06020064 CITY OF CUPERTINO "% �'� ''`- �
BUILDING DIVISION PERMIT N) RA..,CTCIRINFOR ''NIATION'-
BUILDING ADDRESS: PERM"N0.0 6 0 2 0 0 6 4
10289 BRITTANY CT
'R'S NAME: PERMIT ISSIIE DATE
WAHID UMERANI 05/05/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHrTECT/ENGINEER: BUILDING PERMIT INFO
BLDG t9 PO O
300 LICENSED CONTRACTORS DECLARATION Job Description
I surety affirm that I am Ilee"M under previsions of Clapmr 9(commcsing
will,3e don 700M of Division 3 of On Business ad Professions Cade,ad my license is
+� infullfomoand.fftt ADDITION 680 ' -MSTR BEDRM/DINING ROOM
iRE U..naClass Lic. ADD 2 WINDOWS IN LIVING ROOM
Date Cahirecmr
ARCHTIECrS DECLARATION
1 U 1 undersand my plans shall be used as public records
t; Licensed Protean ..I
OWNER.BUILDER DECLARATION
i1 hereby aRrm that I am aempt fore Ute Contractors Leona Law for the
a a following reason.(Section 7(131.5,Business ad Professions Cade:My city at county
`4 so! which requires a permit As canatoct.alai imprme,demoliah-or mpar any structure
zr prior m its issuance,ales requires Ones applicat for met Permit to IN aslgned statement Val ali*6771
G that nee is licensed pursuant to the provisions of the Contractor's L smw law(Chapter 9 Sq.Ft, Floor Area
Ia (commencing with Section 7000)of Division 3 of the Business ad Profmaios Cade)ter
i —
that he Is exempt therefrom and the but,for the alleged Assumption.Any violation of +�.�i M6 . 00
I�,�7t�I�7
Section 7031.5 by any applicant for a permit aubjeca tee applaent he a civil penalty of 3 3 V U 16 r 0 0 Occupancy 1I pe
,ct mare than five,hundred dollars(5500).
Q LAs of tine:Property,or my employees with wage.As them sok compensation,
will do the work.tad the structure n not inW,ded oraRucd In,Ante(Sec.7011.Budrcu Required Inspections
and Pmfeaslaw Cade The Commerce,Licnhx Law does at apply m w
a owner of q P
property who builds or improves darCoe.and who dna amh work naohif or thrmgn his
own employees,provided that such imprevemats are not ioe sed oronered for sale.B,
however.the building or improvement 4 old within One,year o(complclan.the owner-
builder will have On,burden of proving that he did Out Mid ter improve fns purpose of
ale.).
M/1.as owur of dhe Property,am exclusively embracing with IkemW mnuactoss to
construct the project(See.7044.Business tad Profeasias Cede)The Connemara U-
cesse law does net apply An an owner or property who builds or burrows themen,ad,
who mnuwta for such projeea with a eommemr(s)licensed paasnt to the Conua7ors
Licertae Law.
Q T an exempt un tr B&P C for this mon
r r Dare S15_03
—BTW KERS fPENSATP RATION
1 hereby Ahura under penury of perjury,ane of the following declarWmlc
❑1 hive and will maintain sCeNOeem of Conant m wlf-insum fm WmkeraCompen-
andon,as provided for by Section 3700 of to Labor Cade.for the performance of the
work for which this permit is Issued.
❑1 haw ad will maintain Workers Compassion Inmrame,As required by Section
3700 of One labor Code,far the performance of the work fee which this permit Is iamd.
My Workers Compensation Iwanae entries and Policy number am:
Canter. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE v
Cl secOm need not be completed Ilthe permit is Insane hundred dollar($100)
or leas)
I Century that in the performance of Out;work rot which this permit is issued,)shall net
employanyperan in myon romc subieetmNeWxa'
WotCampensaton
Laws of California.Dam •/ 1^
Appllcat •• w
NOTICE TO APPLICANT:If.after making this Ce mm lifSaamption.y6ushould
become subject As the Workers Compensation previsioso of the Labor Cade.you most
.,0 forthwith Comply with ash provisions or this permit dealt be deemed revoked.
z0
CONSTRUCTION LENDING AGENCY
F., I hereby IMM am than I.a Cassandra lending agency farthe purmnae.f
CL the work for which Inst permit is Ismd(Sec.3097,Civ.C.)
Q
Lumber's Ne
0.
0.z Lenders Address
V Q I certry that 1 haw mad this appllewlon ad state that the above Information In
w F conessi agree In comPIY with all city ad county ch inanca sed state laws relating in
QU building conarection,ad hereby euthornc heptesentatives of this city to Omer uponthe
U above-mentioned pmperty for inspection purposes.
G (We)agree to ave,indemnify ad imp harmless the City of CuPmUnO against
CA Habilitles,judgmmWcsta ad.pc.which may in my nay,. simumid City
U,'Z in consmuaee of tee among of this Permit.
.. APPLICANT UNDERSTANDS AI 0 WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
S4,I16 Re-roofs
Signature ofApplimm/Conuawr� Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will day appliant or form building occupmetatmc or handle hamedow mamrial
MN by One Cupertino Municipal Code.Chapter 9.13,ad the Health ad Safety
.Section 35533(.)7 �[� All roofs shall he inspected prior to any roofing material being installed.
❑Ys iYna
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicat or future building eccupam us:equipment or devices which
moll hwardos air cmuminau u dell by the Bay Area All Quality MansgemCOt all new materials for inspection.
Dialet? JJ
MCA g N.
1 have mad tee hwrdo smaterials requirements under Chapmr6.95 ofthe Califar.
nis Health@SafctYCoM,SeNons35505,35533ad35534.imdcnandthnlfdm building
does eat corm y hew a tenml,that It u my responsibility In notify One oxcupat of the
requourne ' sAusj-blleIPdorm Ora ceedrn.teofOcmacy. Signature of Applicant Date
ma ���Y�
A.
t,t6 All roof coverings to be Class"B"or better
Owner m wthmie<d n ant Dam'