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10070072
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19489 ROSEMARIE PL UNIT 1 CONTRACTOR:DANG'S CONSTRUCTION PERMIT NO: 10070072 OWNER'S NAME: MAITRI,INC 3805 MASTERS CT DATE ISSUED:07/09/2010 XNER'S PHONE: 4085056976 SAN JOSE,CA 95111 PHONE NO:(408)365-8615 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONVERT 1 220 VOLT OUTLET TO 1 110 VOLT OUTLET License Classes Lic.#_ � Contractor .( G�'-'�`— `" Date L o' 1 hereby affirm that I a►p licensed under the provision of apter 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$250 1 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:37501008.1 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relatin; 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, costs,and expenses which may accrue against said City in consequence of the Issued by: 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. y RE-ROOFS: Signature Z� w —� Date l 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 all new materials for inspection. L] OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensatio 1, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors tc HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California 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 declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2$505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: -Lf�' �� Date: 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 become subject to the Worker's Compensation provisions of the Labor Code,I mi st I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender'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 relati ig 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 ;mnify and keep harmless the City of Cupertino against liabilities,judgments, .cs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: $250 PERMIT TYPE: Electrical Permit PLA N CHECK TYPE: Alteration /Addition / Repair PRIMARY t{ r APPLICATION USE: SFD or Duplex 1,t gra TYPE: xW � a 00 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Recep/Switch/Outlets 1BRENRECEP 2 $42 TOTALS: $42.00 Elec.PlanCheck 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminatry in ormation available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 09-051 Ljl 7-1,)9) FEE QTY/FEE MISC ITEMS F7 PME Plan Check: $0.00 t PME Unit Fee: $42.00 PME Permit Fee: $4 2.00 Travel Documentation Fee: ITRA VDOC $42.00 Select an Administrative Item Bld<T Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.00 $0.00 TOTAL FEE: $127.00 Revised: 6/30/2010 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT' RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Bll:: Lot: APN . . . . . . . . : 37501008 . 1 DATE ISSUED. . . . . . . : 07 /09/2010 RECEIPT # . . . . . . . . . BS )00010828 REFERENCE ID # . . . : 10 )70072 SITE ADDRESS 19189 ROSEMARIE PL UNIT 1 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MAITRI, INC ADDRESS 234 E GISH RD STE 200 CITY/STATE/ZIP . . . : SAV JOSE, CA 95112 RECEIVED FROM MAITRI CONTRACTOR CU DANG LIC # 25481 COMPANY DANG'S CONSTRUCTION ADDRESS 3805 MASTERS CT CITY/STATE/ZIP . . . : SAKI JOSE, CA 95111 TELEPHONE (408) 365-8615 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- --- 1BCBSC VALUATION 250 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMRECEP NO. OUTLETS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 127 . 00 0 . 00 127 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127 . 00 2459 --------------- TOTAL RECEIPT 127 . 00 sib CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM IWC ©U-42 APN# Date: Building Address: -- Mailing Address (if different from building address): tr nl! I � 1 Z3 Lf 6 (r-, �q 20 A-6. S TC 2a v S P}-f-J no! . LA- 9 S 11 L Are Hazardous Materials being used as part of this project? Yes H No U HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: Lt Contractor: Phone: C v #�Pti�Ct (?0 Fax: Contractor License#: 6 -1 S L, ( L Cupertino Business License#: Contact: Phone: (-t 0, A11A A IA-L.&N Fax: Residential M Commercial Job Description: Building Permit Info: / Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B � -- =3 - Valuation: Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditg •een.or �— Revised 07/14/09 INPUT Resourres FnerpyAD M. ndoor Air Quafty and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 ' 1 1 kmi1 Total Points Available: -1401 1301 57 Total Points Project Received: 0 0 0 G:data/progs/gr;enbuildingguidelines/remodelers/greenpointsfinal2.12.04proteoted.xis 14 amp • r } - 7 d � z a jai INSN Ov LD cn Vi �.S j J w Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Lai Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1 C(4S- 9 l Fz-i �C=(VI A" i t=- P L- PERMIT# OWNER'S NAME: (YEA i l f,( Zai f- PHONE# u 1.3�i - G 5 1 L GENERAL CONTRACTOR: C_ � Ct- BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON�FACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date lSi mature 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature %