06010046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQIYTRiCTOR�INFORMAT,T.-N:
BUILDING ADDRESS: PERMITNO.06010046
1114 HUNTERSTON
R'S NAME: PERMIT ISSUE DATE
SAROJ DAMLE & VIDYA DAMLE 03/13/2006
JW NE: SANITARY NO. CONTROL NO.
ARCHITEMENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�00C LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 thereby affirm Nn ns m
1 Am licensed under provisioof Chapter 9(comencing
O with Section 700yof DIAmM.3afthe Builneu end Professium Code,and my licenxu
I.full forte and eRecL ADD 328 - (FRONT & BACK) /REMODEL 1791 '
;8g uan>caaaa tie.«
Oslo ComrecINTERIOR/RELOCATE KITCHEN/FURNACE
g CL
9e ARCHITECTS DECLARATION
Y I understand my plana shell he used as public recortle ,
�c Licensed Pmfesfonal
OWNER-exempt fo DECLARATION
0 I hereby.(Tram on 1 am exempt Wm the Cosies o :My c law for the
OO following reason.lemic t 7omm t. )Maend M.demoli Code:My city or county
$ which requires permit re enrufucL plot impmw,demolish,or repair any ntmnum
Metpdoetslimn issuance.tlm Rothe flapre ilio of for such Connctor'wce=Lrile a nednalomcm
z < Menhe ton nicenwJ pSectiol to the prevision 3fcC BuinessA Lice=Law(Chaplor9 $q.Ft. Floor Area Val"&0756
zC� thammene xemps amfoan And th Division?thew Business endon.Myavi Ctde)or
3� Nu he h ntmpt thrtfmm and site herb for the alleged exemption.MY Wolelion of
Section 7031.5 by any Appliance for a Permit subjects Mw applicant in A rive peaky of APN Number Occupancy Type
m,t roam than fire hundred dollar,(M). 36222030 . 00
❑I...Mofdaepropeny,mmyemployceawl7h wa,esadae4.kcompensNm,
willdo the work,and shes =in.ts not intended moRcnd foaale(Sm.7044,Business Required Inspections
and Professions Code:The Conuecwr's License law does not apply w an owner of 9 P
property who buildsorlmprotea daemon,andwho doesouchwork himselforda ough his
man employees,lremolded pr such impsmemWtartnminlondedanatase for theme.e,
however.mp de building de improvement is sold mu Ar one year d d cauttia,As,ower.
builder WIN haw the human of proving dot he did on,bai d Or improw for purpose of
rale.).
is ru othe p of the property,Business exG and confusion,Cod li Theed cenuanars m
lanstmA Ne pelota(See.innd4,wnofand raywhoprofusion,Cade)The ConM¢wr'c ed 10
censelawdosenot apply jetsownerofpropertY.whoseWilds orimprov Contra and,
who cmuacu for such Drokcu with a conumwr(O llunsed pursuant in dap CanuacmM1
License law. ��
❑lam axe ptP .B&PC fm Nice recon t
Dewe /O
'S CO ON DECLARATION I thereby affiete under penalty of perjury one of Mw following declanMou
I ha.ondwillmat icalaCcen..uofcaruentioulf-Iaumfmwork compm-
estion,a provided for hY seaelun 7700 of We labor Code.for Me performance of the
woks for which Nis permf Is inmd.
❑1 law and will maims in Worker's Compensation Irumana,As required by Section
3700af the Labor Code,for the performance or the work for which this permit is banned. '
My Workee.Compensation Insurance curia and Policy number art: '
Carrier: Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu antero need not be cunplelod E We Permit Is reason hundred dollars(,100)
or ices)
1 certify that in Ne performance of the work for which this permit is blued,1 shall not
)mployany'Vernon in any mmxr m as w become Ulo V�rten'Cmnpenatian
Lawsof T a ate q 9
Applicena
NOTICE TO PL term g e eni0calo of Latey on,you ushould
most
become sub)c , c W9rkv'iCamporwNwpreelEeRs of dac labor Code.you most
3 O forthwith comply with such pro Morn m this permit""be dcemW revoked.
ZrA CONSTRUCTION LENDING AGENCY
[—i IMreby a@rm that them is a answctiom lending agency fm the Performance:of
p:7 the work for which Nis permit is issued(Sec.7097,Civ.C)
aLender's Name
z Lader.Address
()0 I coif,that 1 have mad this Application and sum that Me also.inform Wan is
Ig,F Corea I a,eee to comply with all city and county ondinarwes and suit law Miming in ,
0 building construction.and hereby audaarms remewnldbCS of this city w Color upon me
u7 ahovcmmtionrA Property for IMIX01011 PWPoses
t,. (We)agree In saw,indcmnify and kaap harmless,ate City of Cupertino against
fr
CA Ilabll4101111H.es,judgmenu.casts and expenses which may In any My IMPAC a, said City
U F7 In consequence of the Sowing of this permit.
APPLICANT UNDERSTANgq ANRYILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
I Re-roofs
HAZARD
Simuofme Appliuor = DA Dalo
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
.911 Neapor fuuni Wilding occupant Chapter
acreorAndhandle Hostile And
deOnrA by the CuCupeNno Municipal Code.Chapter 9.12,And M¢Nealth and Se(my
Secfan 25533(`)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ' ao
Will the applicmt or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
m
il heyandons Air mnuminstu an defincd by the Bay Area Air Quality Management all new materials for inspection.
ict?
❑Yes no .
I haw mW the hm dmusmamials requirements underChopur 6.95 o(the Califor.
calth&Safety Cade,SaMum25305,35533 and 35574.1 understood that lithe building
demetprior tiro' cola ninawarOccupmcr. Signature of Applicant Date
Owner ar th rot , All roof coverings to be Class"B"or better