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10080146 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19489 ROSEMARIE PL UNIT 3 CONTI:ACTOR:DANG'S CONSTRUCTION PERMIT NO: 10080146 3805 M4STERS CT DATE ISSUED:08/20/2010 OWNER'S NAME: MAITRI,INC PHONE NO:(408)365-8615 SAN K,SE,CA 95111 "'NER'S PHONE: 4084368393 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL U LICENSED CONTRACTOR'S DECLARATION REP'.ACE 7 DOUBLE PANE WINDOWS LIKE FOR LIKE License Class Lie.# UPGRADE SUB PANEL Contractor Date 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 Valuation:$8250 performance of the work for which this permit is issued. Sq.FI Floor 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 Vumber:37501008.3 permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information a WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 N. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, Date: 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 r)ofs shall be inspected prior to any roofing material being installed.If a roof is Signature installed without first obtaining an inspection,I agree to remove all new materials for inspction. OWNER-BUILDER DECLARATION Sigr ature of Applicant: Date: 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: 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to Chapter I hive read the hazardous construct the project(Sec.7044,Business&Professions Code). � California a Health&Safety Code,Sect ons 25505 525533,and 25534.9I will he nici al Code,Chapter 9.12 I hereby affirm under penalty of perjury one of the following three n compliance with the Cupertino Mu He dth'&Safety Code,Section 25532(a)should Istd the ma tore or handle declarations: rdous I have and will maintain a ' c Section 3700 f thefite of Consent tolLaborrCodeVfor the e for Worker's air contaminants as defined by the Bay material. Additionally,should I use uArea eAir Quality Management Dch emit istrict I forb o Compensation,as provided y will maintain compliance witht Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sectio s 505,25533,and 25534. 1 have and will maintain Worker's Compensation Insurance,as provided for by Date: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 k b for which thirm that s permit is ere is a iss ed(Sec,3097,Civ agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. Lomder's Name APPLICANT CERTIFICATION L!nder'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, `s,and expenses which may accrue against said City in consequence of the I.mderstand my plans shall be used as public records. ►ting s permit.Additionally,the applicant understands and will comply Liof non- int source regulations per the Cupertino Municipal Code,Section Licensed Professional (` Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST PERMIT# �U JOB ADDRESS: �L- PHONE# OWNER'S NAME: BUSINESS LICENSE# GENERAL CONTRACTOR: CITY/ZIPCODE: ADDRESS: *Our municipal code requires all businesses working in the city to have a City of CuPeSCHEDULEDhUNTIL THE Ou P WILL BE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) GENERAL CONTRACTOR AND ALL SUBCONTRACTOL: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: INESS LICENSE # SUBCONTRACTOR BUSINESS NAE BUS 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 Date wner Contractor Signature CITY OF CUPERTINO 4 ITEMS OF 21 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37501003 .3 DATE ISSUED. . . . . . . : 08/20/2 )10 RECEIPT #. . . . . . . . . : BS000011235 REFERENCE ID # 10080145 SITE ADDRESS 19489 ROSEMARIE PL UNIT 3 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER MAITRI, INC ADDRESS . 234 E G)SH 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, CA 95111 TELEPHONE (408) 365-8615 FEE ID UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - ---------- __________ _____ ---------- ---------- _ 1BCBSC VALUATION 8,250 .00 1BSEISMICR VALUATION 8, 250 . 00 1. 50 0.. 75 0. 00 0. 75 0. 00 1ERT2001K UNITS 00 1 .50 0. 00 1 . 00 15 . 75 0. 00 15 .75 1WINREP EACH 8 0. 00 1 . 00 189 . 50 0. 00 189.50 0. 00 ------- --- TOTAL PERMIT ---------- ---------- ------ 207 .50 0 .00 207.50 0. 00 OWN 1!AW CITY OF CUPE RTINO CITY OF CUPERTiNO GENERAL BUI:LDIN PERMIT APPLICATION FORM APN # "2 S �� , ✓ Date: u(�U V 2-0W 1 0 -J uilding Address: I g �� OSk Nt '� �� lU I-� B Mailing Address (if different from building address):` C�� Z LJ Are Hazardous Materials being used as part of this projeci? Yes No HOA: xterior work on l ) Yes ❑ No If es, pro v Phone eletter# from HOA Owner's Name: _ A - C{ Contractor: C Phone: (,gyp Fax: Contractor License#: (A (,t Cu ertino Business License#: Contact: Phone: Fax: residential Commercial _ Job Description: l0,_Ck W W Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: B ❑ IUIII/V-A ❑ II/III B, IV-HT, V-B 1-A, 1- L Square Footage: Valuation: Project Size: Express ❑ Standard ❑ Large❑ Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist & attach it to the application or if applicable, inch;Lde in plan set & the sheet index. Points Achieved: 'or help, contact Build it Green at www.builditgreen.or,� Revised 07/14/09