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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION°
OUILDING ADDRESS:
L0975 BAXTER AV
NICE & RIGHT CONSTRUCTION
L' �MIT"°'05080113
OWNER'S NAME:
—
-
PERMIT L%UE DATE
MAHESH MAGHET
10663 SANTA LUCIA RI)
QR/lr�/200S
3NE:
SANITARY NO, CONTROL NO.
(408)861-0928
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRAC'TOR'S DECLARATION
lb Description
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thereby affirm Nat I am licensed under provisions of Chapter 9 (commencing
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with Section 7") rrDivision 3 ofd. Business and Pr cions Code. and my license is
in Tae fume and erred
License Cl Liea
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AIICHITECTS DECLARA ION
I undersand my plans shall M used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hcrcby affirm ohm 11. exempt (rum the Cpnons C's License Law for heAffl.w
reason. (Section n0 and tins Code: Any city Or courtly
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stn t. aocax
whiching
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which requires a peril nee aloe improve, demolish, or pair
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IL y � 0 I1 p le 300 O 0
Sq. Ft. Floor Area
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tet,
ed
prim os its issuance, also mquithe the applicantioor for such Permit file s signed stammem
That he is licensed puauanun the pmvisionsofthe Contractor's License law (Chapter 9
(commencing with Section 7(XXE of Division 3 of the Business and Professions Code) ser
that he is exempt therefrom and the bass for the allegod exemption. Any violation of
3AVP4*NM0er00
Occupancy Type
Section 7031.5 by any applicant for a Permit ubjecs the applicant to a civil penalty of
not mom than rive hundred dollar (S500).
El 1, M owns of the pmpmy, or my employers with wage ss IM's sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7064, Business
and Professions Code: The Ctuouss ors License law docs at apply in an owner of
,
property who builds or improves Nemon.and woodoes such work himself or through his
own employers, provided that such improvements are not intended or offered Anent. if,
howcvca the building or improvement is sold within one year of completion, the owrmr-
builder will have the burden of proving that he did not huild or improve for purpose or
sale.).
exclusively contracting with licensed em acto
❑ I, asr of the property, a omrs
constmct Lha project (Sec. 7014, Business and Professions Cade:) The Conm4ner's Lt.
cease law does not apply in an owner of property who builds or improves Merton, and
who contracts (of such projects with a commeno(s) licensed pursuant to the Contractors
License Law.
I am exempt under Sec. .B&PC for this moon
-
Owner Dam
WORKER'S COMPENSATION DECLARATION
---._.. .,._::_.___�._.__. .... .... ....., ..
1 hereby affl m under penalty of perjury one of the following doelsonions:
I ham and will maintain a Certificate of Consent o self -insure for Workers Compete
cation. as provided for by Section 37M of the labor Code, for the pcAormana of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37M of the labor Code, far On performance of the work for which this peril is issued
My Workers Compensation InLrance carrier and Policy number am:
Cartier. xi Policy
FI AT O�Pf10NFROMOWOOKERS'
COMPENSATION INSURANCE
(rds x if. need not M completed tithe permit is form. hundred dollars ($IIX))
or less.)
I ccmfv that in the Performance of the work for which this peril u issued. I shall not
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employ any person in my manner so as to Meomc subject to the Wolters Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with wch provisions or this peril shall he acemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that these is a eorswoinn lending agency for On perimo m m or
the work for which this peril is issued (Sec. 3097, CO. C.)
Lendci s Name
Lenders Address
'
I certify that 1 have read this application and sure that the above informniun is
correct 1 agree to comply with all city and county ordinances and stale laws rearing to
building construction, and hereby amhon7c representatives of this city to enter upon the
mo,cmevtim.d p.r ny for Tmpeeuon pmPoses '
(We) agree to save, indemnify and keep Karl the City or Cupertino against
liabilities, juagmens, costs and expenses which may in any way ..a against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date3 k'•� =�j s -
SOURCE RF��FGtfl S. f
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Re -roofs 1-
Type of Roof
Signa 'c ofA icanYCamfacl 4 Dam
HAZARDOUS MATEBMS DISCLOSURE
Will the applicant or future building Occupant loom, or handle hamdous material
u defined by rhe Cupentho Municipal Code. Chapter 9.12. and Ne Health and Sarcly
Code, tion Sec35532(7)? `.
❑Yes Ikfplo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment ordcvices which
it ha'rardous air contaminants at defined by the Bay Area Air Quality Management
all new materials for inspection.
kuiai
❑Yes 3CwNu
1 have read the haardms materials mquimmens under Chapmr6.95 of the Califon
nia Hoalth& Safety Code.Seeuonx 5505.25533an125534. lundersandthelifthe building
docs not currently have a ¢nano that it is my responsibility to notify (be uxupanl Of the
rexiormrds wit Mosthe met prior ismars. ofd CcnlOam of upon
Signature of Applicant Date
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All roof coverings to be Class "B" or better
owner
r.um vea7gen, Date
is
e A
ciTY OF
UPEkTINO
Buildine D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
nt
JOB ADDRESS: PERMIT #o
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OWNER'S NAME: lLt,C, ilk (�� I PHONE # p `}I ),j
GENERAL CONTRACTOR: ;TFAX # C/ d V?5 /— /,� �I
I am not using any subcontractors:
<LSignature
Please check avvlicable subcontractors and complete the following information
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C.__'er/Contractor Signa
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
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
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C.__'er/Contractor Signa
Date
CITY OF
UPEkTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
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APN # JZ ! / /
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Date: l� 0J
BuildingAAA�ldress:
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Elect. Pennit Issuance
ELECTRICAL
Owner's Name: t
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Phone #:
Contractor: q
Phone-
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License #:
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Contact:
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Phone:
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Cupertino Business License #:
Building Permit Info:
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Job Description:
Residential
Commercial ❑
Cost of Project:
C
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Qty. if
Applicable Fee ID
Fee Description
Fee Group
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Pennit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
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