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05100163 CITY OF CUPERTINO BUIL'SING DIVISION PENT INFbRMAT,IO,N BUILDING ADDRESS: BALDEV SINGH JANDU PERMITN0.05100163 ??779 AT,rAnP Rn OWNER'S NAME: PERMIT ISSUE DATE Am BALDEV SINGH TANDIJ NE: SANITARY NO. ri� CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 tams LICENSED COMitACTOR'S DECLARATION wp I hereby affirm that I am licensed under provisions or chapter 9(commencing Job Description, with Section 7")a(Diviaion 3ofthe Business and ProfessionsCode.and my license is Zr„ imm�raaanderm" TIE IN LATERAL TO BUILDING 6SEWER9INSTALLING a tug z License ClassLic.Y a Dam ContrsemrSEWER CLEANOUT �L ARCHITECTS DECLARATION j n I understand my plans shall be used as public records U /v 0♦GL v a Licensed Professional �y j r`k' OW NER-BUILDER DECLARATION `O f I hereby To.that 1 am exempt farm the Contractors License Law for the 4 // ci o following¢awn.(section 91D I.S.Business and Professions Cc&:Any city of county � 0 =� which mquires a permit to construct,alter.imprnve.demolish,or repair any structure _zy prior m its issuance.also requires the applicant for such permit to rite a signed summent < that he is licensed pursuant o the provisions of the Commctur's License UW(Chapter 9 Sq. Ft. Floor Area � ,y)Yalua[�Q,000 z1-m (commencing with Section]BBB)of Division 3 of the Business and Professions Code)or 'a F$ he,he is exempt thomfrom and the basis far be alleged exemption.Any violation of Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 01,as ownv of the pmpeny,«my employes with wage as dens wlc cvmpcvation, 34244014 . 00 will do Ne work and the awctom is not intended or offered for sale(Sec.]Oats,Business and Professions Cade:The Contractor's License Law docs not apply in an owner of Required Inspections property who buildsor improves themon,and who doesauch work himself ar through his awn employees,provided that such improvements are not intended cra0crcd(or sale.IL s however,the building or improvement is sold within am:year of completion,the owner- builder will bare the burden of proving that he did rot Wild or improve f«purpose of salt.). Ll 6 as owner of the progcny,am exclusively contracting with licensed connotation to tonins the project(Sec.91Wa,Basin.and Profmssiam Cade:)The Contractori Li- music taw does not apply in an owner of propeny.wha Wilds or improves thereon,and who contracts for such projects with a eamnctor s)licensed pursuant o the Convenor's License Law. ❑1 am exempt under Sec.�� B k P C far Nis mason tuner :' _ Dam ' WO ER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of Pvjary ane of 0m following deceleration: - I ham and will maintain a Ceniilna of Consent to self-insum for Workeracompcn- sation,as provided for by Section 3700 of the Labor Card,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3900 of the tabor Code,far the performance of to work far which this ismon,is issued. My Worker's Compensation Imuvnee carrier and Policy number are: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not beeomplewd if the permit is for one hundred dollars($10() sr less.) 1 mmufv that in the perfamennec of the work for which this permit is isued,I shall not employany person in any manner soasm WcomesubM foct Workers'Compensation Laws of California.Data Applicant ' NOTICE TO A PLI AM:If, Iter making this CeniBu¢of Exemption,you should - become subject m the Worker'a Compensation previsions of the lobar Cam,you must .JO Forthwith comply with such provisions or this Permit malt be deemed awaked. Z C7 CONSTRUCTION LENDING AGENCY F+ 1 hereby alarm that there is a consvuetion lending agency for the performance of 15the work for which this permit is issued(See.3097.Ci,C.) G p Landers Name Landers Address U Q 1 certify Nell ban mad this application and same Nat the aWve inf«m rtiun is CL P correct.1 agree to comply with all city and county ordinances and some laws totaling to 0 U building constriction,and hereby authnrive rtpresematives or this city m enter urine the N.1 movomemioned property for inspection purposes. F py (We)agree to sans,indemnify and keep humless Ins City of Cupertino againstar rn Iiabiliues,judgmenla.casts and expenses which may in any way same against said City U Z in consequence of the gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Q-6r^ SOURCER ULATIONS. Re-roofs �,1r—� Si nature of ArcanVCiannetor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tM applicant or future building occupant more orhandle hasudsous material as defined by the Cupertino Municipal Code.Charimr 9.11,and the Health and Safety Code. Nr OVon rion 25332fa>± B All roofs shall be inspected prior to any roofing material being installed. - Will the applicant or future baitrling occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emiI hvardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District' ❑Yes [n NO I have read the Waarelous malarial.rzyvimmems under Chapter 6.95 or theCalif., nia Health&Safety Code,Seetimv 25505,15533 and 25534.I undersaM that if lW Wilding does not cmrtrnly have a ancon that it is my msponability a final fy the omupam of the myuirtmcnu which rbc act ptiorwyaarrm a_n ceni0aaa arOcapscy.2i Signature of Applicant Date owns o arthorized ant Data All roof coverings to be Class"B"or better CITY OF CUPERTINO I 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34244014 .00 DATE ISSUED. . . . . . . : 10/20/2005 RECEIPT #. . . . . . . . . : 31677 REFERENCE ID # . . . : 05100163 SITE ADDRESS . . . . . : 22772 ALCADE RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BALDEV SINGH JANDU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : BALDEV SINGH JANDU CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : BALDEV SINGH JANDU ADDRESS' . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ___ __________ BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 __________ __________ __________ ---------- TOTAL PERMIT 59.95 0.00 59.95 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ____-____-____--__ CASH 59.95 TOTAL RECEIPT 59.95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING I MY -1714 € S M'IN'A � • r � Y RE IDENTZ�� � PROJEG C,®VER SHEf M OF CUPERTINO Assessor's Parcel Number: Name of owner. �3,4!,0cF V 7A-AID Z/ Proje ct address.. 22772 QLGRLDfio AT-) Contact person. Rl Phone. :3qo- 5S� Fax. Net square footage of lot. D� Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N On what floor(s) is work being done? 11 Brief description of work. T iv (�r[4,d -(Cf �ea u�a�L Stam( SPiL✓u L C�� f e envie Code editions: 2001 CBC (_1 -1)2001 CFC (Y - N)2001 CMC (Y-N) 2001 CPC N)2001 NEC (Y - N) Effective 11/1/02 Plan Review Process Work Book Page-8-Revised 4/28/04 p5100\ co3 CITY OF CUPERTINO t U�-(,aaz,-- REPIPE/SEWERS/MAIN SERVICE EkT W-UPINO PERMIT APPLICATION FORM APN # 34a -44 "- O rl Date: Building Address: Owner's Name: Phone#: G t V S,/vg,-/ ,J N 1W -2yo --5577 Contractor: A/ l Phone: p 5 License#: Contact: �� Phone: Cupertino Business License#: GOc jo -s"S 7 Building Permit Info: Bldg ❑ Elect ❑ Plumb El . Job Description: - (�/�L Gc:(il �f—G✓Lt/�— /ltSr r �U)&A e. tSLC�. Residential Commercial ❑ Cost of Project: 2©� Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING j PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING •