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07050250 CITY OF CUPERTINO BUILDING'DIVISION PERMIT ® k � C?I2 Zt ? T ©lY; BUILDING ADDRESS: PERMIT NO. 10218 TONI CT XTERIA INC 07050250 OWNER'S NAME: PERMIT LSSUE DATE ALOK GOYAL PO BOX 5460 05/24/2007 )NE: SANITARY NO. CONTROL NO. (408) 289-5353 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description %m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 70(10)of Division 3 of the Business and Professions Codc,and my license is REMOVE 39 S Q. OF EXISTING WOOD SHAKE ROOF AND in full License roc an ff c Lic.M Z in � (°/O� APPLY 36" MOISTURE BARRIER IN VALLEY AREAS, AND conARCHITE1-13DECCLARA ON ROOFERS SELECT UNDERLAYMENT i a< I understand my plans shall he used as public records )yU U.y Licensed Professional 0 J OWNER-BUILDER DECLARATION `10<2 1 hereby affirm that I am exempt from the Contractors License Law for the :CO following reason.(Section 7031.5,Business and Professions Code:Any city or county ,�, which requires a permit to construct,alter.improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation EEO 1-- (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $7000 L 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 Q� Number Occupancy Type not more than five hundred dollars($500). 3162310 1 V ❑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 ns Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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.). ❑1,as owner of the property,am exclusively contracting 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 contractor(s)licensed pursuant to the Contractor's License Law. ❑1 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: L]1 have and will maintain a Certificate of Consent to self-insure for Worker's 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 Codc,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are:: Carrier.STA �'/�D Policy No.: I00j/ —1-VO-07 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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'Compcnsadon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z h"' CONSTRUCTION LENDING AGENCY E~- CA I hereby affirm that there is a construction lending agency for the performance of Q!> the work for which this permit is issued(Sec.3097,Civ.C.) Lender's Name 2 Lcndees Address U C) I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction.and hereby authorise representatives of this city to enter upon the W ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities•judgments•costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Z vZ7 APPLICANT NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC TIONS. Re-roofs Signature of licant/Contractor bate HAZARDOUS MATERIALS DISCLOSURE Type of R)of Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed. ❑Yes Jj]No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m Iterials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth afety Code.Sections 25505.25533 and 25534.1 understand that if the building does n cu oily have a�tcnant.that it is my responsibility to notify the tofthe requi which must et priors issuance oCa Certificate of Oc a Signature �f Applicant Date ownermr uthorizcd agcnDa' All roof coverings to be Class"B"or better INVOICE INVOICE INVOICE INVOICE IrfVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31623101. 00 INVOICE DATE. . . . . . : 05/24/2007 REFERENCE ID # . . . : 07050250 SITE ADDRESS . . . . . : 10 :18 TONI CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . . ALOK GOYAL ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2073 CONTRACTOR . . . . . . . : PH:=LLIP ULLIO LIC # 22346 COMPANY . . . . . . . . . . : XTERIA INC ADDRESS PO BOX 5460 CITY/STATE/ZIP . . . : SAN JOSE, CA 95150 TELEPHONE . . . . . . . . : (408) 289-5353 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ----------------- ---------- ---------- ---------- BLDG PERMIT FEES PRINTING :?ERMIT 137 .16 0. 00 137 . 16 SEISMIC FEE RES PRINTING :?ERMIT 0.70 0.00 0.70 ---------- ---------- ---------- 137. 86 0. 00 137 . 86 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN . . . . . . . . . 31623101. 00 DATE ISSUED. . . . . . . : 05/24/2007 RECEIPT #. . . . . . . . . : BS000001457 REFERENCE ID # . . . : 07050250 SITE ADDRESS . . . . . : 10218 TONI CT SUBDIVISION . . . . . . . CITY CUPERTINO INO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . ALOK GOYAL ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2073 RECEIVED FROM . . . . : XTHRIA, INC CONTRACTOR . . . . . . . : PH:=LLIP ULLIO LIC # 22346 COMPANY . . . . . . . . . . : XTERIA INC ADDRESS PO BOX 5460 CITY/STATE/ZIP . . . : SAN JOSE, CA 95150 TELEPHONE . . . . . . . . : (408) 289-5353 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 7, 000. 00 137 .16 0.00 137 .16 0. 00 BSEISMICRE VALUATION 7, 000. 00 0.70 0. 00 0.70 0.00 - --------- ---------- ---------- ---------- TOTAL PERMIT 137 . 86 0 .00 137 .86 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 137 .86 1863 --------------- TOTAL RECEIPT 137 .86 t CITY OF I.UPERTINO RE ROOF LUPE TINO PERMIT APPLICATION FORM APN # I Date 5/a /ate Building Address: L �FC7700 c19 Owner's Name: Phone #: /a OK GU SAL (6,,50) 1l?i 31b Contractor: License #:&aIXZ Contact: Cupertino Business License #: -.2,;) 3 4/6 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ® Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ® To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu)ertino's Tear Off Policy: l Job Description: /�P/np�' 0 gq Sauaie cf E`er/fTj C .4q,Qe,0 1/I U,a A2t�S �o, 4o-'er$ ,��� u�{e�/a�rne/Jf. Residential Commercial ❑ Fire Zone: Yes ❑ No [ Confirmed with Planning Dept. if there are an restrictions: U Cost of Project: Type of Conk tion: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue :f Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: 10211'r TU.vI c r- PERMIT# Ca4W-771M 5006 7 LI-2 0 OWNER'S NAME: S7-,'-ve' :(72 '0, l) PHONE# GENERAL CONTRACTOR: Sri,V€ FAX# I am not using any subcontractors: ZV-/a Si€nature Date Please check applicable subcontractors and comT Tete 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/Contractor Signature Date