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10080147 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19489 ROSEMARIE PL UNIT 4 CONTRACTOHDANGTEEON PERMIT NO: 10080147 OWNER'S NAME: MAITRI,INC3805 MASTERDATE ISSUED:08/20/2010 SAN JOSE,CA 95111 VNER'S PHONE: 4082436839 PHONE NO:(408)365-8615 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL KITCHEN 77 SQ FT,REPLACE 7 DOUBLE License Class Lie.# PANIZ Contractor Date WIN ROWS LIKE FOR LIKE,UPGRADE SUB PANEL I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the S Fi Floor Area: Valuation:$17250 performance of the work for which this permit is issued. q I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37501008.4 Occupancy Type: permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information e correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 6)(,-2- w costs,and expenses which may accrue against said City in consequence of the Iss :d by: >�'3�✓� _ Date granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All r>ofs shall be inspected prior to any roofing material being installed.If a roof is insta.led without first obtaining an inspection,I agree to remove all new materials for inspt.ction. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to I ha ve read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.70441 Business&Professions Code). Cal fornia Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the HcOth&Safety Code,Section 25532(a)should I store or handle hazardous declarations: nt to self-insure for Worker's ma erial. Additionally,should I use equipment or devices which emit hazardous I have and will maintain a Certificate of ConseBay Area Air Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants maintain' acompliance withyth eCupert no MunicipalniCode,Chapter 9'12 and performance of the work for which this permit is issued. the Health&Safety Code,Sectioi} 505,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Ov ner or authorized agent: L Date: l.0 permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I is a become subject to the Worker's Compensation provisions of the Labor Code,I must wh.k'sfor whichthis rm that here permit is construction (Sec,3097,Civ ending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lt nder's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, ;,and expenses which may accrue against said City in consequence of the I i.nderstand my plans shall be used as public records. ting of this permit.Additionally,the applicant understands and will comply with all non-p nt source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. re ! G Signatu C Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 [&[IS CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIS G�PFUJO PERMIT# JOB ADDRESS: 194W,() l a� PHONE# OWNER'S NAME: M A1T6Z1 INC. GENERAL CONTRACTOR: cu �� ���5 (��(S�rR.�cTtor� BUSINESS LICENSE# CITY/ZIPCODE: ADDRESS: code requires all businesses working in the city to have a City of Cuper�HEDULEDlicense. UNTIL THE *Our municipal q WILL BE S NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Date I am not using any subcontractors: Signature P Please check applicable subcontractors and complete the following information: BUSINESS LICENSE # SUBCONTRACTOR BUSINESS NA VIE Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile I Date Owne /Contractor Signature CITY OF CUPERTINO 5 ITEMS OF 21 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lo- APN 37501003 .4 DATE ISSUED. . . . . . . : 08/20/2010 RECEIPT ##. . . . . . . . . : BS00001:_235 REFERENCE ID # 1008014'7 SITE ADDRESS 19489 ROSEMARIE PL UNIT 4 SUBDIVISION . . . . . . : CITY CUPERTIiro IMPACT AREA . . . . . . OWNER MAITRI, INC ADDRESS . 234 E GISH RD STE 200 CITY/STATE/ZIP SAN JOSE, CA 95112 RECEIVED FROM MAITRI CONTRACTOR . . . . . . . : CU DANG LIC # 25481 COMPANY DANG'S CONSTRUCTION ADDRESS . 3805 MASTERS CT CITY/STATE/ZIP SAN JOSE, CA 95111 TELEPHONE (408) 365-8615 --FEE- UNIT ID ---- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ---- - ---------- __________ __ ------- --- ____ ---------- BCBSC VALUATION 17, 250 . 00 0 . 75 1BSEISMICR VALUATION 17, 250. 00 0 . 00 0 . 75 0. 00 lERT2001K UNITS 1 50 0 . 00 1.50 0. 00 1REMRESKIT S 1 . 00 15 75 0 . 00 15 . 75 0. 00 Q FEET 77. 00 285 00 0 . 00 285 . 00 1WINREP EACH 8 1 . 00 189. 50 0. 00 189.50 0. 00 __ 0. 00 492 . 50 0 .00 492 . 50 0. 00 TOTAL PERMIT ---------- METHOD-OF-PAYMENT AMOUNT REFERENCE NUMBER --------------- ---- --------------- CHECK 2, 138 . 00 2502 --------------- TOTAL RECEIPT 2, 138 . 00 CITY OF CUPE RTINO I:ci-ry OF GENERAL GENERAL BUILDING CUPElZT1 PERMIT APPLICATION FORM Z�)Z{`��C APN # 3 7501(�0�, Date: AJGtUSr M1 Building Address: q Mailing Address (if different o C�fri address): ct1I2— building a G� .,. S Are Hazardous Materials being used as part of fhis project? Yes No If rovide letter from HOA HOA: (Exterior work only) Yes ❑ es,N° Phone#: U _(� �ai3 Owner's Name: �, rl NC Phone: 409-0 2._ Contractor:C. �,5�"v�L Fax: Contractor License#: G (4 s C1 Cu ertino Business License#: Phone: 1,10 8 69 7 6 Contact: �N� Fax: ,lesidential Commercial Job Description: �1 "-,C.Al\ ZQ-�CW Building Permit Info: Plurr.b ❑ Mech ❑ Bld Elect ❑ Occupancy Type: FVIaluation: nstruction (Usage Class): IUIII B, IV-HT,V-B ❑ II/III/V-A ❑ Square Footage: �- ��a S� ize: Ex ress ❑ Standard ❑ Large❑ Major ❑ g/LEED Checklist& attach it Green Building: Please complete relevant portion of f�lii dee in plan elt& the sheet index. to the application or if applicable, Points Achieved: buildit een.�r +'or hel , contact Build it Green at www• - Revised 07/14/09 s m U R I W m d rn - J Rr v c Q m d O Eca 'a Cv a w ¢ -N ani o � C3 z zm CL Z cc co cn o a s a `O ci �! A w FW.. 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