044, Business and Professions Code:) The Contractor's
202 UNDERFLOOR PLUMBING
License Law does not apply to an owner of property who builds or improves thereon,
UNDERFLOOR MECHANICAL
and woo own is f such projects, with a contriactor(s) licensed pursuant. to The
Contractor's , nscLaw�
�203
204 UNDERFLoof'FkAME
0I am, xe under Sec. _,B As P C for this reason
Date A-,
4
205 UNDERFLOOR INSULATION
0 R'S COMP EN sAnd!-,aD&z_/14a�
301 ROUGH PLUMBING
I hereby affirm under penalty of laeriury one of the following declarations:
302 TUB & OR SHOWER
3 03 ROUGH MECHANICAL
1 ❑ 1 have and Will maintain a certificate of Consent to self-insure for Worker's
Compersation, as provided for by Section 3700 of the Labor Code, for the
304 ROUGH ELECTRICAL
performance of the work for which this permit is issued,
305 FRAME
El I have and will main I min Worker's Compensation Insurance, as required by Section
306 - HOEDOWNS
3700 of the Labor Code, for the performance of the work for which this permit is
issued f Ay Worker's Compensation Insurance I carrier and Policy number are.
3 0-7, 7, INSULATION,.
Policy No.:
j348 SHEFT,�ROCK
CERTMCATION OF EXEMPTION FROMWDRVERS'
M.1116
COMPENSATION INSURANCE
0
(This'section he I ed not be cmitpieted if the permit is for one hundred dollars
310 - INTERIOR LATH
311 - SCRATCH COAT
certify that in the performance of the work for which this permit is issued, 1
313 - ROOF NAI,L
shall:rc,t employ any person in any mariner so as to become subject to the,Worken,
Compa: safion Laws of California, Date
501 - FINAL ELECTRICAL ENERGY
'A
I, Certificate of Exemption. you should
502 FINAL .PLUMBING ENERGY
becon'e subject to the Worker's Compensation provisions of the labor Code, you must
503 FINAL MECHANICAL ENERGY
fb1ih`,;M comply with such provisions or This permit shall be deemed revoked
'CONSTRUCTION
�504 FINAL BUILDING ENERGY;-
LENDING AGENCY
"erebv affirra that there is a construction lending agency forlthe calblimmee
P
505 - FINAL ELECTRICAL
of a. work for which this penult is issued (Sec: 30917., Civ� C.) I , .
506 - GAS TEST
Lerdsr�3 Name
Leader's Address
507 - FINAL PLUMBING,
, certify that have read this application and state that the above faformation is
508 - FINAL MECHANICAL
comet. I agree to comply with all city and county ordinances and state laws misting
tobuiid� airthonizeroresentatives of This city 19 enter upon
ng construction; and bereb
509 - FINAL GRADE
The zbo"e-mentioned property for inspection otion purposes.
nape
we) agree to save, indemnify and kiep harmless ffie City of caperiinio against
510 - FINAL PLANNING
lialbilizi.s, judgments, costs and tlxpeascs which may in any way acme 6
against said
city in con ence of the lfrantitig of thigpiarmit,
Xv
ATPLW UNDERSTANDS AND WILL "COMPLY WITH ALL NON-
U R. . ULATIONS.
M12-1='
S
514 NA�7jP�� WORKS
fj-
Issued by: Date
Re-roofs
9. We clor. Date
Si of.-m,-
OU MATERIALS DISCLOSURE
NIP the ap-p-li, or future hvildmg 6emPam store or haridle hitaxleas material
deth ic u Chapter 9,12� and the Health and Safety
'ape -of Roof
s, no Ktini-if"al,Cude,
u a
Code,' ti 5
*No. %
Airpoh sballbe inspec ed pjjqr to any roofing material, being installed.
Mill the applicant or funtrebuildi2 occupant use equipment ordavices which
emit hazardous air contaminants as defin bythe Bay Area Air Quality Management
If a roof is installed without first obtaining an,inspecti6n,'J agree to remove
DistricO
all new materials for inspection. Applicant understands and will comply.. with
DYes
allhon-point source regulations.
]rave read the hazardous'niabuitTh; requiretry;cuts under Chapt6i,2 6,V5 of the
CalilbTva Health & Safety Cod6l Sections 25505,25533 and 25534. 1 understand that
ifttia bniimn is not currently havo-a tenant; that it is my responsibility to notify the
naus,�Juchrnast be;nsetpriair'jo issuance of a Certificing'of
arent requirem
otcupoc .
Signature of Applicant Date
, ;
Owner
All roof coverings to be Class "B" or better
o th ]
a�uth ed
r ed ag,
OFFICE
OF
Cl
BUILD NG Dpv RonPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
WNER'S NAME:
APPLICATION SUB DATE
MURUGESAN SINNASSAMY2377
SHERMAN DR
02 12 2002
HONE:
tI
SANITARY NO. CONTROL NO.
