07110087 CITY OF CUPERTINO � ` (�
BUILD4�G DIVISit)N PERNIIT �+���������"������� `
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BUiLDING ADDRESS: PERMfT NO.
20220 LYNTON CT BROTHER� HOME IMPROVEMENT 07110087 .
lNER'S NAME: P �� �� DA �
ANURAG JAIN 2510 DOtJGLAS BLVD � 11/15/2007
PHONE: SANTPARY NO. CONTROL NO.
(408)29'�-0680
ARCHI'IECIYENGINEER: BUILDING PERMif INFO
HLDG ELECf PLUMB MECH
� 0 � 0
� O p LiCENSED CON7RACTOR'S DECLARATION JOU DCSCTIpt10I1
i� � C I hcrcby aflicm �hat I am licenscd unJer provisions oC CAaptcr 9(commcncins
_ z�� wiw Sccdon 7000) of Division 3 of ihc Businesc and Protcssions Codc, and my Iiccnsc is RE P LAC E PAT I O DOOR , S I Z E F OR S I Z E S TRA I GHT
'� d in full force a yf �
;�? �;��,,,� i�- �' �•� � RETRO—F CT INSTLTN
� �, G Date Coo►ractor °`� � "'`�
��'` ARCHITECI'S DECLARA770N
��< I undcrswnJ my plans shall be uxd as public rccorda
d
; u. y Licensed P�ufcuionsl
n y � OWNER-BUILDER DECLARATION
I hcrcby nlTirm that 1 am excmpt from thc Con�raaors Liccnsc Law far �hc
� p O following rcason. (Scction 7tY31.5, Busincss and Profcssions Cafc: Any city or county
��� which requiccs a permil to conswct, altcr. impmvc. dcmulish. or �epuir any suucwrc
prior u� i�s issuancc, alw rcquims thc applicant (or such permit to filc a signcd sta�cmcm
^< that hc is licenxd pursuant to �hc pmvisions o[ �hc Conuactor's license [aw (Chaptcr 9 iq. Ft. Floor Area $17 5 5 Valuation
y x
F- �(commencing with Scction 7000) of Division 3 of Ihc Busincss and Profcssions Cadc) or
y � r, that he ia exempl the�e(rom and the bssis for �he allegcd exempuon. Any violadon of
Section 7031.5 by a�ry applicant for a pem�it subjecu ihe applicant w a civil penalty o[ Number Oecupaney Type
not more �an fiw 6und�ed dollars (5500). 3 6 9 3 r J � 1���
❑ I. u owner o[ tt�e penpetty. or my employcea witM wages as their solc compensadon,
will do �he work and �he suucwre is not intended or oHend for sale (See. 7044. Busineu Re uired Ins ections
and Pro[essions Cade: The Contracmr's Lianse Law does not apply �o m owner of 9 P
property who builds or impcoves �hercon, and who daes such wort 6imu1[or throngh hia
awn employces, providcd thai such improvements ue not imen�d or offeeed Cm sale. lf.
however, the building or impmvement ia sold within one year of completion. U�e owner-
builder will have the b�uden oC pcoving that he did not build ar improve [or pmpoae of
sakJ.
❑ I, as owner of the property, am exclusively conuacting wi�h Iicensed canuactas to
construct the pmject (Sec. 7044. Businas and Professions Code:) The Conuxtor's Li.
cense [aw does not apply �n an owner of propeny who buiids or improves themon, and ,
who contncls for such projects with a contractor(s) Iicenxd pursuant to the Convactor's
License L.aw.
� I am exempt under Sec. . B& P C for �his rcaton
�wxr Date
WORKER'S COMPENSA170N DECLARATION
1 hercby �rm under penalty of perjury ane o[ ihe (allawing declaralions:
Q 1 Iw+e and will mainuin a CeniGcate of Consent to self-inswe [or Workcrs Compen-
sation, u providcd for by Section 3700 of the Labor Code, for Ihe performance of the
work (or which Nis permit is issued.
