13020037I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10067 BYRNE AVE I CONSTR CT ON BERINGER I PERMIT NO: 13020037
OWNER'S NAME: INDERJEET SINGH I PO BOX 6676 I DATE ISSUED: 02/08/2013
OWNER'S PHONE: 4083904650 I SAN JOSE, CA 95150 I PHONE NO: (408) 881-0512 I
❑ LICENSED CONTRACTOR'S DECLARATION
(� 4I,
License Class Lic. N �zs (i i -1
�P 1�� R. CONS Datte �l t�
Contractor o -LO
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above 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 accrue against said City in consequence of the
granting of this permit Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
i
Signature Date 0
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 &Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that. in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infornation is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above 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 accrue against said City in consequence of the
granting of this permit Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
JOB DESCRIPTION: RESIDENTIAL
TEMPPOWER
Sq. Ft Floor Area: I Valuation: $100
APN Number: 35711003.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 18 DAYS OF PERMIT ISSUANCE OR
180 D= LAST CALLED INSPECTION.
Issued by: Date
v RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: 10110 _ Dater
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
upf, VQ9riMA9Pnl2 _RITunINf DIVISION
NOTE: This estimate does not includejees due to other ueparrments p.c. �.an...s, •...•n�, - •• ,------- __. _
__.: _-_ r'nnmrt the Dont far addn'l info.
District efc.. Thesefees are based on me rettmtna
FEE ITEMS (Fee Resolution 11-053 C . 7�
l T1<,n c hrrk
-
Elec. Plan Check 0.0 hrs $0.00
10067 BYRNE AVE DATE: 02/08/2013
REVIEWED BY: MENDEZ
limiADDRESS:
Urher )tech. hnq�.
'VALUATION: $100
Other Elea Insp. 0.0 hrs $45.00
APN: I BP#:
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*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
PENTAMATI0N 1REAP14
SFD or Duplex
10
PERMIT TYPE:
:
Suppl. Insp. Fee.e Reg. 0 OT
0,
hrs
$0.00
MEMPPOWER
PE
PME Unit Fee:
NOTE: This estimate does not includejees due to other ueparrments p.c. �.an...s, •...•n�, - •• ,------- __. _
__.: _-_ r'nnmrt the Dont far addn'l info.
District efc.. Thesefees are based on me rettmtna
FEE ITEMS (Fee Resolution 11-053 C . 7�
l T1<,n c hrrk
vlll;�h Ptrl„ Ill�t,
Elec. Plan Check 0.0 hrs $0.00
t.tr,h. Pr;,uir I i•.-
17nmi. Pc nrlir Y�rr
Elec. Permit Fee: IEPERMIT
Urher )tech. hnq�.
Orel-� t>nlll,t� b�,,,.
Other Elea Insp. 0.0 hrs $45.00
i-lach. Lnp. I?c.
I hmd, bal - l e.<:
_ n.. u:., u1
0", rmp, hu':
- -t. G:.e C....:mnr .Cower Dictriet. SCA00l
NOTE: This estimate does not includejees due to other ueparrments p.c. �.an...s, •...•n�, - •• ,------- __. _
__.: _-_ r'nnmrt the Dont far addn'l info.
District efc.. Thesefees are based on me rettmtna
FEE ITEMS (Fee Resolution 11-053 C . 7�
ars orrnuaaa acn.ano.o
FEE
�•.....•
QTY/FEE
�•••
-••--•-----_. _ ___ _.
MISC ITEMS
Plan Check Fee:
$0.00
L13 amps Electrical
$45.00 /ERT<200 Temporary Power
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg. 0 OT
0,
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
�OIlSh7(!'ilOn Tax.
Administrative Fee: (ADMIN
$42.00
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee
$0.00
Select a Non -Residential
Building or Structure
O
A
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$133.50
$45001
TOTAL FEE: $178.50
Cevlbwu. V vu ucu i.:
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228• FAX (408)777-3333
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E-MAIL
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FAX
CONTACT NAME
PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER .AGENT
*CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TEN.ANT
CONTRACTOR NAME
LICENSENUMp
LICENSE TYPE
BUS. LIC#
COMPANY NAME
FAX
STREETADDRESSP(, 1U'"
%
CITY, STATE, ZIP`1 J,� _
PHONE t
ARCHITECTIENGIEEEd NAME
LICENSE NUMBER
BUS, LIC#
COMPANY NAME
E-MAIL
FAX
S =ET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑COMMERCIAL
PR03WTIN WILDLAND ❑ IFS
URB AN LNTERFACE AREA NO
PROJECTIN ElYES
FLOOD ZONE No
IS THE BLDG AN [IYES
EICHLER HOME? [I NO
DESCRIPTION OF WORK
TOTAL VALUATION: 100
RECEIVED ALL
By my signature below, I certify to each of the following:
application and the information I have provided' correct.
ordinances and state laws relating to b I I g c struction.
Signature of ApplicanVAgent
I am the property owner or authorized agent to act on the operty owner's behalf. I have read this
I have read the Description of Work and verify it is ace e. I agree to comply with all applicable local
I authorize representatives of Cupertino to enter the above -identified propeffy for inspection purposes.
Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
y�
OVER-THE-COUNTER
Y
❑ EXPRESS
U
U
❑ STANDARD
Z
❑ LARGE
❑ MAJOR
M6PMiscApp_1011.doc revised 06121111
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: O V M\G
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:/I V('0frBUSINESS
LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: —
Signature
Please check applicable subcontractors and complete the following information:
Date
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date