05100024 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORiINFORMATION':
BUILDING ADDRESS: CAL-WEST INSULATION CO. PERMIT N005100024
10114 R ESTATES ng
OWNER'S NAME: PERMIT nUE DATE
Alk RAJENDRA LIMAYE 4173 VICTORIA 10/06/2005
ONE: SANITARY NO. CONTROL NO.
(408) 292-3363
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT 0
PLUMB MECH
0 0
u0ZLICENSED CONfRACTOR'SDECLARATION Job Description
-
C I hereby affirm that I am licensed under provisions mm
of Chapter 9(coencing
U
with Section 7")of Division 3 of Ute Business and Profession Cod,and my licensee
;U tom Bull in=and effect ADD INSULATION PjTTf ItC� & O SPACE
j�Z License Class Lk.g
Dale Contractor
ARCHITECTS DECLARATION
aga9M< 1 understand my plans shall be used as public records
oGLicenedPmfessimeal NOV 2005
OWNER-BUILDER DECLARATION
I 1 herehy.trslm Nat I ont exempt from the Contractor'.License Law for the
O O following reason.(Section 7031.5,Business and Professions Code:Any city of county F11
m which requires a Permit ,,construct.arm,,improve,demolish,or repair my svucmre S f .(i�;a it a $2250
prior to its issuance.also requires the applicant for Such permit to File a signed statement ams d 'N I
that he is licensed pursuant to the provisions of the Commons leave law(Chap¢r9 Sq. Ft. Floor Area `id Valuation
YFO (commencing with Section 7000)ofDivision l of Ne Business and Profession Code)or
Q that kis eanmpt thcmfrom and tM base for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r U U Occupancy Type
not more than rove hundred dollars(SSW).
0 I,as owner of the property or my employees with wages se their sole compensation,
will do Ne work and thesim cture is not intended N.Mond for sal,(Sec.7045,Business
and Profession Code:The Contommres s License Law donot apply to an owner of Required Inspections
nmprny who Wildsorimpfines Nttcon,mil who docs such work himself.,through his
own employees,provided that such improvements ve not intended oroRered formic.If.
however,the building or improvement is said within one year of rompletion,the owner-
builder will have one burden of proving that he did not build or improve for purpose of
sok/.).
f�1,as,owner of the pmpcny,am exclusively contracting with licensed oncesc nes to
lconstruct the project(Sec.7044,Business and Professions Cade:)The Contractors Li-
miue Law does not apply to an owner of property who bolds or improves dmreon,and
who contracts for such projects with a contractor(&)licensed pursuant to the Convectors
License law.
0l am excon under See. .B h P C foe this..on
Owner Dale 1 0 6 D
KER'B MPENSATIONDECLARATION
1 hereby affirm under penally of perjury,one of the following declarations:
I have and will maintain a Cer ifiesm of Cement be self-insure for Workers Compcn-
don.as provided for by Section 3700 of the labor Code.for the performance of the
7M37W
rk for which this permit is issued.
1 have and will maintain Workcr'a Compensation Inurxnce,as mqumed by Section
of the labor Code,far the pmm
erfmec owo
f the rk far which this permit is issued.
y Workers Compensation Insurance carrier and Policy numrMm arc:
rtier: Polity No.:
CERTIFICATE OF E KEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(The section need not be completed lime permit is foronc hundred dollars(SIM)
nr less.)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any mruij� nl l�A ,subject t�Workers'Campenation
Laws of California Date ,�T/1
Applicant
NOTICE TO APPLICANT:If. fu�f +rt5rt Cci iri me of Ea� cmption,you should
become auhject to the Worker's Compensation provisions of the labor Code,you mus ,
.J Q forthwith comply with such rocoman or this permit hot]M dermcd revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency fm the performance of
5 the work for which this permit a issued(Sec.3097,Ci,C.)
W Q Lender's Name
D Z Lenders Address
f)0 1 certify that 1 have read this application and sum Net the thow information is
W r correct.1 agroe to comply with all city and county ordinaries and state laws relating to
O V Wilding construction.and hereby authorim repremnutives of this city to comm upon the
r fS.l .hove-mentioned property for inspection purposes
,n 0. (We)agree to save,indemnify and keep harmless she City of Cupertino against
m
y
liabilities,judgments,costs and expenses which may in any way accc against said City
U Z APPIL.ICANTeUNDERSTANDSthis
AND perm
WILL COMPLY WITH ALL NON-POINT Issued by: Date ,f—
SOURCERE9VLADONS.
