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07090153
CITY OF CUPERTINO BUILDING DIVISION PERMIT �kThLT '1 I } tl �T� N• BUILDPERMIT NO. J�t�a1� EssHAZELBR00K DR RAJESH JOHN & SHERRIN 07090153 OWNER'S NAME: FTUMCU PERMIT ISSUE DATE RAJESH JOHN & SHERRIN FRANCO 21074 fAZELBR00K DR 09/24/2007 )NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATION Job Description %m I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;Z� with Section 7000)of Division 3 of the Business and Professions Codc,and my license is INSTL TEMP POWER POLE r= II, in full force and effect. ?4 Z License Class Lie.N t Date Contractor ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records �aU oH Licensed Professional y OWNER-BUILDER DECLARATION } I hereby affirm that 1 am exempt from the Contractor's License Law for the jC O following reason.(Section 7031.5,Business and Professions Code:Any city or county e 1.i'Ll which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to 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 $500 Valuation a F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5 0 0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not more than five hundred dollars($500). 326550--2 . V ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). as owner of the property,am exclusively contracting with licensed conuxtors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exe under Sfa ,B&P C for is relon Ow ER'S OMPENSATiON DECLARATION - I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any maytsr T-18 Dco�e subject to the Workers'Compensation Laws ofCalifogp�4a-�/VVA"�1 11 rill Applicant ` FR NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. 7-- CONSTRUCTION LENDING AGENCY [~-r tom+ I hereby affirm that there is a construction lending agency for the performance of (Sa> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is Ll~— correct.I agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. t7. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►4 APPLI ANT UN STDate ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU REGU ATI NS. ®9 a Re-roofs Signal licart ontractor I D tc ARDOUS MATERIALS DISCLOSURE Type of F.00f Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:]Yes �o If a roof:s installed without first obtaining an inspection,I agree to remove Will the applicant or forum building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? —f C]Yes �o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building docs not current] have a tena t it is my responsibility to notify the occupant of the requirements w must be met r w isxmancc era Cenifica a Signature of Applicant Date © fit' All roof coverings to be Class"B"or better Owner or authoriz nl Date CITY OF {;UPERTINO 0(-;3 :3 TEMPPOWER CUPEkTINO PERMIT APPLICATION FORM APN# 2,2 t 5.5D -3,;?-, 0 1 Date: O 9 I,0 0 I Dr7 Building Address: )10-7W I A t�� k Tell l`PE i I N CA 9 SP10 Owner's Name: RAUF�H 30 F 1 N �I �, Phone #: L Contractor: �`�i�f�i Kk1(CV I C_ Phone:(Lg)e)A5-�LGj - I $I License #: ;s 9 19 Contact: ��N EK Phone: Lipp, Cupertino Business License#: Building Permit Info: Elect ❑ Job Description: 4KS'jl'} tt-1o0Pbd2p pt.)L,c Residential Commercial ❑ Cost of Project: T Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Tc.m orary Power ELECTRICAL EPERMITFEE El-,et. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blc: Lot: APN . . . . . . . . . 3255032 . 00 DATE ISSUED. . . . . . . : 09/24/2007 RECEIPT #. . . . . . . . . : BS)00002728 REFERENCE ID # . . . : 07 )90153 SITE ADDRESS . . . . . : 21)74 HAZELBROOK DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RAJESH JOHN & SHERRIN FRANCO ADDRESS . . . . . . . . . . : 21)74 HAZELBROOK DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SHERRIN FRANCO CONTRACTOR . . . . . . . . LIC # *OWNER* COMPANY . . . . . . . . . . : RAJESH JOHN & SHERRIN FRANCO ADDRESS . . . . . . . . . . : 21)74 HAZELBROOK DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY. AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BTEMP FLAT RATE 1. 00 62 .10 0. 00 62 .10 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 102 . 89 0. 00 102 .89 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 102 . 89 AMEX --------------- TOTAL RECEIPT 102 . 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL Community Development so� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPEkTINO Building Department JOB ADDRESS: -)10-71-1 PERMIT # OWNER'S NAME: _': HEPCIOO FkA nuc D - rt J o x N PHONE # NbM%S- )q b GENERAL CONTRACTOR ,S Cb roS i c-n rDN 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 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 e�- ^ C91 Owner ontract r Signature Date