�;'I Aave and will maimain Workers Compensation Insurana, u required by Scction
3700 oC the Labor Codc. Cor thc perfortnance o[ the work for which Wia pecmit is issued
My Worke�s ompensadon Insurance nrticr and Policy number a�c:
�u; 1 Poliry No.: �'�bm01(03
CERTIF[CATE OF EXEMPl70N FROM WORKERS'
COMPENSA770N INSURANCE '
(Thu sec[ion necd irot bc complcted if the permit is far onc hundred dollara (S I00)
ar Icss.) �
I cenifv iha� in thc perfwmance af ihc work fw which ihis permit is issced. [ shatl not
cmploy any person in any manncr w az to bccomc subject w the Workcrs' Compenution
Laws of Cali(omia. Datc
Applicant
N017CE TO APPLICAM: !f, aMr making U�is Cenificatc of Ezcmption, you shouW
become subjcM to thc Worter's Compcnsadon ptorisions of ihe Labor Codc, you must
, O forthwith camply wi�h such provisions or �his permit shall bc dccmed ecvakcd.
z "" CONSTRUCTION LENDING AGENCY
(.~.� �-�. I hefeby affirm ihat there ia a conswctinn Icnding agcncy 1'or thc perfortnancc uC .
a� �hC work far which ihis permit is iuued (Sec. 3097. Civ. CJ
W� Q L.endcr's Namc '
Csnde�s Address
(� � � certifY Ihat I havc rwd Ihis application and sutc �u ihc abovc informatlun is
w�" corten. l asrr.e w comply with all city and county ordinances and su�e Iaws reladng W
0 U building consuuction, and hercby amhoria cepresentaGves of U�is city m cntcr upon the
� W atrovc-mcntioned p�operty for inspection purposes.
a (We) agiee to save, indcmnify and kecp harmless �he City of Cupenino against
�� liabililia, Judgmcn�s, costs and expcnses which may in any way accruc agtinsl said City
V z in consequencc oC thc granting oC ihis permi�. Date
►"� APPLICANT UNDERS'fANDS AND WILL COMPLY WITH ALL NON-PO1NT Issued by:
SOU GUL 61 j5`0 �
� Re-roofs
�S' ure of ApplicanVConusclor Datc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
wll tAe spplicant or futurc building acupant storc or handlc ha•rardous matcrial
dcfined by Ihe Cupertino Municipal Codc. Chaptcr 9.12, and thc Hea1W and Safcty
�o�, s�o� usszca�� All roofs ;;hall be inspected prior to any roofing material being installed.
❑ Ycs �No
If a roof i;� installed without first obtaining an inspection, I agree to remove
Will the applicant or fuwre building occupant use equipment or Jcvices which �
emi� harardous air contaminanu u dcfincd by thc Bay Arca Air Qualiry Managcmcn� all new materials for inspecr.ion.
Disuici?
❑Ycs �No
1 havc rca�i �he hvardous matcrisls rcquiremcn�a undcr Chaptcr 6.95 of thc Califar-
nia Flcalth & Safety Code, Sectians 25505, 25533 aru125534.1 undersund ihat if ihe 6uilding
dacs urtcnUy ha�c a tcnant, ihat it is my msponsi6ility to noufy Uu occupant of the
�: nentswhichm 'orwissu �a • SignatureofApplicant Date
�� rl / S 0 �
pa � . All roof coverings to be Class "B" ar better
ncr or authori�cd agcn�
. �'�l l l 0� � �
�-� � CITY OF I�UPERTINO
� ���F PERMIT APPI,ICATION FORM
CUPER�TINO
APN# �� -n -6 ��� t� z�UQ Date1 t5
V�
Building Address: aQ�1p �yr� c� Mailing Address (if different from building address):
CK c�-�� v.�a ct'� q5 � t y
Owner's Name: . Phone #:
Mc + r'�rs . P r��u, r o� S�`� (.`100�44- b-�4 a.-► �
Contractor: License #:
Q'jrv�hea'S �o�� �r��rdv�v�ewtiC Co��o� \
Contact: Phone '�oQ,�� ��°�� Cupertino Business License#:
Q Pn-.) �. Ci�.�..�,�.a.Y. Fax: �-�1Qio�
Building Permit Info:
Bldg� Elect ❑ Plumb ❑ Mech ❑
Job Description: 1 Pa��� o�a'' s�� s�e
Residential � ���°�`"�` �" �'} z "' S} ``'�� ° `��� Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Proj ct: Occupancy Group:
� i��SS=
Type of Construction: Please check this 6ox if the project is a
�,�,,,�_ F�� �„��a���,ti�,n second-sto addition: �
Pro'ect Size: Standard ❑ Large ❑ M�jor ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other A liances MECHANICAL
BBOILERI Bc�iler <= 100,000 Btu MECHANICAL
BBOILER2 BoilE:r > 100K to SOOK Btu MECHANICAL
