10080145 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19489 ROSEMARIE PL UNIT 2 CONTRACTOR:DANG'S CONSTRUCTION PERMIT NO: 10080145
OWNER'S NAME: MAITRI,INC 3805 MASTERS CT DATE ISSUED:08/20/2010
°''NER'S PHONE: 4084368393 SAN JOSE,CA 95111 PHONE NO:(408)365-8615
LI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# REMODEL KITCHEN 77SQ FT,BATH 65 SQ FT REPLACE 7
WINDOWS,UPGRADE SUB PANEL AND REPLACE
Contractor Date FU1'NACE
I 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. Sq.F Floor Area: Valuation:$25250
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. APN Number:37501008.2 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agreecomply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the /��,// � L
granting of this permit. Additionally,the applicant understands and will comply Issue I by: /-rl�F- el_ Date: -2-�
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
instaBA without first obtaining an inspection,I agree to remove all new materials for
OWNER-BUILDER DECLARATION inspec:ion.
'
I hereby affirm that I am exempt from the Contractor's License Law for one of Signat ire of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
Califo•nia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maints in compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Healtb&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air cor taminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will mAntain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the He rlth&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �C_ ( — tl
permit is issued. Owner or authorized agent: <- Date:
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereb-,affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's or which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender'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
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
`s,and expenses which may accrue against said City in consequence of the I under tand my plans shall be used as public records.
ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section License I Professional
9.18.
Signature '4 iJ'l l Date lZ V
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (P PERMIT# d ��
OWNER'S NAME: cu4iZr1G PHONE#
GENERAL CONTRACTOR: ✓\, BUSINESS 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 SUBCONTRACTOF.S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
le
i
t6
O ner/Contractor Signature Date
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: SylviaM
8 ITEMS OF 21 COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37501008 . 2
DATE ISSUED. . . . . . . : 08/20/20:_0
RECEIPT #. . . . . . . . . : BS000011235
REFERENCE ID # 10080145
SITE ADDRESS 19489 RO3EMARIE PL UNIT 2
SUBDIVISION • • • . . CUPERTIN�
CITY . . . . . . . . . . . .
IMPACT AREA . . . . . .
OWNER MAITRI, INC
ADDRESS 234 E GISH RD STE 200
CITY/STATE/ZIP SAN JOSE , CA 95112
RECEIVED FROM MAITRI
CONTRACTOR CU DANG LIC # 25481
COMPANY DANG'S CONSTRUCTION
ADDRESS . . . . . . . . . . : 3805 MASTERS CT
CITY/STATE/ZIP . . . : SAN JOSE,
CA5 95111
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL-
--------
------ 0 . 00
--- ------------- ---- 1.00 ) .75 0 . 00 0 .75
1BCBSC VALUATION 0 .00 1 .50 0 .00
1BSEISMICR VALUATION 25, 250 .00 5. 50 0 .00 15 .75 0 . 00
1ERT2001K UNITS 1.00 15 .7S 0 .00
0 .00 126 . 00 0.00
1MFR=<100 UNITS 1 .00 1226
1REMRESBAT SQ. FEET 65 .00 570 . 00 0 . 00 570 .00 0 . 00
1REMRESKIT SQ FEET 77 . 00 285 . 00 0 .00 285 . 00 0.00
1.00 42 . 00 0 . 00 42 . 00 0 .00
1TRAVDOC FLAT RATE
1 . 00 189 . 50 0 .00 189 . 50 ------0_0
1WINREP EACH 8 -
_
120 . 50 0 .00 1230 . 50 0. 00
TOTAL PERMIT �
a ' 1 CITY OF CUPERTINO
CITY OF
CUPEi�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Date: /�, I C S T o` Q>
APN # 3—45 a) o N.. - �`�
Building Address: �uSEMARlL ?L-A U l)N17S
Mailing Address (if different from building address):
s AN Z0
Are Hazardous Materials being used as part of this project? Yes No ❑
HOA: Exterior work only) Yes ❑ No If yes,pr(-vide letter from HOA
Phone#: 409
Owner's Name: M �i1 T Rl NCS
rie: �p
Contractor: N ��GIS CoKstR�x�loN l Fa019, �3 � 6��12
Cv
Contractor License#:
Cupertino Business License#:
Phone: 40'9 - '0 S �
Contact: IAQ,N Fax:
.Zesidential Commercial ❑
(Owl,
Job Description: '�j��-} � �1� �i-1z�� t""`''
NLktC/ "2-� u�
�CVO Arq��(,� NN 2,)
Building Permit Info:
Bldg Elect ❑
Plumb' ElMech El
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B_%
Square Footage:
Valuation:
Project Size: Express ❑ Standard ❑ Large❑ Ma'or
ChecklisGreen Building: Please complete relevant portion of th,: Green Builset& the sheet index.
& attach it
to the application or if applicable, include in plan
Points Achieved:
�or help, contact Build it Green at www.builditgreen.or
Revised 07/14/09
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