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06090095 CITY OF CUPERTINO _ - BUILDING DIVISION PERMIT CONTRACTQRNFORMATION, BUILDING ADDRESS: BAL V SINGH JANDU PERMIT N0.06090095 10276 ORANGE AVE OWNER'S NAME: PERMIT ISSUE DATE BALDEV SINGH JANDU 06 NE: SANITARY NO. CONTROL NO. ARCHTTEC(ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH Op w LICENSED CONTRACTOR'S DECLARATION IVIOb Description 1 Mach,affirm that 1 am licnsed umlen r provisioof Chapter 9(commencing I P � =N wish 5Cc4on]IXM)Of DIVL51on JOfNCB.LnLmartd ProICSSIom Code.alM myli[CnY'IS d f 11 ram e an a effccl `� TEMP POWER POLE t�Z Liccnx Class Lk.a S 70 L9 Dale Camraa L .1 IO Ccs TTT A..hall Cre DECLARATION i < 1 uneemamd my .....hall be used az public mcoNm 1as U LL y Licensed Professional OWNER-BUILDER DECLARATION I a F I hmsca affirm that I em exempt from Ne Cows.ofa License Law for thc :p o fallowing moon.lards(Sceti..u IDB nu Business and Pro&.,sl Conte:Any city someone county which requires a rearms ro con s life pplic improve,h pansil t ore a stg ed mw $200 -¢a hat heistscensed issuance, flue Ne applicant for suchpennitmhleasLaw( hapten Nonarnm imansust )ofDisioivafdmConoacea andI m(Law(sCode)9 Sq. Ft. Floor Area Valuation `r$ (cotill is mor it ssmeion7 and basis n3 of the al elicited exemption. Any Cadger _ Nat he u exempt therefrom and Ne basis for the allcgc0 exmp0on.Any violation or Section 7031.5 by any applicant for a permit subjects the appf¢ant to a civil penally of 309 AldtriFer w w Occupancy Type not more Nan five handled dollars ISSOO). 1,as owner of the proper y,or my employees wish wages a their sole comperamon, will da thc work and dal swan¢Is not intended car offered for ash:(Sec.?014.Business Required Inspections aha Professions Cade:The Comm�ofs Lima n Law doOut apply m e an owner of q P property who Wildaorimpamcs sheraon.and who doessuchwork himselfor through hisown however.the Wildinprovided shm such impsand wit are =year ulted ofco plesied for sales. builder.the Wilding hu bod of pmemtacoldwithinoro year of improve theowner.of builder will have the burden of proving that be did not dub m improve for purpose of salt.). 0 1,o Owner of the property.am exclusively contracting wish licensed comtracmrs to canvoua hedes project(See o an owner of and Professors Code:)Tbe esaoanah nd come Law docs nalchp r to an owner of property who builds or improves thereon,and. Q who cons for such projects wish acontranoKs)licensed pursuant to he ContrxsoYm // Lxealaw. / ❑ lamexemptuneer Sec .B&PCfor this reason 91 Owner Data J WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury arc of she following declarations: ❑Ib:rtand will mainuinaCeni!xaf Comenua self-insurtforWorketmCompcn- sasion,as provided for by Section 3700 Of dre Labor Code,for she pmfomu.c of the work for which this permit is issued. ❑1 have and will maintain Wallace,Compensation htsutance.az requires by Section 37W of dm labor Code,for she performance of Ne work for which this permit is Issued. My Workeh Comp nation Insurance carrier and Policy number am: Cartier. Sf. Gorki Policy N., I SSO 7 N_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This sender need trot xcomplesed i(ft permit is faro.,hundred dollus(SIM) ser less.) 1 certify Net in she performance of Ne wah for which this Permit is issued.l shall not employ any poser in any transfer so as us became subject to the Wafkeri Compemadon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making but Cenifieae of Exemption,you should become subject 0 she Warker'a Compnuation provisions or Ne Lahr,Cade.you tent .,O forthwith comply with such provisions or this permit shall be calmed revoked. Z" CONSTRUCTION LENDING AGENCY [—r khereby which thi Nat Ncrc isaconatmctionl.Car agency for Nc perfurmanc of a shmLa walk(or which this permit u issued(Sec.J097,Civ.C.) aA Isndl,.Name .7 z 1<nderi Address U Q 1 certify that I have mad this application and mate Nn the above information u lL Pcorm.1 epee to comply wish all city and county ordinances and sale laws misting to O V building construction,and hcmby aurbomd represcmatives of this city to cmc,urns thc shaveaka judgraoned property for a pe uonexpenses purposes. F 0. (We)agree ro save,indemnify and kdep ham 1.thc City or C.Peam.against y inconsequeracofsh,cossand oxpdnsumit. may in any wyaccrue againstsaiOCity U z Aconsequence of she gaming of shim permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date <'7 SOURCE REGUBA S. , p 44 `" `"_1'4le6 Re-roofs Signameof Applicam/C ter Oat, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding=upon,store or handle haurdous mammal as defmcd by tM Cupertino Municipal Code.Charts,9.12,and the Health and Safety code.Sccaoa 255324)? ❑Yom ❑Ne All roofs shall be inspected prior to any roofing material being installed. 41 Will the applicant of future building amupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haraNnus air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection. DimicR p Yes ON. I have maJ Ne hvardous malerials rtquimmenu under Chapler5.93 of thc Califory ria H..IN k Safety Code,Sccuun 25505.25533 and 25534.1 undersand Nmif thc building don not currently Imvc a sonar that it u my acsponihility to noti(y the occupant of thc rcquinconaL whicIs bemlrt pada,toi:: ca f.Cmdr..of a,ara y� Signature of Applicant Date Owner a aashnn.of al Data, All roof coverings to be Class"B"or better OWNER-BUILDER VERIFICATION 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. XAll of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to ev J. I /oz o j - -- ell • 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 performed . ..................................................................................................................................................................................... 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: /6/— /y- O 6 Job Address: /o 6 B6y Yx Gt*tG Permit# O Any changes to the information provided on this form shall be submitted to the City of Cupertino Build • Department. Jy i y 3 i City of Cupertino Building Department CITY OF 10300 Torre Avenue• C U P E kT I I o Phone: (408)777-3228 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-builder 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 Drotect vourself 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 California 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, then 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 withholding,federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation* 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 U.S.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 intended 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 1020 N Street,Sacramento, California 95814. Please complete and return the enclosed owner-builder 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 Printed on Recycled Paper CITY OF CUPERTINO lom 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31642006 . 00 DATE ISSUED. . . . . . . : 09/14/2006 RECEIPT # . . . . . . . . . 36034 REFERENCE ID # . . . : 06090095 SITE ADDRESS . . . . . : 10276 ORANGE AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BALDEV SINGH JANDU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2227 RECEIVED FROM . . . . : BALDEV JANDU CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY BALDEV SINGH JANDU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2227 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 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- -- -------- ---------- ---------- TOTAL PERMIT 100 . 47 0 . 00 100 . 47 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ---------------- - ------------ ---------- -- -- - - -- OTHER 100 . 47 VISA TOTAL RECEIPT 100 . 47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 OCUPEI�TINO Building Department JOB ADDRESS: PERMIT # /19,2 O :? S OWNER'S NAME: bq1j9CV S. PHONE # 3 Jo -55-7 GENERAL CONTRACTOR: FAX # yNG - Jy$ I am not using any subcontractors: %I 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 Owner/ onir patu7e Date Tilt, CITY OF CUPERTINO TEMPPOWER CITY OF OCUPEkTINO PERMIT APPLICATION FORM APN # �II 0 Date: 9— /4,-06 Building Address: W Y0.21-,4 O Au2 Owner's Name: Phone #: Q�� S• ���ou 390 ss� � Contractor: pwna, Phone: 3 90 ,5577 License #: 42- Contact: 2Contact: JJ / Phone: Cupertino Business License#: UGt�1F.V S', JO�+aG�U 4-1� Building Permit Info: Elect Job Description: nS"T Residential m/ Commercial ❑ Cost of Project: Qty. if Applicable Fee ID e Description Fee Group BTEMP Tem orary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING