08060020 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGTOIiI1VF4RMA.TI�1�
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PERMTT N0.
Bull.p�Nr ApgJLES9,ANNA DR TBD - TO BE DETERMINED 08060020
OWNER'S
NAME: H FERMrr ISSUE DATE
1?AISAL & FARAH MERCHANT 07/02/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB ME(.Ti
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION Ib Description
C i hucby am.mat 1 am li¢vW uMcr provisions of Chapter 9(mmmcocinOBSCrIP
;
t� with Section 7")Of Division 3 of Ne Bulinus and Pmfessium Cade,arW my liccomu HOUSE DEMO
u in full face am elm
Z Lice se Ciao Lk.N
nip Date Conuemor
47W7W ARCHITECTS DECLARATION
W V 1 uncontested my plans,hall h used as public retards
g n Licensed Prapssanal
3 OWNER-BUILDER DECLARATION
I barely affirm that I am exempt from the Conuanors Lkcnsc Law for the
a O following reuan.(Section 1031.5,Business and Prefetians Calc Any city or county
29 which nhyuima a permit an mala.alter,improve,dcmm11sh.m repair my suunme
w prior m is issuance,also requires to applicant forsuch permit to rile a sigmd sarcoma
WNathpursuant isllccnmlpursuanomeprovisiosoflhConumhn'sLicenLaw w(Chaptu9 Sq.Ft. Floor Area Valuation
0 (commencing with Smsion7000)ofDisisiun3ofdue Business and PmfessiomCode)or $20000
e r3.- that he Is exempt therefrom and the basis for the Melted exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil porosity of
ant moa them It.hundred delkn(5500). 37529010 .W Number Occupancy Type
0 I,u owner of Bk property,or my rsoploycv with wage m Nest mk eompemudon,
and
dathemak,anile: eeOmuretintendedaonemAfaral7016,...Of
aM erywho u Code The wsthecmrs Licence law ache ret apply lf rt uwnu is Required Inspections
propertywho ser proriimprawch paper andwhodocsotechwort hsomlfar Iluough his
awnnm,thebu,provior this awnsimProvemusartrel ear ofcm laN far tele B, .
however,the build ase or imgovemmtg mrd within use year of completion.prowr the oamer-
sale.). will have the sada of proving Nu h did rot build m improvm(or puryom of
teak.).
1,as owner of the property,am exclusively convecting with licensed contractors a
tract the project(Sec 7004,Business and Professions Code:)The Cmuaaars U. .
cane,Law doca not apply W an owner of progeny who builtls or immaws thereon.and
who contracts for such prejects with a eanuaum(s)licensed pursuant an the Contractors
Lkeve law`
❑l ren exempt under See ()/) B&PC
Owns koy,22 r rlM Dau � Z u)r
WORKER'S COMPENSATION DECLARATION
I thereby affirm under penalty of Ndury am of the following duluationc
1 hart and will easinuma Certiftute of Covent an self-ims.fa Wor sCampcn-
.don,as provided far by Sacuan 3700 of the lobar Code,for the performance of the
work for which this permit is issued.
❑I lase and will maintain Workers CompevNan Insuraee,u required by Schon
3700af the labor Cade.for the performance of Ne wade fmwbich this permit's lured.
My Workers Compevauao tomMce earria and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu ander reed rot be completed lith permit H foram,hundrrra doeana(5100)
or lou)
I cera(.met in the pe rmor.or Inc work for which this permit is iuuhd.l"I nus
employ my .n in any arm umbecome mbjeclmthe Wohus'Compeommon
Laws of California.Data� _�.�a�0. l
LawsApplicanl AA4 �T t
NOTICE TO APPLICANT-If.after making this Cenleam of Exemption,you snouW
become subject m the Woher's Compcvition previsions of the labor Code you mus
.J 0 EN
forthwith comply with such provisi as or this pewit shall be deemed mated.
'z CONSTRUCTION LENDING AGCY
C4 the Ihrtby aRrm Vert uaeovuuui7ng agenry for the perfonmmtec of
C> work for which dtis Permit
u stoodrmistood ism.30097,civ.G)
W Q Lcndch Name
=z laMerte Aanm..
U 0 1 certify that 1 hate mad this application aM state that the above informauun is
I%, t— comes.I agree W comply wish LI city and county ordinances and state laws misting in
.O L Wilding conswcuon,and hereby mNarirs reproam uanam'this city in ensu upon the
above-mhndonad Property for inspection pugefes
Fy (We)agree se ave,indemnify and k,P harmless the City of Cupertino against
IV) liabiliaujudgmens.cans and expenma which may in my way accoe against said City
C)Z in consequence of the gnoung of this permit.
^' APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATIONS. I -y
Ni"ohi ,�`pPIialwCanuacor '^` qI�ID p Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 1 Due Type of Roof
WIR Ih applieanr or future building oavpantmrt a laMlc havrdeus mu:sind
u deRhed by the Cuperdna Municipal Code.Chapter 9.11,must e Heald and Safety
case,Sectionoyer 25532(e)7 (,�^{No All roofs shall be inspected prior to any roofing material being installed.
Will 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
lavardos air commivns as de0md by the Bay Area Air Quality Management all new materials for inspection.
District P
Oyu ON.
I have mad the ha»mns,mstcrials requirements under Clamor 6.95 of the Califor.
as Meet"Safety Cao,Sees.25505,15533 and 25534.I understand Jus lfdte building
saes ret currently law a meant"it a my mtepomibility a Maly the comments of de
requinerat,14 which rour to=L priuare
araisaaraCcnlhateaf mm Signature of Applicant Date
rnt �" - Q2l -y
Owner a amixed All roof coverings to be Class'%¢"or better
agent Dau"