05010011CITY OF CUPERTINO—
ERMBUBUILDINGDIVISION PER-
BUILDING ADDRESS:
ILDINGADDRESS: -
PERMIT NCO 5010011.
922 BLAZINGWOOD AV
OWNER'S NAME:
PERM17 ISSUE DATE
SUMAN & SURESH KALBAG
2005
E:
SANITARY NO. - CONTROL NO. '^'•-
ARCHITECT/ENGINEER:
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BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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/ LICENSED CONTRACTOR'S DECLARATION
/1h,mpY .from Nat 1 am licensed urtkr pro(5eons of Chapter 9 (commencing
Job Description
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wim Steueq'/MEof Division 3 of the Business aridAdfnsions Code, and my license is
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lrmnrp eandCUCC& -'_ y
PATIO ENCLOSURE (170.') /ELECT. ON CONCRETE PAD - -
License CI Lic. M
oate%camrr:etar
CONTRACTOR: BACKYARD LIFESTYLES
ARCHDE(.TS DECLARE
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1 undcrwnJ my plans shall W uwJ u Public records - ..
Licensed Professional
OWNER-BUILDER DECLARATION
1 heathy affirm lm exempt from the Contractor's License Law for he
following mason. (Section ](131.5, Business and Pmfuumns Code: Any city or county
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which requires a pearri construct, alma, improve, demolish, nr repair any structure,prior
uae, also requires me applicant for such permit to file a signed statement
to les issx
me( he is licensed Purwamtothe pmvi5ioonfthe ConmcmhlimnmLs- (chapter 9
Sq. Ft. Floor Area
-
- Valua"i00
(commencing with Section ]BBB) of Division 3 or the Budneu am Nofeuiaas Cook) or
_
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that he is exempt themGom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type.
Semon 7031.5byanyappimantforaPermitsubjectsWeapplicanttoacivilPenaltyof
am mom man five hundred dollars (SSNp. -
36917013.00
❑ I. as owner of the property, or my employeas with wages as their sole compenvdon,
Required Inspections
will do the work. and line structure is not immnd<d or offered for side (See . 70d4. Bueiroas
and Profnanioru Cade: The Contractor's License Law doer not apply to an owner of
q -- - -----
isometry who Wilea or improves daemon. and who doessuch work himulfor through his
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ownemployco. provided thatsuthimpmwmmuamnr'immndr oroRemd fofsaln If.
however. me building or improvement issold withinane year nfcompledon. the owner-
builder will have me burden of proving that he did not Wild or improve for purpose of
sale.).
0 1. as owner of me propcny. am udusively commcting with licensed .... In
consumer the project (Sec. 7844, Business and Profeeniam Cade:) The Contractor's I.I.
cense law dao not apply m an owner of property who Wilds or improves'hmon, and.
who camases far such projects with a commistaaf(5) licensed p...tt to the Contract.(.
-'
License La-
0 l ass attempt under Sea . B h P C far this moon
Ownef Data
WORKER'S COMPENSATION DECLARATION
1 hereby affim under pmulty of perjury arc of the following dulanuous,
I ha.e and will maintain a Certificate of Consent to.ulrl4sure fm WahCt's Compcn-
'
titian, as provided for by Section 37M of the Labor Code, for the perform ose of me-
work for which this permit is issued. . - ..
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
..,
3900 of the labor Code, for the performance of lie work for which this Permit is issued.
MyW km/s Compensation lnwmmm caancand Policy� art:
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CwaiW�r
Policy arao /OZ9
OF Z0X RKERS'
1mFIC TE OFE E
CERTIFlC
COMPENSATION INSURANCE
O SATION1INSURANCE
(This section need not be complt m l if th Permit is reform hundred dollars SIM)
less.)
1 certify that in me performance of me work for which this permit is issued. I shall nor
employ any pawn in my manner w as to becomt subject to'h Work rn Compensation
Laws of Califomia. Data
Applicant
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NOTICE TO APPLICANT: If. after making this cmuricam of Exemption, you should
become suhjca 10 the Worker's Com penmtion provisions of the Labor CMC, you must
forthwith comply with such provisions or his Permit shall W deemed mvokcd.
LENDING AGENCY
Ihr louCONSTRUCTION
Natt iss leading agency Ito de Perfurman¢of
which t issued
' the work fur which this permit u issued (Su. J099, Civ. C.)
Lender's Namc
I<ndcr'A
l/�
Iddsess
certify that 1 have read this and sou that tot show information is
and county
1 agree m comply with all city and county oNioancef and sum laws
City
e
r upon t
builds.
Construction, and hereby authorimreosea tisv of thiscity mentorup�n'hc
mime-rcrumned for inspection an
ahovo
J
(We) agree to saw, keep ho
(s ju g me m ave, indemnify and keep humkss the City of Cupmmo against
j costsand calamities which may in any way accrue agvnv sold City
/
incoisequudgmenu,
of the Permit.
thtNo
' APPLICcenaUNDERSTANDf W COMPLY WITH ALL NON-POINT
Issued by: Date
SOUR R GULAnONS
Re-roofs
Type of Roof
/
-Sigmalione of ApplicanVCon r Data
HAZARbous MATERIALS DISCLOSURE
Will the applicant or fmurt Wilding ucuprofstore or handle hmardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and f Health and Safety
Code, Seeman 25532N)?
�
All roofs shall be inspected prior to an roofing material beinginstalled.
[3
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
t havardaus air canmmir teas as defined by the Bay Area Air Quality Management
all new materials for inspection.
❑YesbNu
1 have mad the hazardous materials requirements underChapter695 ofme Califor.
1o�,�A
licalthg: SafctyCWe, Secduns25505,25533 and 25534.1 understand thatifthe Wilding
n not Connally have a timaL that it is my responsibility m am notify me WCUPof the
mmme ichMustbemepflonU ceofaCCmf`1CteafOccapaney.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Oite
0wner or aumonand agent