06010087 CITY OF CUPERTINO % s"Tte+q'^�"x•ti:>E f �'"''"°'
BUILDIPIO DIVISION PERMIT ,y^e N;T.RACT�QRI
MAT
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BUILDING ADDRESS: JITHENDER MAJJIGA PERMIT"0.06010087
21354 DEXTER D
OWNER'S NAME: PERMIT LSUE DATE
JITHENDER MAJJIGA 6
NE: SANITARY NO. CONTROL NO.
ARCHTTECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
0
±p p LICENSED CONTRACTORS DECLARATION Job Description
m 1 hereby affirm Out l am licensed under provisions of Chap=9(commencing
E with Section 7")of Division 3 ofthc Business and Profusion,Code.md my license is
in full fares and cGeeL DEMO (E) POOL
Licsma Clw Lc.0
n F Dam Comuner
ARCHITECTS DECLARATION /
1 understood my plans still tic used es public records'
>s /
yiso Lleanhad Protcsaionel 5
m Oat I ars UII.DER es the RATION O
i q 1 hereby.afrime(Son an I su�exempt from the Canins Co c:Ansa Law o far tic
O O (ollowinp massa(Saban 7U3 L3,Burrows and Pmfwalnu Cade:Any city ar county
5 which mquiru a permit to comaruct.alms.himem,&mot W,nr repair any sure.mm
$�+y 00
Sr prior to its Lauence,WO mqulma the applicant far each permit m tic a signed wmmem
UwhelsliwwedpmostomodupmvisiowafNCowacmr'$Liceweiaw(Chapw9 Sq.Ft.Floor Area Valuation
,�a (commencing with Sectian7001))a Division 3 oftin BuslnwsaM Preteedow Code)or
t, that he ts...min aluminum and the buts for the alleged uempdan.My violation of
Section 7031.5 by any applicant fm a Permit subjects to APPlicant to a civil Penalty of 3M99niblernuOccupancy Type
not mom than It.hundred dollen(SSW).
0 1,u m w arum pmpmy,m my emplaym withwags u theb halecampemdan.
Mid dorluwork,and the he Conttsmtmmadedar Law
dfmum(Su.toN,Bwircer Required Inspections
and property
he as Code:sat u CanW man.Claws law dm sot apply 1f rt owtth of q p .
men emywho e,prooredt atea theman,sadwho dmatiltworkhimscirorthrough his
Moemplthe building
or i pr hashempm mid
satnot year
afoded molreted Battle,n.
budder theeavete ae Improvement11hathe did ahayea of improve
the awe of
brewer halo baro the harden of proving that he am mat build m knpaaa far purpose ar ,
am.)/.
01.u Maur of the Property,un exclusively contracting with Renamed mnuemme to
construct the pmjea(Sec.7044,Business and Professional Code:)The ConlraeaMs U-
comm Law does act apply m an matter of prapertywho build,or impnuw tintan,ad,
who convects for each projects with a eanmctdr(s)licensed puntaat to tlu Conuretoes
U farms,law.
0 l we tempt ander See .B&P C far Werenin
13700.1'
wner �1.•{. ��a4' Dam f ( 06
WORKERS COM - RATION
1 hereby aBBm under penalty of perjury arc of the following daW Worn
I have and will maintain•Cenifiom of Consent m relf-insure rm WOftel ComPWo-
station,u provided for by Section 3700 of the Lobar Code.for to perfarmume of the
rk for which this permit is Laud.
1 have and will maintain Waraces Compensation resonance.u required by Section
the labor Code•far the perfearen.often work for which this panni,is iecuaLy Warlues Compensation Uuurance carrier ad Poliry number ate:
rtier. Policy No.:
CERTIFICATE OF EXEMP 10M FROM WORKERS'
COMPENSATION INSURANCE
(Dtbualan need notbeconpmud Irthe permit Is ranine hundred WOW($100)
or lest)
1 cerity that in the performance of the work for which this permit is issued.I shall not
employ any person in any manse y }sigma subject m the Workers'Compensation -
Laws afCalifnmiL 1/1' r – —
Appliant - —
NOTICE TOAPPLICANT:IL after making this OefilF assumption,you should
become subject as the Worker's Compensation previsions of the labor Code.you muss
,az forthwith comply withsuch provisions or this permit shall be darned revoked.
