05120067 (2) CITY OF CUPERTINO .�' ^+=e-,'gaff
BUILDING DIVISION PERMIT CONTRACTORINFORMATIO.N
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BUILDING ADDRESS: BJURMAN CORP PERMIT No.05120067
10316 TONITA WY
OWNER'S NAME: PERMIT ISSUE DATE
SRINDHAR R. PALLA 1250 HIGHWAY 101 12/13/2005
NE: s SANITARY NO. CONTROL NO.
(831) 726-9907 ft
ARCHITECIENGINEER: BU LNG'PERMIT INFO
BLDG CTS PLUMB MECH
I /f t0's t�
-p LICENSED CONTRACTOR'S DECLARATION p�yTy. A�
O C 1 hereby affirm trialM.l em licensed Bu under provisions of Chapter 9(commencing Job Description 0
w veld Scction70(IU)ofDiviaion Sof NC Business and Profcssiurta Cour.and myliccvc is
D'_ Lfuurarteand r� � L{�.2tf 7 DEMO (E) POOL & ELECT. 6C�7�
Z LICCnY Claes Lle.Y
E;, Dam sa Canlruwr J�
eEE ARCHITECTS DELLA ATION
I C I understand my plans shall be used u public records
Dgu
;pin Licensed Professional ggpp qq
OWNER-BUILDER DECLARATION
I I hereby affirm that 1exempt frommuse fead a License w for the 'NV.A+j
p O following reason.(Section 7031.5,1.1.3,Business and Pmfcauons nns Codc: LaAny city or county
m Pi which requires a permit to construct.almr.Iropmve,diamdoh,or mpail any stoscture
poor to its issuance,also requires the applicant for such permit to rile a signed statement
iia< that Ine is licensed pursuant to the provisions of the Contractor's Umnm Law(Chapter 9 Sq. Ft. Floor Area Valuation
%t g (commencing wish Section 7")of Division 3 of the Business and Prefessioru Code)or
that he is eumpt therefrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by say applicant for a permit subjects the applicant to a civil penalty of uL'
not mart Nen five hundred dollars(S500). P Occupancy Type
❑1.as owner of the property,or my employees with wags as Noir sole compensation,
will do the work,end de mucture is not inmWed or offered for sale(Su.7014,Business
and Pmfcsaions Codc:The Concactor's Liana Law docs not apply be an owner of Required Inspections
property who buildsor i mprovea decman,and who dors such work himsel f or trough his
awn employee,pmvidcd that such Improvements tie not intended oroffered for sale.If,
however,the building or improvement is said within one year of completion,the owncr-
builder will have de burden of proving that W did not Wild or improve per puryox of
sale.).
❑1.as owner of IW properly,am ucl.awly cartooning with licensed m nsacbrs in
construct the project(Sec.7044,Business and Profem.Code:)The Coetomfs Li-
mrse law does not pply to an owner of prapeny.who Wilds or improve thereon,and
who contracts for such projects with a contactor(s)licensed pursuant to the Contactors
License law.
01 am exemptinder Sec ,B&PCfor Nismason
owner Dow
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following declarations:
have and will maintain a Cenifiate of Contin to self-insure for WorkersCompen-
mdon,as provided fm by Secuw 3700 of tie Labor Code,for the performance of the _
work for which this Permit is issued
❑1 Marc and will maintain Workers Compensation Insurance,as required by Section
3700 of the labor Codc,for the performance of the wort for which this permit is issued.
My Workers Compensation Insursna carrier and Policy number am:
Cartier. Policy No.:
CERDFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
(Tbus smai n need not be completed if the permit Is Imone hundred dollars($I00)
or lean)
1 certify that in the perrorman a of one work for which this permit is issued I shall not
employ any remain in any manner an as sobecame sub'ecua Newmircrs'Competummi
Laws of Cali Pae I A 7't–'r"}—
Applicantrn
NOTICE TO APP CANT:IL after making Nis Cenificnc of Exemption,you shuuW
become mbjecl W the Warkm3 Compensation provisions Of de Labor Codc,you mat
.JZ forthwith comply with men prnvisions or this Permit shall W deemed revoked.
,zr O CONSTRUCTION LENDING AGENCY
'C4 I hereby aRum thatthemi isameSee.3 ]ending agenry for the perfurmana of
C4 the work for which Nu permit is issued(Sec.309'1,Civ.C.)
Q Lenders Name
CLU
6r 1<nder's Address
U Z
I)Q 1 certify met 1 have read urs city
and coon and sue ccs and
shave iws mratiun u
O U wilding I agree to comply with y city and county ordinances and stem laws relating On
e
�C.7 ishow-memkinedlding prmandher my audorpur,ci anuli es of this city to enter Upon lbe
ahnillim. rigimproperty for inspection which ea
F y (We)agree to save,indemnify and keep harmless me City of Cupertino against
rA inconsequnce of she gratsand expcnsemit. may in anywayurneagaimisaid City
C)z inconsequence NDER TAN of Nis pertain.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT Issued by: Date 2 /
SOURCE RE FLATIONS.
P' �� f'2- I 'T� 3 Re-roofs
a -f <v
Signum of ApplicH Z _ARDOUS MATERIALS DISCLOSURE Oam Type of Roof
Will de applicant or furore building occupant a.or handle breardous material
as defined by me Cupertino Municipal Codc,Chapter 9.12.and the Health and Safety
,1111111�udo,Section us3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
�. �No
ww the, ream m future Wilding amr of rte If a roof is installed without first obtainingan inspection,I agree to remove
No PP g W cyuipment m ueHcrs which P g
it havfdous air contaminants as dcrined by dm Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes [3 No
I have read the harandous materials requirements under Chapter 6.95 of the Califor.
.is Halm&Safety Code,Seeumu 25505.25533 and 25534.1 unfsrsand Our if do Wilding
docs not currently have a tenant,don it is my mspomibility m notify the occupant of Ne
mquiremcntswhich muslW metpiortussumccora Ccnificamafacupmry. Sig attire Of Applicant Date
_ �. � ;? (2_ , 3 _�
Owner or authorims!agent D,m All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
' 4 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
D3i d S, z o aG
OWNER'SNAME: PHONEHs? — 08
GENERAL CONTRACTOR: 13�txrwv.;� Cin FAX # (-c 7t 1 'I ZE- S 7 S
I am not using any subcontractors: n r`Z /Z - (
Signature Date
Please check applicable subcontractors and complete the followin 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/Contractor Signature Date
CITY OF CUPERTINO
0 DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# / —I::.- Date:
Building Address:
( (.) 1 rlk `I.vz�-
Owner's Name: �Ipne#:
Contractor: � � License #:
Conta Phone#:
�I--, � u.' L�,.�c,�r„�,�
Applicant/Contractor:
Building Permit Info:
Bldg El Mech
Job Description:
Residential: (�L�L h/� ,�"� ✓ Commercial: d S'G�r\nQc
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
o
Type of Construction: Occupancy roun:—
Qty. if
Applicable Fee ID Fee Description Fee Group
1 BPERMFEE Bld Permit Fees BUILIDNG
i
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG