03080119 CITY OF CUPERTINO
BUILDING DIVISION PERMIT v CONTRACTdR XNFURMATION "':
BUILDING ADDRESS: AMAR aUPTA PERMIT"03080119
03080119
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WNER'S NAME: 0A PERMIT ISSUE DATE
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MARqITPTA
ONE: SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTORS DECLARATION ] bDescri [ion
�j F I Wreby affirm Nn 1 am liaaed under provisions of Chap¢r 9(.......uop
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ZZ`uf with Section 7")of Division J of the Business and Pollmions Code.and my Ronnie is
^=N in full farce and effect.
i8
License Class Lie.g NEW 2 STORY SINGLE FAMILY DWELLING
a Dam Card.,., LIVING SPACE 9435 SQ. FT. /GARAGE 528 SQ. FT.
ARCHITECTS DECLARATION
�u< I understand mypAmsMllthe uoil As public recnNt (INCLUDING BASEMENT 3500 SQ. FT. )
�yU
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Licensed Porfeasional
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OWN ERoBUILDER DECLARATION
9<f i hereby.sec that 11. enempt from On Cantrprofession
Liana Law for ZW
0o fallowingmoon.Permit
to str taltatand wale era Ca le:Any city or county
$ which its bma s permit le rnnnroe eller,nt for se deermiti or repair any tatawre
_Zi
prior miu iauance.afw rcquimuW applicant for ach Permit in fleuignalsWcmcm
< Nel he is m
licensed puranua the provisions Of the Cmnractor.U..Law(Charter 9 Sq.Ft.Floor Area Valuation
gF�On (commencing with Section 7004)of Division S of the Buenc..and Professions Code)of
y Nal he u exempt determine and the buss for the alleged exemption.Any violation of $1500000
Section 7031.5 by any applicant for a permit subjects the applicant m a civil pcnahy of APN Number Occupancy Type
not mom than foe hundred dollen($500).
❑I,As owner of the property,or my employees with wage.As Heir wk compensation,
will da Ne work and Ne.wnurt i.nolinxndedoroffMadfoaale(Sm.7044,Business13719031
Re aired Inspections
and Professions Code:The Commoner's Lice=Law docs net apply to an owner of q p
property who builds or improves Jurcon,and who does such work himself orthrough his
Own employees,provided that such Improvements vee not intended oroffered for Asia.IL
however the building ver improvement is mid within ane year of completion.the...,.
Wilder will hoe she buNen of proving that M did not Wild or Improve for purpose of
INC , ner of the property,am exclusively contacting wish licensed commictom to
on met the project(Sec.71144,Business and Normal...Code:)The CWMAM r'.Li. ,
.vee Law does not apply to an owner of property who Wilds or impmva Neuron,and
who contracts for such projects with a eomrator(.)licensed p rmeanrto One Contractor's
License Law.
❑1 am aempt under gee. .B&P C far this reawn
n
WORKER'S C MPENSATION DECLAR1i1mN
1hereby aRhm under pe.fly of perjury one of the following declamations:
Q 1 have and will maintain a Cenificou of Conant to sel6lnsure for Workefa Compcn.
.alien,As provided for by Section 7700 of the labor Code,for the perfmmana of On -
work for which this permit Is issued.
❑1 have and will maintain Worked Compensation Insurance,As required by Section
77M of the Labor Code.for the performance of dm work for which this permit I.blued.
My Worker'.Compenmhon Insurance caner And Policy number art:
Carrier. Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm becomplexJ if the permit is forone hundred dollars($fall ..
ver ASL)
I certify Jul in thc perion sion of to work for which Ni.permit a laved.I Nall nm
employ any person in any manner an a An become subject to the Workeri Compeallon
Law.of California.Data
Applkat
NOTICE TO APPLICANT:If.after making Nle Certificate of Exemption.you should
haeme subject m Ne Worker's Compensation provision of the Lahr CMc,you must
.,O forthwith comply withsuch provisions a data permit shall W dccmil mveked.
'Zy CONSTRUCTION LENDING AGENCY
P: I thereby affi
rm Na Nem k rn
a nstratirm lending.geray,fm Jet performana of
D:� Ne wort for which this permit b issued(Sec.3097.Ci,C.)
WW- Lender's Name
z Lenders Address
V 0 1 anify that I have mad this applieaion and sum that the above Informaiun is
11, correct.I agree m comply with all city and county oNinantts and sum laws relating to
O Wilding construction,and hereby auNaris repremnudws of Nis city to enmrupon the
r W above-mcndoncd property,for inspection purposes
4 I%)agree to um.indemnify and keep harmless Ne City of Cupertino against
IDT Iiablli0as,judgmenu,cosh and estimates which may In any way acme agsinst mid City
U in consequence of the gaming of this Permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU1t®ULRTIO�}NS.S./ �•+Dal
Oy/ l a l� /' Re-roofs
Signature of Applicart Canuxmr AM
HAZARDO SMATERIALSDISCLOSURE Type of Roof
Will the applicant or future building Occupant none or handle humdous material
As defined by the Cupertino Mu kipal Code.Chapter 91,and the Health ad Safety
oJc.section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
Ya o
Will the Air co at or future Wilding by the B tax ea Air Qu or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit District? ons air contaminants u JCOncJ by the Bey Area Air Quality Management all new materials for inspection.
DlstrinT
C)Yen (k(N.
I have mad the huetdous material&requirements under Chapter 6.95 of the Califor• -
Me Health a SafelyCode,Sections 25505,25533 and 25534,1 understood that if the Wilding
docs not currently hew a tenet Net it in my responsibility In nod I the exultant of the
re immcnu which must W caror to issuance of.Cendficale of Occupancy. Signature of Applicant Date
UsuitfS o
er or aulhorivcJ agentAll roof coverings to be Class "B" or better
Dane