BBOILER3 Boi ier > SOOK to 1M Btu MECHANICAL
BBOILER4 Boil�;r > 1M to 1.75 M Btu MECHANICAL
BBOILERS F►oiler > 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Ccnstax — Resi/Mobile BUILDING
BELEC 1000 E:� ec 600V <= l 000A ELECTRICAL
BELEC1001 E lec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD =3nergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
CITY OF ��UPERTINO
CUPE T�NO PE�IT APPI,ICATION FORM
�
Quanti Fee ID Fee Descri tion Fee Grou
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Cornm. Housing Mit. Fee BUILDING
BNUCOMME 1`1ew Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNLJCOMMP ;Vew Comm Plumb PLUMBING
BOVERTIME I�spection Overtime BUILDING
BPBACKFLOW Atmos heric Vacuum PLUMBING
BPCESSPOOL Cess ool PLLJMBING
BPERMFEE Bld Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS G��s Pi in System Fee PLUMBING
BPINTERCEP Ir�d Waste Interce tor PLITMBING
BPLANCHK Plan Check Fee BUILDING �
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Pl �n Check Re eat Fee BUILDING
BPREPIPE �te i e Of Fixtures PLUMBING
BPSEWAGE Sewa e Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BPVENT ��lt of Drain & Vent PLIJMBING
BPWATER Ins talVAlter Water Pi e PLUMBING
BPWHEATER \'Vater Heater/Vent PLUMBING
BPWSVCS l✓Iain Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A� C Unit > 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > lOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD I nstallation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAFP Re:n Non-Res Ap liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Povrer Device/A aratus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Zelocation of Hood MECHANICAL
BREMREPALT F:epair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res A pliance ELECTRICAL
2 of 3
CITY OF I�UPERTINO
CUPE(�TINO PERMIT APPL,ICATION FORM
Quanti Fee ID Fee Descri tion Fee Grou
BREMSIGNAD Rrr.dl Signs Add Branch ELECTRICAL
BREMSIGNS Rerlodel Signs, Mar uee ELECTRICAL
BREMTHEATR Theatrical Li ting Fix ELECTRICAL
BREMVENFAN Vi�nt Fan Sin le Duct MECHANICAL
BREMVENSYS V entilation S stems MECHANICAL
BSCBLVD Scb S ecific Plan BUILDING
BSEISMICOM S��ismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL 3 ecialIns ection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP 7'em ora Power ELECTRICAL
BTEMPPERM Teni ora Bld Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical s foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE r�iechanical sq. foot MECHANICAL
MPERMITFEE M��ch Permit Issuance MECHANICAL
PPERMITFEE Plu mbin Permit Issue PLUMBING
PPLBG P: umbin Fee s foot PLITMBING
PLLONGRNGC Plannin l LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Plannin�� Lon Ran e Residential PLANNING
:+ of 3
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI7' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bll�:: Lot:
APN ......... 36�35019.00
DATE ISSUED.......: 11
RECEIPT #.........: BS(100003250
REFERENCE ID # ...: 07�.10087
SITE ADDRESS .....: 20�;20 LYNTON CT
SUBDIVISION .......
CITY .............. CU]'ERTINO
IMPACT AREA .......
OWNER . ... . . .. .. .. . AN[JR.AG JAIN
ADDRESS ........... 20:'.20 LYNTCN CT
CITY/STATE/ZIP ...: CU]'ERTINO, CA 95014
RECEIVED FROM ....: RY��N BUCHANAN
CONTRACTOR .......: GEI7E V. CAVANNA LIC # 27964
COMPl1NY ..........: BRc)THERS HOME IMPROVEMENT
ADDRESS ..........: 25:L0 DOUGLAS BLVD
CITY/STATE/ZIP ...: R0;3EVILLE, CA 95661
TELEPHONE . . . . . . . . : (4�)8) 295
FEE ID UNIT QUANTITY .�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00
BPERMFEE VALUATION 1,755.00 83.16 0.00 83.16 0.00
BSEISMICRE VALUATION 1,755.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 123.58 0.00 123.58 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 123.58 MC
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TOTAL RECEIPT : 123.58