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07030115 CITE'OF CUPERTINO BUILG;NG DIVISION PERMIT C� C � INFU]�MAT�O Bu1Lr�rj TA'ssB:ELLEVUE AV SEARS HOME IMPROVEMENT P07030115 OWNER'S NAME: PERMIT ISSUE DATE GILL TEJINDER S AND SARJIT K 283 E. AIRWAY BLVD. 03/15/2007 )NE: SANITARY NO. CONTROL NO. (925) 245-2000 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT o PLUMB MECH a 0 a &Z LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and Profcssiuns de.and my license is INSTALL 794 S Q.FT. VINYL SIDING (BACK ONLY) 87 o. in full fore and effect.J2 1 ; � License Class Lic.B �/ C L.F. FASCIA/ LOFT, REMOVE AND REPLACE 141 3 E o Date Contractor ARCHITECTS DECLARATION SUP. STRAND WOOD, NON—STRUCTURAL a U 1 understand my plans shall be used as public records y y Licensed Professional ;w.j OWNER-BUILDER DECLARATION 2 a f 1 hereby affirm that I am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county < Pi which requires a permit to construct,alter•improve•demolish,or repair any structure aYy prior k)its issuance,also requires the applicant for such permit to file a signed statement x that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor AreaValuation 2 t- (commencing with Section 7000)of Division 3 or the Business and Professions Code)or $8794 8794 1. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of aRC A g Number QCCII not more than eve hundred dollars($500). 3 5 7 01 0 2 8 . DU Occupancy Type ❑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 and Professions Code:The Contractor's License Law does not apply to an owner of, Required Inspections progeny who builds or improves thereon,and who does such work himself or through his' own esaployV4,provided that suare ch improvements an6fintendedoroffered for sale.If, however,the building or improvement is sold within one year of completion,the owner- 4 wner builderwilt•havq the burden of proving that he did not build or improve for purpose o( sale.). Q.L as owner of the property,am exclusively contracting with licensed contractois_to construct tltt!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 contractor(s)licensed pursuant to the Contractor's Licepse'Law. - - _ []I am exempt under Sec. B&P C for this reason' _Owner..__, - --__.. _____. ___.._Date _ _ - __ _. .i.. _. _7WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will ritaimaln aCeni(ieaile,gf Cotlsehtto'self-insure for Workees Compen-0 cation;asprgvided:fpr by Seciiom.3700 of die{abor Code,,for the.performance of the . . 'Work^.felrwblch:ltls perAtrl.IS{SSUCd. .,.r .:.: '- .... [7 l f;ave and iwimaintain Worker's Cogipensation Insurance,as required by Section, 3700 of the'labor Code,for1110-pceformancc of the work for which ilk's permit is issued. My Wtst WfttCMftW4aup Z mor Pull Bomber are Carrier.'A Cer:y h .: 3YO aD CERTIFICATE.OF-EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i(This section seed.Qt bocpmpleted ifihe pemtit is for.onc hundred dollass{S.IQO form'or lcs�•)r pcIn _ Laws of Ca`(1{orcin inDanre mind of the work Cor tubi this permu is LSsued j Sh511 non P d f R y go as to become subject to the Workcis Coittflensation n . Applicant NO I ICE t(5 APF"tic N1 if after making this Cegtecatc of Exemption you;ItoZld. Webme Sobjcst to the;Wotker'V thpcnsaiion provisidn3 of the Labor Codc,ybd mdst ! =Z 9orllniiilh'eemplyw(th such provisions or this permit shall be deemed revoked. a that there is co• tructioni�idin .a c u of _ CON$'i'Rt)CTI¢N LENDWO AG�1+1CY ; I.betekY,frtfm. ? ^r g z ticycfor the p_rfurman .ac. Gr,C.) �i ltic warktor which dtis,permit is.iss d{Sec.3097r A Lggdcr's Namc. (.pnder's.Addre'ss ;) I certify Uiat-1 hive read this application and'state that the abiivc information iso i, correct.I agree to comply with all city and county ordinances and state laws relating to, =V buildi(tg,coo;ykcy'pn.;aodhcmbyauthoO7zccprWilL.4liy Qflhiscily(ocgter.uppitbhc �+W ah4Ye-mWltion:d Propcity(x tnspepoon PuTosm. C>w (Wc)agree to.save indemnify,and kocp harmless the City of Cuperlmo against; ..