1016 � Re-roofs
Signewr pli Contn Im blue
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
Will the applicant or future building occupant store or handle hazardous mammal
az defined by the Cupenina Municipal Code.Chapter 9.12,and the Health and Safety
Cade.Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea �Nu
Will thea applicant or future building occupant usec t ordcviess which If a roof is installed without first obtaining an inspection,I agree to remove
PP s p aAirQn
mit hazardous air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection.
— DixvimT
0Yes �}u
1 have read the hvarem smaterials requirements under Chapter 6.95 of the Cali for.
nia Health 6 SafetyCode.Section 25505,25533 and 25534.1 undersand lWlif be building
does not Cu m y hnw,a tenant that Il is my RspansitnNy b m try dM 0.e.E.,of TIM
mquim whlohmusbeme issuance fa CemrincoroceuhaiiSignature of Applicant Date
11 fir
Ownzed-grow Dam All roof coverings to be Class"B"or better
l
ra, - Community Development
10300 Torre Avenue
` ✓ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: I 0 114 . E V-Sf�- o aQ Y;v4� PERMIT #
C fi wee CA grz i$ tl O a o 2
OWNER'S NAME: tiq i ry A (F PHONE #(--Pa B) Cq
GENERAL CONTRACTOR: COJ-Lu l i V,�-LkOLfi't- 60 . FAX #
P .0 • 3 6 26 1 c, '1a'-)e C
I am not using any subcontractors:
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
rO 6 a s—
Contrfor Signature Date
(�v`= CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEVINO /
N# 7/ c- G 3 6 Date: 10 ' o . O�
Building Address: 1 p//!1. G ,, , Mailing Address (if different from building address):
r oot7 OmT /
Owner's Name: Pzz� L/ ✓na r 2 Phone#: 0 8
C_4 ) °I
Contractor: Com_ w u� }- j g"� C p . License#: 5 q q 2-? -�-
Contact: Phone. 4o 8 i i 3363 Cupertino Business License#:
Fax: stn 2 2-33 3
Building Permit Info: AGt ^� i�J v(Ar9 �1 .6,41
Bldg ' Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Project: 1 ZZ 3-0 , 6-0 Occupancy Grou
Type of Construction: Please check this box if the project is a
t-� second-story addition: ❑
roject Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3. Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
f
1 of
412;3 . 5-Z
FG CITY OF CUPERTINO
QTY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Stom]/Raln Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLUUiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Li ting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BRENIRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
CT"OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEW Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
3of3
CAL-WEST INSULATION CO.
State of California Contractor's License Number 599277
P.O. Box 36261 a San Jose, CA 95158 1'►,`
San Jose Area
(408) -2.9 2-33 63
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH \
CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE
OF CALIFORNIA. IN THE BUILDING LOCATED AT:
LINAy£ RESIDENCE LOT .—TRACT
STREET 10114 E. £S7A7£S DR. CITY CU £/27INO, CA.
EXTERIOR WALLS: 05
R.
MANUFACTURER. —THICKNESS/TYPE—VALUE I`
CEILINGS;
BATTS:
R.
MANUFACTURER THICKNESS/TYPE VALUE
13LOWNIN: R- 19 OVER £XISMg.MINIMUM R.
MANUFACTURER COCOON THICKNESS 5. O VALUER- 19
APPROX.
SQUARE FOOTAGE COVERED 1 • 500 NUMBER OF BAGS USED 28
FLOORS:
R.
MANUFACTURER THICKNESS/TYPE VALUE
SLAB ON GRADE: R-
_M ACTURER THICKNESS/TYPE_ VALUE
WIDTH OF INSULATION__ INCHES
FOUNDATION WALLS. R_
MANUFACTURER— THICKNESS/TYPE—VALUE—
GENERAL
HICKNESS/TYPE VALUEGENERAL CONTRACTOR
CALIFORNIA CONTRACTORS LICENSE
DATE
SIGNATURE TITLE
INSULATION CONTRACTOR CAL-WEST INSULATION CO.
CALIFO IA CONTRACT S LICENSE NO. 59_9277 DATE ,7
7'U S
a% /
51 TI
SIGNATURE TITLE
Nov 0 2 2005