05070201 CITY OF CUPERTINO " „; ° '
BUILDING DIVISION PERMIT CbNTr.RA,4c'1'01UN CSRMA' TUI ,M.
BUILDING ADDRESS: PERMIT NO.0 5070201
10580 S FOOTHILL
OWNER'S NAME: PERMIT ISSUE DATE
MADHU & JAYA KOPALLE 09/16/2005
E; SANITARY NO. CONTROL NO.
ARCHITECIfENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
w00 LICENSED CONTRACTOR'S DECLARATION Jb Description
I hemhy affirm that I me Remnant under Provisions of chapter 9(comenOCSCrIP
cing
< with Section 1")of Division 3 of the Business and Professions Cade.and my license is
n<� nfullfomeandeffect. 1, 3111
ADDITION-ROOM/FULL BATH/BREAKFAST NOOK
N4 Clan Lk.N
FAMILYRM/COVERED PORCH-1, 4915 ' REMODEL ABOVE
Dam Date k. hr
9
ARCHITECTS DECLARATION
1uedcratmd my plansCHIused CYNICrGARAGE SPACE INTO LOFT/MSTBATH/CLOSET ETC.
�i
J U
sad 5 Licensed Professional
OatNEm exempt
DECLARATION
0 I hereby.(Sere that 11. exempt from Um Cmlons C tLicense: c Law for the
p O followwhich
rowan.permit
t 7031.5,Business and Ne,de ons Code:Any city or county
$ which requlma a Permit re uires;the alum,improv,demolish,or e a sig any structure
�^
that hprior e
itsissuance.0.also nt in the previsionsapplicof for such ContrarmiuoficamLaw(ned humcnl
E O (mart inllccveitpunuammNeofDivision3theCantrmessandegecusimCode)or Sq.Ft. Floor Area Valuation
$ (Com ha,
inj exempt
Seefromon andth basis far of al Business and Any violalum
Code)or $356400
.. Nn he 6 ewmpt dmm(rom and the hula far site alleged exemption.Any vloletion of '
Section 7031.5 by airy applicant for a permit subjects pre applicant N a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(S5001
❑I.u mwnu of the pmpeny,M my cmPIOy U with wages u Noir role compenudon,
will M the workan
, d the nclum Is not Intended Mortered Image(Sax.IDN,Business Required Inspections
and Psofeaeinu CodCommon's The Conon's License Law does not apply m an oweer a( q P
property who builds or Improves themen,and who does suchwrrkhimeelforthrough his '
own employees,provided Ihstsuch improvements am sat intended nrnRered forage.If.
however,Ne building or improvement is sold within am year of completion,the Owner.
builder will haw the burden or proving that he did Out build M improve for purpose of
sale.).
El 1.as owner of the property,am exclusively contracting with licensed contractors in
coutroct the pmjm(Sec.7064,Business and Profiled.Code:)M Contrmhra Lt.
cense law does noupply in an owner of property,who build.or improves thereon.and,
who contracts for such projects wits a comou tots)licensed pursuant to Ne Comm mora
License Law.
❑I am exempt under Sen .B&P C for this recon
Oww kB-tSezA Doh
WORKER'S COMPENSATION DECLARATION
!, I hemhy a Inn under pevlty of perjury m of the fallowing declaudov:
1hero and will maintainCCW0nte of Coventrsede.for performance
of -
worn,uproh tai for mi Section 3700 of the lobar Code.for Ne pegormunm of sire
work for which this permit is iaucC
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the performance of the work for which this permit Is lewd.
My Worker.Compensation Insurance canter and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThlawcdM need trot Wcompleted lithe permit is Image hundred&It=($10f)
or lea.)
1 cmify Not In the perfnrmahm of the work for which Nis permit H issued.l shall not
employ any person In any ma Per u ccom,sobiemthc
ct Workers Compensation
Laws of Califf I Dam
APPlic..I b stare e
NOTICE TOAP CANT:If.Igher making this Cenidcam of Exemption,you Mould
bttome auhim, the Worker)Compensation previsions of the Labor DOM,you mug
,J O forthwith comply with such provisions or this permit all he learned revoked.
r 55CONSTRUCTION LENDING AGENCY
[—� )hereby affirm Na New Is a construction lending same,for the performance of
C(i Ne work for which this permit is weed(Sec.3097,Civ.C.) '
QLenders None
.7 z Landers Addmat
U0 1 certify that 1 Mw read this application and turns that the above information is
W E• Correa 1 agme to comply with all city and county ordinances and gain laws missing to
0 U Wilding construction,and hereby anNosire representative;of this city to now up"ft
W above-mmuaned property for inspection purposes
pL (We)agree in save,indemnify sod keep bsrmleu site City of Cupertino against
!n liabiliues,iudgmenti.cats and caper es which may in soy way amus against sold City
U 7in cavegmnce cribs granting of this permit. y
t'•t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 0
SOURC GULATI NS.
t A,--,e Re-roofs >n
Si{ngumo IicanVCon of —I Dam
u — HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will pre applicant or future building uccup.ntstm an handle bawrdou material
u MOaed by tins Cupertino Municipal Code.Chapter 9.12.and pre Health and Safety
we.Suedon 25532(07 All roofs shall be inspected prior to any roofing material being installed.
❑Yu Q(qo
WIII the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t weardot,air contaminants as Mnncd by the Bay Area Air Quality Management all new materials for inspection.
tmict7
❑Yes r(pnu
I havemmd Ne husrdtws mamrialsmquimmenu under Chapmr6.95 of tins Califor-
niaHulthBSafctyCo ,Sccduv25505.25533uu125534,lundcnmod thetifthc wilding
does not currently have a Runt•that It is my maponsibllity,in notify da mmupmt of the
require cent.which must be met prior h iwuance of Cenificam of Occupancy. Signature of Applicant Date
?ooS All roof coverings to be Class"B"or better
Owner sira minad agent Dam