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07080196 77777777777777777 CITY OF CUPERTINO BUILDING DIVISION PERMITS PERMIT NO. BUILD�x�ggp�xEssS PORTAL AVE GOLDEN STATE BUILDERS 07080196 l j PERMIT ISSUE DATE OWNER'S NAME: MAHESH MATHUR BUTHAM 148 E V::RGINIA ST 08/21/2QO7 SANITARY NO. CONTROL NO. NE: 4082871221 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1%Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is INSTALL JAMES HARD I LAP SIDING R/R SIDING "C y in full force and effec Z License s Lic.p p DatC • Uf- contractor 'F w ARC CTS D I aa < I understand my plans shall be used as i,U U.ti Licensed Professional a OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the : :no following reason.(Section 7031.5•Business and Professions Code:Any city or county pair any s which requires a permit to construct,alter,improve.demolish,or re structure prior to its issuance,also requires the applicant for such permit to file a signed statement g ;Ft. Floor Area Valuation that he is licensed pursuant to the provisionsof die Contractor's License Law(Chapter 9 � 18OOO h (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation ofOccupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3690501 ; , Number not more than rive hundred dollars(5500). 0 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 Contractors License Law does not apply to an owner of 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 We.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.). 0 I,as owner of the property,am exclusively contacting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worlizes 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. M War ' Com Compensation a carrier and Policy number are .... Y �� Cartiera Policy No..CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z -- CONSTRUCTION LENDING AGENCY Er I hereby affirm that there is a construction lending agency for the performance of Q: > the work for which this permit is issued(See.3097,Civ.C.) Lender's Name z Lenders Address U C) I certify that 1 have read this application and state that the above information is tf. correct.I agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Mto liabilities,judgments,costs and expenses which may in any way accrue against said City r 2 U Z in consequcncelif the granting of thi it Date l �- AP ANT DERST DS A 1 O PLY WITH ALL NON-POINT Issued b'r: SQ R EG TI S / Re-roofs aturc Applicant/Contractor Dare HAZARDOUS MATERIALS DISC OSURE Type of Zoof 0 the applicant or future building occupant sto o handle hazardous material d cd by the Cupertino Municipal Code•Chapter 9.1 .and the Health and Safety Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant r future building occupant use equipment orevic devices all new materials for inspection. ait hazardous air contaminants as defined by the Bay Arca Air QualityManagement District? 0 Yes _[ o 1 have read the hazardous marc• require encs under Chapter6.95 of the Califor- nia Hcalth&Safe Code.Sccti 25 , 533 d 534-1 understand that if the building does urentl have a tcn tha i my po ibifty to notify the a:cupant of the Date requremc w i h usst tpri issu a TicatcofOcc cY• Signatur-of Applicant All roof coverings to be Class"B"or better 0 ner or uthorizcd agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIP RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36905016 . 00 DATE ISSUED. . . . . . . : 08/21/2007 RECEIPT #. . . . . . . . . : BS000002443 REFERENCE ID # . . . : 07080196 SITE ADDRESS . . . . . : 10153 S PORTAL AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MAHESH MATHUR BUTHAM ADDRESS . . . . . . . . . . : 10153 S PORTAL AVE CITY/STATE/ZIP . . . : CUPERTNTO, CA 95014 RECEIVED FROM . . . . : GOLDEN STATE BUILDE CONTRACTOR . . . . . . . : GILL, FARR LIC # 21174 COMPANY . . . . . . . . . . : GOLDEN STATE BUILDERS ADDRESS . . . . . . . . . . : 148 E VIRGINIA ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : 4082871221 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ----------- ------------- ---------- ---------- ---------- ---------- ---------- 13ENERGY PERMIT FEE 255.96 122 .86 0. 00 122 .86 0. 00 13PERMFEE VALUATION 18, 000. 00 255.96 0. 00 255 .96 0. 00 BSEISMICRE VALUATION 18, 000. 00 1.80 0. 00 1.80 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 380. 62 0. 00 380.62 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 380. 62 40995 --------------- TOTAL RECEIPT 380. 62 MF CITY OF CUPERTINO CITY F PERMIT APPLECATION FORM CUPEkTINO 0-76 R o l 6P '�PN# Date: �Cp �C�sOi � � y ?-ak % 074= Building Address: _Mailing Address (if different from building address): Owner's Name: Phone#: Contractor: License #: Coontta"ct:� Phone:,16"JL• La-a I Cupertino Bus rl�s License#: --I Fax: �. • 1 Co l Ll Building Permit Info: Bldg 11� Elect ❑ F lumb ❑ Mech ❑ Job Description: ` Residential �— s N�' Commercial ElSq.Ft. Floor Area: 10 APAQ1 GAR Sq.Ft.: stoIt-16 10 Cost of Project: Occupancy Group: 112s o=)(=) Q1- 3 Type of Construction: Please check this box if the project is a IX-Nncc� ' yam second-story addition: El roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID :Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bol'ler<= 100,000 Btu MECHANICAL BBOILER2 Boiler-> 100K to 500K Btu MECHANICAL BBOILER3 Boil,-.r> 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 In(UOff/Comm/Quasi BUILDING BCONSTAXBQ Coal. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 El,-,c 600V <= 1000A ELECTRICAL BELEC1001 E(ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD F?nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 Community Development - 10300 Torre Avenue ?, Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 17UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # to l > S • oi�-�-�L.. OWNER'S NAME: VAPV4es PHONE # GENERAL CONTRACTOR FAX # I am not using any :subcontractors ' 0 •a S:gnature Date Please check applicable subcontract d corn plete the fo owing information SUBCONTRACTOR BUSI14ESS 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 A L U*,,�ner/Contractor Sign tune Date �. Community Development Depa rtm !nt Building Divis on City of Cupert no 10300 Torre Aver tie Telephone: (408)7i'7-3;28 �lTY of Fax: (408)i�'7-3; 33 %,LTEkTINO Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re—roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building;inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. i. All roofs shall be inspected prior to an) roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. a. If plywood is installed, a plywood nail inspection is required. r. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1.R Flat roofs must have a minimum of 1/a' per foot slope and demonstrate that there is no ponding. 2. An I.C.B:O. report is required to be on he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: .•�'//ei �/� moi ' /��'g Joh Site Address: �o�O y— ��y% �o. ��-� �• Roofing Company Name: A plicant's Signature: ,�/=�—� • ""�-----nate: l 1 Crag teal Building Official Revised 1/30/03 Printed on Recycled Paper