(408)309-0822
O O
ARCHITECT/ENGINEER :
BUILDING PERMIT INFO
ii.i
BLDG EI.ECr PLUMB MECH
IJ r_t L_I U
ora-,
z
-
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereb firm that I am licensed ander f Chapter 9 (comrtuncin
thereby prad Pomo p
nJanheesame..anaprnfeadmnsceae.anemvi_en."
e
wimsatRo,can
CARPORT (345 SQ. FT. )
-�
effect.
in full farce and effect.
i 6
Dis.mD
Linnu Claaa Lic. a
FINALE®
3
Data Cnntraaur
ARCHITECT'S
O a
`ao,
DECLARATION
=
I understand my pans .shall ore used as panic records
FEB 21 2002
,o o L,ittnsJ Professional
u R LL OWNER BUILDER DECLARATION
v. 1 hereby aff fin that 1 am exempt from the Camra tur's License Law far the
- a following match. (sailors ]03L3, Business and oli Code Any city oreounry
tlnnaliah, or repair any duvaure
ss, de
E D which requiresit permit reconstruct. ohea impress,
W�
BUIL�IPYIT Q
- ......_ -
its is
.trio ( t 1.requiresthe applicant for chpc 'uo Emasigned
for such
5 PD PJOOPA[ea ..
��t dt a_¢:`
• Valuation
(atatemem.
- (hath I n -epee lion) pro'.(s fthe t ( ('dad ProluwfmCod9
(cord g- tnsem fD 'i J Code)
Business andi'mi.
or that n_,s exempt mecerroto a,e m_ basis for me alleged _u...... Anti slam)..„
ori'm the Any
,>•° V ,4'1.'�S
3 2 0 80'54' ` 0`0'
-ofStt(ion4031.3 by airy applicant for a pmni(aubjata (he vpplicam m v civil penally
mrnot,mrctn,nEvehnndrcadmmm(ssWl.
APN Number
yr .,, Occupancy Type
101 - FOUNDATION
❑1,.d mwmer mime ro n.mm m tts P=nea
wan.se ed.. fiadr oleamm, eon.
P per rernp Y s
' win Je the work, and the ode:Tstructure is norm., I Li erofmae for dee apply I.
and Code: The Contractor's Licence Low Joss net apply to
Required Inspections, " -
q p
103 UFER
emyWhProfession,
owner of work hied_.if
owner or tmpeny who buds, or impreves thereon, who sees
-
improvements ares
or througgh his wn employees. provided that such vementemeots ere no( intended_.,iiaar
-'fei-sole.,(( M1ewever, the FuilAin--" rtis sold -within otic -�f
offered
_ 104 -- _ - REBAR
-----�-�` ------
'completion, the ownerbuilder will have a,bura n of proving the; he did not build or
105 - ANCHOR BOLTS
improve roti parre'e of'old'),
_. .. __.-._..._...._... --- - -
.6--=..SEWER._&_.WATER.. -- _....._...__.. -.....
-'--...10 _ -
O 1, as ow nor of the property. am ex msively contracting with licensed contractors to
202 - UNDERFLOOR PLUMBING
e eastract the Project fsa. 7044. Business and Pm@ssmo, Code:) The Centacerd
License wd«. not apply ,aanmwnetarpmp_nywho bmIds improves
203 - UNDERFLOOR MECHANICAL
t.to_an,
h pursuant.to tae_
-- an w o cont B or sue Prelate with a eonwno � cen,d
cnnna_mrx nuww.
"'
204 - UNDERFLOOR, FRAME ,
)-
' Olemexe code, Sec. .B&P Cfonnis rtason
�'✓�7.�i17i'
205 - UNDERFLOOR INSULATION
o ER's COMPENSATIOMIJEC A.licenxd
_ own Dme'
ATIN
301 - ROUGH PLUMBING
I hereby.lino uaderpenalD or perjury, more of the following declarations:
302 - TUB & OR SHOWER
'maintain
303 - ROUGH MECHANICAL
❑ 1 have and will a'cctii0crie of consent to self-msum for Worker's
Compensation, as -provided -for by Section 37W of the Labor Cade. for the
304 - ROUGH ELECTRICAL
perfomance of the wmk for watch this pormit is lorded.
-
305 - FRAME
❑ I have end`will maintain Worker'. C.. .cation Insurance, ss required by Section
306 - HOLDOWNS
J]W of the Labor Code, .'or the Performance of the work for which this permit is
.. _ _ -. ..._ ....... -. ve:
(sued. MY Worker's Compcndvtian lnsumne ca "er end Pmliry number.,, ,..,.
..30.7... -...INSULATION_.
., --_.-._:_...•..-_,.+-_�.--.-:..--_.r.:----�---.-�—_�--:�.
cam t' ' i . n'vPobcyN.i'
{ €3b8s-• •6;SHEETROCK-,:rpa. Lm r.
WORKERS"
1 CI RTIFICACOMPENSATION
OMOI ATION INSURANCE
- coanver+snnoN�nsuRANce`
.-t +l.
3,09-_.-_EXTERI.ORLATH' _ _ _
-;', _
,(Thidde6,onndanmtbeemmpl<ted finepetm,tidfar on_natarcdmuars
_
310-' `INTERIOR LATH J r,, ,
41000tr'e,A)
311 -_ SCRATCH COAT_
ccndr that in the ori= work tar whim t rake; 1
s oyn
313 - ROOF NAIL •., t i;, ' ! I'
in u b ub ct
om not employ am person Cm any manner so as to become iuM1leet m thb Workers'
cmmicaut n<wsotcaufmmia:uam
Compensation
501 - FINAL ELECTRICAL ENERGY
ApidNOTICE TO APPLICANT: If, after makingthis CeniGcme of Exemption.
pen. you anoglp
- 502.._- FINAL-_ .. PLUMBING
Z become subjectmthcWorker'sCompcnsationprovisionsofthel3almrCode,youmust
503 - FINAL MECHANICAL ENERGY
forthwith comply with such provisions or this permit shall be deemed revoked.
-'---504 -= 'ENERGY
z0 .. ... ... .. .........__
VI "!"> "'• '•' 'CONSTRUCTION LENDING AGENCY.
(hereby afrm,the, note is. canstracome lending asenry tar the;erfirmance
"_
FINAL- BUILDING .,-.-:-.�.:-,i,-.-;,--.._.......
505 - FINAL ELECTRICAL
-tiof the work for which perjnit, is issued Sec. 309], Co C. ,
'TJ '..,- ( .,.- I .._ t
__..._. .506---- GAS. -TEST-_....-.
Leadec'iName
>.Z Lene_andeaxs'
507 - FINAL PLUMBING.,'
Icenify that1 have aced this applica(ion .nd state thenhe above information is
508 - FINAL MECHANICAL
.gra ,o _comply with all city and
tacountyordinances auction, l,aws rc.ating
Jme Id' g lon M1d h rchy mho z representatives of this 'tytser
509 FINAL GRADE
lince-arriantioned pro,sm,r peetpurposes.
p.(We) ogreem solve, demmy keepCu,'mfCu,om'iaoo,mmI
510 FINAL PLANNING
W .iab 1 t es judgments, costs and esp=nscs which may in any ay c gams( said
.7 Z City' f the g nt ng f this perms
514 NA P WORKS
/ U v
'APPLIC UNDERSTAYDSAhDWILLCOMj LYWITHALLNON INT
Issued by: r Date
Y
S U EGULATION, L Y
-
'
sign re of pli oatmc(or .: '. "' 'ti' . Da!e -:., .
','
Re -roofs
'
AZARDOUS MATERIALS DISCLOSURE ''
..• 'o;i;I (Ibsr topiphearm aware b6ildir,a p t some orhandle haluddicas material
Type Of Roof,..,,
'
as defned by thec pen r M r c pal cad Chapter 9 11, and the Health and Safety
Cad SOY n253JI4a1 -
-(y
i( v
1 t. y t i[
q,No •I, d ( s ec t•
T 7 =
k.
All roofs,shall, be inspected prior to any_roofing material being installed__
Will the app),uses or future building occupant use equipment or devices which
.._. -.. _
If a roof is installed without first obtaining aminspec[idri';'I•agree'to remove
emit standards air communism, as defineby lh_ Bay Arca An Quality Management
District? .
all new materials for inspection. Applicant understands and will comply with
Oyes • 01, No.
all holt-point source regulations,
•_
„
f h 'reaJ the h d seri req roam undo Ch pte fi 93 iif lore,
@I f Health & Safety Code, scion 233(13 13373 and 33374 I demand that
- if the Wildin s not currency have a unseat, mato is my respomibility m notify he
ucdup ( of eequircmenta which armi bemc( trill, to issuance of o CeniGcate'of
Signature of Applicant Date
._.. . _. s f _.
All roof coverings to be Class "B" or better
t:
owae r.ud, ea as '' ate
;L
,. 1.
2.
.-OFFICE .... ..... .... . .
H�
uc- f4at fiooe total UMn9 Araa 1 bY. tt.
PeoposeG AaUten e<
U 125' %
'� FAR. Tobl fhoe Aeea 16'T3 oav IO6.t9
ceoao of oa' mow' �l } 1
3eiP.oP =aaa arnart : Rtt � p � i �
Number of SMeY IU f!� 1 f�'
w.en .o e..v of e:uv e.a�n, oPma eoe a *,7 ''�'�MNitlN .„,ae
ki t rzv,
_ �iyl E{ 'lJl lldl r A
.............
t
1 jL -
rraadh r7 �lI�g@ ! Va ,
711>
1 nw- 4 a xx tivw-
e
-� t'nr���V� �� irk t,.u�� v a",>ca•...
r6etall ity map C I•
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4 ( !
rc
� 'ex
�W k.- u ads p� c ,e^• -; l i
Alot ola� 3A6°
Detail - A n r
I f
t
K O
� I
P .,, rFelaes
� I
t � IIY
FLOOR PLAN '14" d_ ROOF FRAMING PLAN 'l4'
I
r .III
l
dS3
G- r�tt.PURT
�
� I
P .,, rFelaes
� I
t � IIY
FLOOR PLAN '14" d_ ROOF FRAMING PLAN 'l4'