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10080143 CITY OF CUPERTINO BUILDING PERMIT 19489 ROSEMARIE PL UNIT 1 WILDING ADDRESS: CONTRACTOR:DANG'S CONSTRUCTION PERMIT NO:10080143 3805 MAS TERS CT DATE ISSUED:08/20/2010 )WNER'S NAME: MAITRI,INC PHONE NO:(408)365-8615 SAN JOSI',CA 95111 )yNER'S PHONE: 4084368393 JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL `] LICENSED CONTRACTOR'S DECLARATION REPLiLCE 7 DOUBLE PANE WINDOWS,UPGRADE SUB License Class Lic.# PANEL, Date Contractor 1 hereby affirm that I am licensed under the provisions 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 Valuation:$9250 performance of the work for which this permit is issued. Sq.Ft F oor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Ni mber:37501008.1 permit is issued. APPLICANT CERTIFICATION p ERMIT EXPIRES IF WORK IS NOT STARTED 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 NITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter 80 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save f� ' indemnify and keep harmless the City of Cupertino against liabilities,judgments, Date: 'L2-a— costs,and expenses which may accrue against said City in consequence of the Issued by: 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. RE-ROOFS: Date___ All roc fs shall be inspected prior to any roofing material being installed.If a roof is Signature installs d without first obtaining an inspection,I agree to remove all new materials for inspec ion. OWNER-BUILDER DECLARATIONDate: Signal are of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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&Professions Code) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). P Califrrnia Health&Safety Code,Sech'ons 25505 requirements under Chapter 6.95 o 25533,and 25534. I will the Chapter 9.12 and the I hereby affirm under penalty of perjury one of the following three Heal hmainta'n compliance with the Cupertino&Safety Code,Section 25532(a)should Is toreCode,al or handle hazardous or devices which emit hazardous declarations: I have and will maintain a Certificate ti Consent to of the Labor e for Code,for the Worker's material. Additionally,should I use ntaminants as defined by the Bay Area ent Air Quality Management District I Compensation,as provided for by Section 3700 will maintain compliance wik—t— I upertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,S550,25533,and 25534. k 10 I have and will maintain Worker's Compensation Insurance,as provided for by n. Date: Section 3700 of the Labor Code,for the performance of the work for which this Owr er or authorized agent permit is issued. certify that in the performance of the work for which this permit is issued,I shall e Worker's CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to th Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must wor b for which this permit is irm that there is a sued(Sec.3097,CrveC)for the performance o forthwith comply with such provisions or this permit shall be deemed revoked. Len der's Name APPLICANT CERTIFICATION Ler der's Address 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 building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, y Tans shall be used as public records. and expenses which may accrue against said City in consequence of the I u iderstand m p ng of this ermit.Additionally,the applicant understands and will comply witn all non--p t s urce regulations per the Cupertino Municipal Code,Section Lis ensed Professional 9.18. C � Date U Signature Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 CONTRACTOR/SUBCONTRACTOR LIST Fax: 408-777-3333 ;ADD=RESS: E: PERMIT# Q TRACTOR: PHONE# BUSINESS LICENSE# *Our municipal code requires all businesses working in the city to haveCITY�a City Of Cupertino busin NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) ess license. BE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE BISA CITY UNTIL THE TAINED BUSINESS LICENSE. OF CUPERTINO I am not using any subcontractors: Please check applicable subcontractors and complete the 1following information: Date ✓ SUBCONTRACTOR BUSINESS NA WE Cabinets & Millwork BUSINESS LICENSE # 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 r� Owne /Contractor Signature f Date CITY OF CUPERTINO OPERATOR: SylviaM 4 ITEMS OF 21 PERMIT RECEIPT COPY # � 1 Sec: Twp: Rng: Sub: Blk: Lot APN 37501008 1 DATE ISSUED. • • • • • ' : 08/20020L035 RECEIPT #• • " ' . 10080143 REFERENCE ID # SITE ADDRESS . . . . . . 19489 RCSEMARIE PL UNIT 1 SUBDIVISION • • . . . . : CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . • OWNER • MAITRI, INC 234 E G:-SH RD STE 200 ADDRESS CITY/STATE/ZIP SAN JOS];, CA 95112 RECEIVED FROM MAITRI CONTRACTOR CU DANG LIC # 25481 COMPANY DANG' S CONSTRUCTION ADDRESS 3805 MASTERS CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : (408) 365-8615 UNIT QUANTITY AMOUTIT PD-TO-DT- -THIS-REC- --NEW-BAL- FEE ID ------ ----- ---- - 0 .75 0 .00 ---- ---------- ---------- 0 .75 0 .00 0.00 ------ VALUATION 9, 250 .00 0 .00 1 .50 1BCBSC9, 250 .00 1.50 15 .75 0 . 00 1BSEISMICR VALUATION 1 .00 L5.75 0 .00 0 .00 1ERT2001K UNITS 139 . 50 0 .00 189 . 50 1.00 ---------- ---------- 1WINREP EACH 8 _--- 207 .5 ---------- 207 .50 0.00 207 .50 0 . 00 TOTAL PERMIT CITY OF CUPERTINO �`1T NO GENERAL BUILDING cvP �, PERMIT APPLICArCION FORM 0/ 3 Date: - c 0 APN # � ') UiC7v - I Building Address: ��, pS ��i C ' L ct c U + I- 1 � Mailing Address if different from building address): `� &A ,�� -Z 2 3cI C�rsrf � �n s I C v - ' �, Are Hazardous Materials being used as part of this projez Yes No ❑ If es provide letter from HOA HOA: xterior work only) Yes ❑ NO phone#: Owner's Name: u Phone: � o g - 23`��- �.�12 Contractor: (��v Ct � Cx,�N ST I�v C'r� u N` Fax: Contractor License#: 6 67 c 4/ Cu ertino Business License#: phone: u o , S� S - 6 9 7 l Contact: Fax: Zesidential Commercial Job Description: In I C( Lt Building Permit into: Elect ❑ Plumb ❑ Mech C3Bld J Occupancy Type: Type of Construction(Usage Class): II/111/V-A ❑ II/III B, IV-HT,V-B 21 1-A, 1-B ❑ Square Footage: Valuation: Pro'ect Size: Ex ress ❑ Standard ❑ Large ❑ Major ❑ J Gsheet reen Building: Please complete relevant portion of tike Green B i dlt& the D Chendext & attach it to the application or if applicable, in.lude in plan se Points Achieved: or help, contact Build it Green at www.buildit reen..)r Revised 07/14/09