� to Jtabtliues ludgmcnu costs and6Ep4ttsQa which may in any way accrue agatnst.said,Cily .� in consequence of the'granung;oftbi3jXrmit. / A PEW QA , STANDSL COM Y,WITH ALL NON-POINT; Issued by: Sr Date �J SOURCE s. - _ Re-roofs Signature of Applicant Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or futum building occupant stere or handlq hazardous materials as defitred by the C*h1oo Municipal Code.Chapter 9:12 and the'H'ealth and Sat'ety C6& Stttiori 255s3(a)9t All roofs shall be inspected prior to any roofing material being installed. n : Will use heart nrrntarc,buiidin tiCCp,ant If a roof is ins(ailed without first obtaining an inspection,I agree to remove i app g.. P ux equipment ordcvices which _mn hazardous air.comaminan as,dcrmcd b the ay,Area Air Quality Manage incni all new materials for inspection. District? y I have read the hazardous matcrialsrtquirements undcrChapter 6.95 of the Califor nia Health&Safcty Code,Sections 25505,25533 and 2553.4.1 understand that if the building does noucurrbhlly have a i6nah tit il'u y W14D to nritly the occupanCbY`rfsc Mge nbe t to u n;rieateofoccupancy Signature of Applicant Date '. Owner oi,pxgtboriza9 agent Rate::_. All roof coverings to be Class'iB"or better CITY OF CUPERTINO � 7,°,3�0 C1 F PERMIT APPLICATION FORM CUPEkTINO 'PN#� � Date: Building Address: Mailing Address (if different from building address): _.227 ✓ � UC - Owner's Name: Phone#: S N J 17- Gig - P Es-- "7 a Contractor: License`-I #- 7�-1 rz4 RS �✓`r!" ICl [ Qontact: Phone: Cupertino Business License#: J.-W f. Fax: 3/-6- Pr— _? Building Permit In o:/NS)9LL r) QC1Lj vt,,jYi- �(Ot^G CK U L, -f !9 - "l o SoFFI?��MV�� Bldg Elect ❑ Plum i ❑ Mech ❑ Job Descriptio 11 Residential Commercial El Sq.Ft. Floo Area: Sq.Ft.: Cost of Project: Occupancy Group: 2 - � Type of Construction: Please check this box if the project is a second-story addition: ❑ - roject Size: Standard ❑ ----Large ❑ - Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL BBOILER3 Boiler> _'100K to IM Btu MECHANICAL BBOILER4 Boiler> 1:V1 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 Hote. and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 60)V<= 1000A ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscelaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Cor.un Mechanical MECHANICAL BNUCOMMP New C omm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmosp Zeno Vacuum PLUMBTN`G _ BPCESSPOOL ct�sspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pbl; Fixture PLUMBING BPGAS Gas Pipi ig System Fee PLUMBING BPINTERCEP Ind Way to Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Chock Add Multi BUILDING BPLANCKREP Plan Chc:ck Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm'Rain Water PLUMBING BPTRAP- - -- - - Kitchen Trap PLUMBING .,_ BPVENT_ Alt of Drain &Vent PLUMBING BPWATER Inst Ali/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PL_UM_BING BPWSVCS —,- --� - aiTiier Service PLUMBING BREINSPECT - Reins section Fee BUILDING BREMACOVER - A/C Unit > 10,000 do MECHANICAL BRENIAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appli ince Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocati Dn of Furnace MECHANICAL BREMFURNOV Relo Fun tace> IOK 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 BREMRELOCA Relocat ion of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 a-V CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORINT CUPEkTINO Quantity Fee ID Fee ;Descri tion Fee Group BREMSIGNAD Rmdl Si,;ns 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 _ I BL1I I3INC BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tem )rary Power ELECTRICAL BTEMPPERM Tem orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Busir ess License BUILDING ELECTRIC Elect-ical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING -PL-L-ONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lon;;Range Residential PLANNING ZADDCHG Addr,-ss Change BUILDING 3 of 3 CITY OF CUPE RTINO 3 ITEMS' OF 3 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rsn.g: Sub: Blk: Lot: APN . . . . . . . 