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09100204 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1699 S DE ANZA BLVD CONTRACTOR:BAINS DEVELOPMENTS PERMIT NO:09100204 OWNER'S NAME: ATAM SANDHU PO BOX 1575 DATE ISSUED: 10/29/2009 IER'S PHONE: 4084063158 FREMONT,CA 94538 PHONE NO:(510)445-0227 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class r � Lic.# 7.fes Qom._ MECH RESIDENTIAL COMMERCIAL Contractor � a Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALLATION TEMP POWER POLE (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 Sq.Ft Floor Area: Valuation:$100 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 APN Number:36610120.01 Occupancy Type: permit is issued. 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 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 a rue against said City in consequence of the _ granting of this permit. Additio ly,the applicant understands and will comply Issued Date: with all non-point source regul ins per the Cupertino Municipal Code,Section `~' 9.18. Signat Date ti RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is Li OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by 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 Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this pennit is issued,I shall Owner or au trt: �y not employ any person in any manner so as to become subject to the Worker's � Date: Compensation laws of California. If,after making this certificate of exemption,I C become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this pennit shall be deemed revoked. 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.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. &Lanting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36610120 . 01 DATE ISSUED. . . . . . . : 10/29/2009 RECEIPT #. . . . . . . . . BS000009073 REFERENCE ID # • . . : 09100204 SITE ADDRESS 1699 S DE ANZA BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ATAM SANDHU ADDRESS 1699 S DE ANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VIKHAR INC CONTRACTOR . . . . . . . : BAINS, RAJ LIC # 23984 COMPANY BAINS DEVELOPMENTS ADDRESS PO BOX 1575 CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE (510) 445-0227 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 100 . 00 1 . 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 100. 00 0 .50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0.00 42 . 00 0 . 00 1ERT<200 UNITS 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0 . 00 127.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127 .50 #1938 --------------- TOTAL RECEIPT 127 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO L 00�z Oct TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # 0 U' Date: 101-2114 Buil ing Address: � ,� ^ �� C� S Owner's Name: Phone #: f Contractor: t� Phone #: Fax #:Y/ NJ Contact: Phone #: A-�qq� N I 4<' o " -64 � )-- Contractor License #: C _ -I S�` Cupertino Business License #: Job Description: Residential Commercial Valuation (cost of project): Type of Constructio • N/A /oo . Quantity Fee ID Fee Description Fee Group Permit Type 1 ERT>1 K Res. Temp Power>1 K E 1REAP14 Amps 1 ERT<200 Res. Temp.Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps / 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee Revised 01/07/09 ` Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �MkTINO Building Department JOB ADDRESS: PERMIT# l Se� a-Vj OWNER'S NAME: c T d PHONE # o - ej$- `t Z GENERAL CONTRACTOR: ,v o w e G FAX # I am not using any subcontractors: i e 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile on for Signature Date