,'zLEN
r� CONSTRUCTION DING AGENCY
F+ 1 hereby alrvm that them ts•romuuctinn leading spenry,for the pertmmurce of
Da;> the work for which this permit Is board(See.3097,Cho.C.)
W 6Loraine. m
dne.Nac
7 Lendstr Addren
V O I certify wt 1 ban need this applkatian and,tan Nat the show bfnnwtim is
Ips i� comet 1 agree to comply with all city and county Orel uuer and mm laws muting m
Uca building construction,mrd hereby mthorce,mpmmnutlwa of this city in enter upon tlu
y+ al,on-memiund property for Inspection purposes.
RTI
( (We)agree to um,indemnify and kap boneless the City of Cupertino against
jnliabilities,judgments.costs and expewer which may In any way accrue agalwt raid City
t,2 Zin camega es,of the grandmg of this permit
'" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOVREEG..ULA�TIONS.
/l G a 7zfn Y� t I � Re-roofs
Signature of AppliaRAZA DOUS MA -Dao Type of Roof
HAZARDOUS MA AIS DISCLOSURE
Will Na applicant or future building oaupentaora or handle hwradow material
as
dented by the Cupertino Municipal Code.Chapter 9.12.and the Health ad Safety
ode.Sedan25532(+)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes M141.
Will the applicant or future binding ma,pant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haradnw ai,cmeaminanu or aided by tlu Bay Amo Air Quality Management all new materials for inspection.
Mount?
OYw P14
1 have mad the huudaus.=data requirements under Chap=A95 of the Calif..
me Health At SalmyCode,Sections 25505.25533 and 27534.1 understood ma IrNe building
Wal not currently have a anent that It u my MmOwlihiiity an notify Oat omupemt of Ne
mitiTnuwhmh themet�priarto sstaanceofaGeminate oraaP, Signature of Applicant Date
All roof coverings to be Class"B"or better
owner or authm"vad agent Dare
UWNhK-13U1LULK VhK1k1UA11UN
1. . (Check one) I or my immediate family (parent,spouse or child) will perform:
A ✓All the work authorized by this permit
• B. = A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Conked" Address/City, Phone # State License # I Type of work to
Ot m� b.j1 Jar— q be performed
o ec z�3S[ iN. og tso2.Wo- 2u one
CA-
3. _ I will utilize unlicensed person(s) other than my,immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
• Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City . Phone Number Type of work to be
erformed
............................................................................................................................_.......................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature: Date:
Job Address ar3 S4 D el)KA L))',t be. CL/1e t� CA 9 SO(( Permit# 6 t� 0 8 �
Any changes to the information Rrovided on this form shall be submitted to the City of Cuvertino Build
Devartment
City of Cupertino Building Department
Cl 10300 Torre Avenue
CUPERTINO Phoma `4W
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property,improvements specified.
For your protection you should be aware that as owner-Mulder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of Calffomfa and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
if you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,thin you may be an'employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholdmg,federal social
secmmrranre Costs,and unemployment compensation
security taxes.workers' compensation insuranced
, isab�lnty '
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially,serious with respect to workers' compensation insurance
For more specific information about your obligations under federal law,contact the Internal Revenue
Service(and,if you wish,the US.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is untended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1070 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner bolder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department ,
City of Cupertino
PNMd M RacyGsd Pepe!
CITY OF CUPERTINO
0DEMO
CUPER,TINO PERMIT APPLICATION FORM
• APN# 32- o7Z
Date:
Building Address: 213
Dpjub CUPE2T/NO CA 97Dt
Owner's Name: Phone#:
�Tk��J(3n- m fI71rGl� �U-o�,�2 -255
Contractor: (�CuNE� License#:
Contact: Phone#:
-r7K�oE� m �G+� c,og��oz_zSS�
Applicant/Contractor:
�l/Tfi&-vVOCRL
Building Permit Info:
Bldg � Elect Plumb Mech
Job Description:
Residential: rMm/te, Pool 0 e- Yna • Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Groin
Qty. if
ApplicablFee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
•