357010,', 8. 00 DATE ISSUED: . . . . . . : 03/15/,,007 RECEIPT #. . . . . . . . . : BS000000698 REFERENCE ID # 070301:.5 SITE ADDRESS 22278 BELLEVUE AV SUBDIVISION . . . . . . CITY CUPERT==NO IMPACT AREA . . . . . . OWNER GILL T1lJINDER S AND SARJIT K ADDRESS CITY/STATE/ZIP . . . : CUPERT: NO CA, 95014-2703 RECEIVED FROM . . . . : RECEIP" INTERFACE CONTRACTOR . . . . . . . : MARK C GOOD LIC # 23097 COMPANY SEARS ]TOME IMPROVEMENT ADDRESS 283 E. AIRWAY BLVD. CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE (925) 215-2000 FEE ID UNIT QUANTITY AMOUIT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---- BPERMFEE VALUATION 8, 794 . 00 18.76 0. 00 158.76 0. 00 BPLANCHK PERMIT FEE 158.76 211 . 87 0.00 211. 87 0.00 BSEISMICRE VALUATION 8, 794 . 00 0. 90 0. 00 0. 90 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 371 . 53 0. 00 371. 53 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 371 .53 1242 --------------- TOTAL RECEIPT 371 .53 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . 35701028. 00 DATE ISSUED: . . . . . . : 03/15/2007 RECEIPT # . . . . . . . . . : BS000000698 REFERENCE ID # . . . : 07030115 SITE ADDRESS . . . . . : 22278 BELLEVUE AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER GILL TEJINDER S AND SARJIT K ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2703 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MARK 2 GOOD LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 283 E. AIRWAY BLVD. CITY/STATE/ZIP . . . : LIVERKORE, CA 94550 TELEPHONE . . . . . . . . . (925) 245-2000 FEE ID UNIT QUANTITY AMO:JNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 8, 794. 00 158.76 0. 00 158 .76 0. 00 BPLANCHK PERMIT FEE 158.76 211. 87 0. 00 211. 87 0. 00 BSEISMICRE VALUATION 8,794 . 00 0. 90 0. 00 0.90 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 371.53 0. 00 371 . 53 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 371.53 1242 --------------- TOTAL RECEIPT 371 .53 CITY OF CUPEFTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . 3570102E . 00 DATE ISSUED. . . . . . . : 03/15/2C07 RECEIPT #. . . . .`. . . . : BSOOOOOC698 REFERENCE ID # . . . : 0703011_` SITE ADDRESS 22278 BE,LLEVUE AV SUBDIVISION . . . . . . CITY CUPERTID O IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GILL TE�INDER S AND SARJIT K ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTID"O CA, 95014-2703 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MARK C C-OOD LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 283 E. F.IRWAY BLVD. CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE (925) 24E-2000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------- --- ---------- ---------- ---------- VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- - ------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST Community Development 10300 Torre Avenue Cupertino CA 95014 }' Telephone(408)777-3228 Fax(408)777-3333 Cfflf OF . UPEkT1NO BuildipZ 7HONE # artment JOB ADDRESS: RMIT# V �-2 8 EC.L vu 8 A �� _,`70 o�l� OWNER'S NAME: J j l K. a SY— /17 o GENERAL CONTRACTORS 140-M O I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete he followin information: SUBCONTRACTOR BUSINES'p 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 Date Owner/Contractor Signature