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09070105 CITY OF CUPERTINO BUILDING DIVISION PERMIT IT BUILDING ADDRESS: PERMIT NO. 10633 S BLANEY AVE SUREST BAJAJI & ADH 09070109 —IV NER'S NAME: RAMAIP LM PERMIT ISSUE DATE TRT+CTS F27�T�� PHONE: SANA CONTROL NO. RAMA TAT,M ARCHITECTIENGINEER: BUILDING PERMIT INFO REPLACE WINDOWS LIKE FOR BLDG ELECTPLU�MH 0 q O p LICENSED CONTRACTOR'S DECLARATION LIKE Job Description ma I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Scetion 70(10)of Division 3 of the Business and Professions Code,and my license is =an in full force and effect vM Z License Class Lic•N '—t—a Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records DyU 4 O y Licensed Professional y OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from the Contractors License Law for the i p O following reason.(Section 7031.5,Business and Professions Code:Any city or county e,.,9 which requires a permit to construct.alter,improve,demolish,or repair any swcture n Zy prior to its issuance,also requires mite 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 3q.Ft.Floor Area Valuation yt= (commencing with Section 7000)of Division 3 of tic Business and Professions Code)or y 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 of APN Number Occupancy Type not mote than five hundred dollars(5500). ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q 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.). %U.as owner of the property,am exclusively contracting with licensed contractors to nstmct the project(Sec.7044.Business and Professions Code:)The Conractors Li- cense law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects wi a con tor(s)li ens p uant to the contractor's License Caw. ❑I am exempt under See B&P C for this reason ..der Date WORKER'S COMPENSATION 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 (Mis section need not be completed if the permit is for one hundred dollars($100) or Ices) I cenify that in the performance of the work for which this permit is issued,1 shall not employ any person in any m r so u to co bj to the Workers'Compensation Laws of 1!ifb Ile�1 Da Applicant NOTICE [] after making This Cert' te 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. z' CONSTRUCTION LENDING AGENCY Fr rz I hereby affirm that there is a construction lending agency for the performance of . p;5 the work for which this permit is issued(Sec.3097,Civ.C.) W A L.etdoes Name Lender's Address U 0 I certify that I have read this application and state that the above information is LC,m" correct I agree to comply with all city and county ordinances and state laws relating to 0 V construction,consction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes W W (We)agree to save,indemnify and keep harmless the City of Cupertino against Cn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date APPLICANT UNDER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE RE Re-roofs Signature of Applican ontractor ate Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material at defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ,de.Section 25532(a)? All roofs!hall be inspected prior to any roofing material being installed. ❑Yes 10No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes WO 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building does not curmndy have a ant,that it is my responsibility to notify the occupant of the requirements h; m met prior issa a certiricate of Occupancy. Signature A Applicant Date All roof coverings to be Class" or better Owner or authorized agent ate .ry Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: (7 33 Sou PERMIT # CM I 0 1?0 7 0th OWNER'S NAME: i PHONE # 4,0 t GENERAL CONTRACTOR: FAX# I am not using any subcontractors: d off. Si mature 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 Owner/Contracto Signature Date b 633C+ L ►� hoc' ��•�'�-� ��" I� �g ��" C�e��v�r '� �.nn�"r" '��•�.Ss �" C CS L 2�a 7 ;.. g 6 Ae- "-V-Yb Yt N `r w t -- .:ww r� :150 o ID Z = Y y Q n e CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36933007 . 00 DATE ISSUED. . . . . . . : 07/13/2009 RECEIPT #. . . . . . . . . : BS000008177 REFERENCE ID # . . . : 09070105 SITE ADDRESS . . . . . : 10633 S BLANEY AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SURESH BAJAJI & ANVRADH RAMAI ADDRESS 10633 S BLANEY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4542 RECEIVED FROM . . . . : SURESH BALAJI CONTRACTOR LIC # *OWNER* COMPANY SURESH BAJAJI & ANVRADH RAMAI ADDRESS 10633 S BLANEY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4542 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1. 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 1, 000 . 00 0.50 0. 00 0 . 50 0 . 00 1WINREP EACH 8 2 . 00 760 . 00 0. 00 760 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 761 .50 0 . 00 761 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 761 . 50 1198 --------------- TOTAL RECEIPT 761 .50 ,am., CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM 0-7 O ) D 5� APN# 3 Date: Building Address: 0 633 Souk Vuy" AVeyw,1L, �'+-0 v'II -35olj� Mailing Address (if different from building address): Owner's Name: Svp_4& L �i f�VU"D" Phone#: �,,Xr�r019 6-72-3 72-3 9 HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: ` Phone: Of Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential 54 Commercial Job Description: Building Permit Info: Bldg ftl Elect ❑ Numb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: W N I-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-1; Valuation: 1,000/" Square Footage: Project Size: Express Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion cif 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.buildj=en.or Revised 02/05/09 � =- CITY OF CUPERTINO COPCITY E TING GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 3 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E I MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M IPLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone J 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT I TYPES I BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5