08020190 CITY OF CUPERTINOa �t�i.»u��*a♦♦a`>(p?t"k'::;ivTp' " ' '"" '�� �"" '" -
BUILDING DIVISION PERMIT COL!Lsl.l�t?-(�TORZIN�'ORMr�TO,IY
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PERMR N0.
BU1LD1tq{'s�DPF" ARGO DR TBD — TO BE DETERMINED 08020190
L'SIJNAA IE:: PERMIT ISSUE DATE
1WRI
VISWANADHAN N/29/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
poZ' LICENSED CONTRACTOR'S DECLARATION - Job Description
U I bereby afOm that l am limneed under provisions of Chafer 9(comme to ng
AN,Secdon?ll(IU)of Division 3af de Bminees and Profeeiuw Cade.and my licensee INTERIOR STAIRS REBUILD
in full forte and effect.
i Z License Class Lic,a
:i-p Dae Contractor
ARCHITECTS DECLARATION
i I underuand my plans shall W used As public records
IdU
�H Liccned Professional
OWNER-BUILDER DECLARATION
f 1 Wmby aim that I am exempt from she ConVanars License law for IW
D o following swop.(Schon]031.5.Bus vee end Pefersiuns Cam:Any city or cowry
squ
$ which ires a permit to omal u t,alert Improve,demolish,ar repair any tvsetum
AZi prior act its issuance,also requires the applicant for such Permit o file a signed swemem
mat N,is lkenmd pursuam to 00)the pmvisiowaf d¢Conuacmri L'uLicenselaw(Ciorytt9 Sq.Ft.Floor Area Valuation
e� (commencing with SectimT0nfDivision 3 clam Businessand ProfeeinwCode)w 5000
Net be Is exempt thcrefram end Ne basis for the alleged essmpdm.Any vkelauw of
Section 7031.5 by any applicant for a permit subjects live applicant to a civil penalty at A Number Occupancy Type
oat mare man live hundred dalhn(SSaB). 3263303
. 8�
wi 1.et owner of And
property.m my a Intenens with wages na theirhale7W.Bu Wm,
will dodewmk.Codec sh Cardaunatl Lierameded Laoffw
md does Am apply Ad an BudwSA Required Inspections
and Professions Cade:The CmueemYa nd who law does rot apply m an owner N fl p
property nmplohobisildeor im Oal=beson,a and UmnotihwrorkhimuJfmthroagbhu
own emplaycw.provided mat sash imprommmu ve not inremdN aroRerW fm sale B, '
builder me buildingarimprovement4hathe did one)earormmomformeowov-
Am.).r will haw circ burden of paving that be did rot dtikl a improve far purpme of
ak.).
as awwr,of rhe prepemy,am welwively convecting wish licensed mnYana,s m
cow ct the project(See.90dd,Business and Praf esioru Cade:)M Commit U
C.
law dans not apply m an owner of property who builds or Improves meteas,and
who conmcu for such pmjecu witha cmuracel(s)licensed pursuant m the Conhuvo8
Lienee law.
❑teamµcrop,under See B k P C fm Nis m}hae
Date
WORKERS COMP DECuiunoN
1 hereby aim under pendlyof perjury oro of cin:fallowing decluved.
I hem and will milmain aCenifcam of Camera m self-insure far Wohcra Cmopeo-
ANver,As provided for by Section 3700 of tae labor Code,far the per frons.of the -
work for which this permit is ivuN.
❑1 have and will maintain Worker'a Compensation Imuranse,As required by Seim
3100 of the Labor Code.for the performance of lie work for which this permit is WuN.
My Workcts Compensation Insuunce came,had Polley number am:
Carrier. Polity No,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This shim aced net W complced If d e pewit is fmone hundrW dollars(5100)
or len)
1 certify the,in the Performance of de work for which this permit is issued.l shin out
employ any person in any m cr gxJesubject to the Worked CamPermdm
Laws of CAW Dae
ApPIk m
NOTICE TO A PT e WOrk If,after making this c c'ofshe
Exemption,you u mass
become mbje y the Wmhcr's Comp a,Baia provisions of the labor Cs kc,you mm
�O forthwith comply with such provisiansor anis pcmitehallWticemcd mwkcd. r
z CONSTRUCTION LENDING AGENCY
E•+ I hereby aim dor inert is A consuuctian leading agency fm the Perfenwmw N
a ? the work for which tabs Permit is issued(Sec.3(19'l.Civ.C.)
W A LendcYANemc
LL Lendei s Add.
7Z
U 0 1 certify Nat 1 have mad anis application and Aram this me arum information u
Uy F correct.l agree to comply with all city And county ordinammes and sum laws telating to
0 U Wilding eonswction,and hereby authorim repa,mmatims of this city to enter upon cies
W mum-namObued property far inapcctian puspoes.
W (Wc)ogee m save,indcmmfy and keep humless the City of Cupertino against
aHy to Iimilitiea,judgmenu,costs and expenses which may in any way aceme against said City
V z APPof ran raming;of LICANTnsecitscmaeUNDERSTANDS ArND TWILL COMPLY WITH ALL NON-POINT Issued by: ; Date L'�7
SOURCE REGULATIONS
Re-roofs /
Signewrt of ApplianuCm r Due
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tM eppliant w future Wllding accupantsaom orhandle hwudaw maeri9
defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safay ..
Seniors 35533(a)? All roofs shall be inspected prior to any roofing material being installed.
GYw No
Will the applicant or factum building by she B acre equipment ar Mona whkh
If a roof is installed without first obtaining an inspection,I agree to remove
Dist hevamnus air cmuminanu w Jcfined by she Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 03tu
1 have mad the hxaardms materials mquimmenu umlcr Chimer G95 ofine Califor.
niaFlwlthkSafctyCotle,SCNam 23505.25311 anJ 35S34.IuMcrstand thni(de Wilding
does not cummly haw A AMank that it is Mymal MIN liI to noe fy the acupam of the _
myuim rwepmrmiwneneeof Signature of Applicant Date
Owne authorized agent Dam- All roof coverings to be Class"B"or better