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07100032 CIT� OF CUPERTINO n � , � T f ''� �n BU[LDING DIVISION- �EltLV11T �� ""�� _, . :;. ;: -: PERMIT NQ. BUII.DI D RESS: ��6 PALOS VERDES CT INDER S BHANDAL 07100032 • PERMIT ISSUE DATE OWNER'S NAME: INDER S BHANDAL 11236 P.�LOS VERDES CT SANITARY NO. CONTROL NO. NE: BUILDING PERMITINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH �� 0 0 i p Q LICENSED COMRACfOR'S DECLARATION JOb D2SCT1pt10T1 %�" I hcrcby aCfrm that I am liccnscd undcr provisions of Chapicr 9(commencing ; Z� wiih Sccuon 7000) of Division 3 of thc Bu�incss and Profcssiuns Cadc, and my ticcnse is TEMP P� aER POLE �� y in full Corec and cffec� � � ? Licensc ClaSS �• # ; �, p Datc Con�rxmr � ARCHfCECTS DECLARA7'ION i a e ! undcrstanJ my plans shall bc uscd as pu6iic rccords )yU ' u� F' Licensed Profcssional : � a OW NER-BUILDER DECLARATION '}� 1 hcrcby alTirm that 1 am exempt Crom ihc Contractors Liccnsc Law far �hc � p O Collawing mason. (Scctian 703 L5, Busiocss and Profcs.aions Cafc: Any city or rnunty �^�i which rcquires a pcimit to conswcC altcr. impmvc, dcmalish, or repair any structucc prior u� its issuancc, alsu rcquiccs U�c applicant fot such permit to filc a signod statcmcnt �' q . Ft. Floor Area Valuation -?< tha� hc is liccnscd pursuant ta thc provisions of �hc Contractor's Liccnsc Law (Chap�cr 9 �� ,� t �(commencing wi�h Scction J000) of Division 3 of ihc Business and Profcssions Codc) or � 2 � � L�� that be is exempt Ne�cfrom and the buis Cor t6e alleged exempdon. Any violation of Section 703I.5 by any applicant Cw a pertnit subjccu �he applicant to a civil pena►[y of Number Oceupancy Type noc morc [han fivc 6undred dollars (5500). 3 5 6 2 1 � 3 3�� ❑ 1, u owncr oC ttie property, or my employces with wages a5 thcir sotc compensation, wil: do the wark, and the stcucwm is not intendcd or o[fered [or salc (Sec. 7044. Business Required Inspections and Professions Code: The Contnctors License Law does not apply w an owner of property who builds or improves thereon, and who does such wort himul[ or Uvougd his awn employccs, providcd ihat such improvemenls are not imm�ded or o[fercd tar sale. IC. however, the building or improvement ia soid within one yesr of completion, ihe ow�rcr- builder will have the burden of pcoving that he did not build or improvc tor purpose o[ sa1eJ. ((�ll, as awner of the property, am wcdusivdy contracting wiW licensed rnnuutors w conswct the projea (Sec. 7044. Business and Pro[essions Code:)'ll�e Contractor's Li- ce2se Law does aot apply to an owner of pcopeny who builds or improves �Aneon, and . who convacts for such Qrojeas with a comraaor(s) Iianxd pursuant to the Contrxtors License Law. ❑ t am aempt under Sec. . B dc P C fw this reason Owner � - _ � Date f � _ .. -. — �AKER'S COMPENSATION DECLARATION 1 hercby �cm under penalty o( perjury one of thc following declarations: �j ] hs+e and will maintain a CeniGcatc of Consent to self-insum for Worker's Compen- sation, at providcd for by Sectian 3700 aC the Labor Code, far thc pedormancc oC ihe work for which Ihis pe�mit is issued. ❑ I havc and will maintain Worl�cYs Compensation Insurana, ac rcyuired hy Scction , 3700 oC �hc Labor Cadc, for thc performanee of the work for wbich �Ais permit is issued. My Workcr's CompensaGon In:urancc carricr and Policy numbcr arc: Cartier. Policy No.: CERTIF[CATE OF EXEMPI'fON FROM WORKERS' COMPENSATION [NSURANCE (fhis scction necd nat be comple�ed if the pecmit is fw onc hundred daAars (5100) . or IcssJ 1 cenify thxt in the performance of the work (or which Ihis pem�it is issucd. [ sMall not em lo an � rson in an manner w omc sub'cet m �he Workcrs ComQcnsation Laws of Calf�(omi �� /� n Applicam ° - NOTICE TO APPC.I�AM: If, afYcr making �his CcrtiGcate of Eaccmpuon, you slwuld become subject to thc Worker's Canpcnsecion provisions o[ �hc Labor Cadc, you must � O foMwi�h comply with sueh provisions or this pecmil shall be deemed awoked. z �""' CONSTRUCCION LENDWG AGENCY [.-i �-�. 1 hcreby aflirm that there is a consuvctinn lending agency for the performance of . (Y., � the work fur which ihis permit is iuued (Scc. 3097. Civ. C.) W Q Lendcr's Narnc � z l.cnder's Address U � I ccrtify that I havc read Wis application and staic that tNc abovc infocmatiun is ►�+ cortcc�. 1 agree to camply with all ciry and counry onlinances and state laws relating to � U 6uilding conswction, and hereby authome rcprescnu[ivcs of this city to cntc� u�n thc W abovc-mcntioncd properly for inspccuon pur�wses. /" a (Wc) agrce to save, indemnify and kecp harmless thc Cily of Cupertino against �' � liabilitiu, judgmcn�s, costs and expcnscs which may in any way accruc againsl said City U z in conseqcencc of t6c grandng of ihis permi4 �+ APPI.ICAM' UNDERS7ANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by Date � �Ci� SOURCE REGULATIONS. c��2_ � o� ? � a'� Re-roofs �� Signaturc of ApplicanUConvacwr � a � T of R oof HAZARDOUS MA7'ERIALS DISC[.OSURE YPe �11 the applicant or futurc building occupantstorc or handle ha•rardous matcrial az defined by lhc Cupenino Municipal Codc. Chaptcr 9.12, and t6e Hcalth and SaCety c� Section 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑Ycs �No Will the applicam or Cuturc building occupant use eyuipment or devices which If a roof i� installed without first obtaining an inspection, I agree to remove �mii ha•rardous air contaminan�s az cicGncd hy the 8ay Arca Air Quality Managcmcnt all new m aterials for inspecr.ion. District? ❑ Ycs �� 1 havc rcad the hvardcws ma�crials requircmcna undcr Chap�cr 6.95 otthc Califor- nia Hcalih & Safcty Codc, Sections 25505, 25533 and 25534.1 un�rstand ihat iCthc building docs no� curren�ly havc a �cnant, that it is my rcsponsibili�y w noufy thc occupant of Ihc m gignature ofApplicant Date ��• -- � ��/-��- All roof coverings to be Class "B" or better Owncr or w�thorizcd agcn� �� ' �'�i v a��. � . CITY OF C UPERTINO '�`��` ` �`�1��` ��'�� CUPEI�TIN� PERMIT APPLI:CATION FOR1V� �PN # Date: o� J��' �/C�.�,� o � C� �°�3l � 7 Building Address: / ' / i 2 3 6 j�� Lo� � G7�� 'G�E� , C/�, 9Sv/�/ Owner's Name: Phone #: �''�,�DE�4 ✓�1��}-L - _3o9--�tn�-6 G -- - - ------- �� ---__ — __ ___ _ __ _ --- -- ___- , ' C'or - actoi - : F .�1 N�Es YL. ��.i�'�-�I�one: �� , � Rt��`� D1- -- License #: � � � ontact: �' Phone: Cupertino Business License #: .TiD� /.�:a,��,a-�. � 3� � �'o �-6 07 � c�o73 Building Permit Info: Elect � ��Z�D �E�-�'- ��rrL.. �eCG .�� Job Description: Residential [� Commercial ❑ Cost of Project: �a � , � Qty. if Ap licable Fee ID Fee Description Fee Grou BTEMP Te:n orary Power ELECTRICAL EPERMITFEE Ele Permit Issuance ELECTRICAL BUSLIC Bu siness License BUILDING CITY OF �:UPERTINO 2 ITEMS OF 2 � PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 356�1033.00 DATE ISSUED.......: 10/�3/2007 RECEIPT #.........: BS0�0002875 REFERENCE ID # ...: 071�0032 SITE ADDRESS ..... 11236 PALOS VERDES CT SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............. INDER S BHANDAL ADDRESS ...... 11�36 PALOS VERDES CT CITY/STATE/ZIP ...: CUFERTINO CA, 95014-4721 RECEIVED FROM ....: INLER S BHANDAL CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: INLER S BHANDAL ADDRESS ..........: 11236 PALOS VERDES CT CITY/STATE/ZIP ...: CUFERTINO CA, 95014-4721 TELEPHONE ......... FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------ BTEMP FLAT R.ATE 1.00 62.10 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 102.89 0.00 102.89 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 102.89 VISA --------------- TOTAL RECEIPT : 102.89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- 103 UFER 304 ROUGH ELECTRICAL ' ` OWNER-BUILD�:R VERIFICATION 1. (Check one) I or my immediate family ;parent, spouse or child) will perform: A, � All the work autho� ized by this permit B. _ A portion of the wcrk C, _ None of the work If B or C is checked, c�mplete 2 or 3 below. 2. A state licensed contractor will be hirec to do: A. _ All of the work B. _ A portion of the wc rk (complete section below) Contractor Address/City Phone # State License # Type of work to be erformed 3. I will utilize unlicensed person(s) �ther than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' corr�pensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed ............................................................................................................................................ I declare under penalty of perjury that the aY ove is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: � . �1 Date: �� Job Address: � � Z 3 � '�� -s' � 'Tir� Permit # � � � � � 7 � G✓� 9'fvrt�' Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. Community Development � � ' 10300 Torre Avenue ;� �'' ` �'� Cupertino CA 95014 t Telephone (408) 777-3228 , CITY OF Fax (408) 777-3333 'UPEI�TINO Buildi:n De artment JOB ADDRESS: _/� �� PERMIT # ��-�� /l 23 � �.92.e�s` �/�-v�� , c-�- m� ��'-�-�-�- OWNER'S NAME: �1�D�2 �Ll,�/Da,� L PHONE # L. o�'1 3� p-- y� o s-� GENERAL CONTRACTOR p � FAX # .�- I am not using any subcontractors: � r � 3 Si�;nature ate Please check a licable subcontractors and com ►lete the followin information: SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectr�ical 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 -" iv/ Owner/ Contractor Signature Date