06080102 CITY OF CUPERTINO .+ r•.ax.:ag? 3rs;:Yi 'Q
BUILDING DIVISION PERT wCQ1QR �ILu�iI�. Iy_N
BUILDING ADDRESS: TARA HOMES PaRMITN0.06080102
640 JOHANSEN DR
R'S NAME: PERMIT ISSUE DATE
SUBRO KOLLAR 20200 LUCIL
ONE: SANITARY NO. CONTROL NO.
(408) 253-7828
ARCHITEC IENO1NEEK: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
l� O O
op LICENSED CONTRACTOR'S DECLARATION lob Description I Mrcby aff(os he I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 nigh,Bnsienew end preetedo,n Code.and my III,
in full farm and affect. REVISION-ROOF FRAMING, CEILING JOIST
iyzo ltn Lte "
Dago ORIG PERMIT #06030063-NO NEW PERMIT
~7 Dete GenDEC
ARCHITECTS DECLARATION
< I umlorsund my PUN Shall nee uud as Wblic records
h U
Licensed Proresuorm
OWNER-BUILDER DECLARATION
i1 hereby from that I em exempt film Ne Comm cloys Liecnse Law for he
.o o following mason.(Secdan 70313,Business and Professions Code:Any city or county
:39 which mquims a permit m emawe4 alma improve.dcr lisA or repair my swctum
1 i�2 prior m its issuance,Stan requires the applicant for Such permit in file a signed statement
: C NatMtalicensedpumsan,tociteProvisionsoftheComuemerUccrecLAW(Chapter9 Sq.Ft.Floor Area Valuation $0
(commencing widt Seddon 700M of Doiaian 3 of the ease.and PNfessiono Codc)or
S the he is exempt therefrom and new huts fee the alleged esempt on.My violation of
Seotan 703M by aa)'applicant fee a permit subiacu the applicsnt m a civil Puulty of APN Number Occupancy Type
no,ream than five hundred dallsn(rim). 37536009 . 00
❑Luownerof the property,mmy intended
or
nguu Neu sole compruMm%;
will Pr thework.Code:
he ComtswULicenserafferedwcha for Side
tapplySec.7044,Bunaof Required Inspections
and Pro who Wilds Cade:Thr Comue con. sad who law dons ret apply lf an owner of q P
own eny who provid Improves impr and who does such enork dedhimself mhrough eta
awnemplayra,progOurIIMIweerImPro id wit are not ear ofdmeRercd for Safe.If.
however,the builhaw
its burden
omoviniswitwihinet Wife of compleimprovton,he owner. /(
builder will Mw tte burden of proving tut K did m,WLW m Improve for Purpose of
i
owner of dte property.am eeluaivrJy corseting with licensed cohhsetma muct cite project(See.7044,Business and NafceSION Cade)The Cmo s V-
law docs not apply m an owner ofproperty who buildsorimprows hereon.and,om um for such Projects with a onuacto )fidehued purawnI to he Questioner
nse Law.
on Ptu du Sec ,BBPC this mason
er Data
0 PENS RATION
1 hereby Silos under penalty of perjury one of IM fallowing dMeulimht
0[him am will meirum S CWRcamor Censer,in self-hwrm for Wortels Compen.
radon.a pmAv fm by Sensor 7700 of cite labor Code.far tte perf..of tte
work for which this permit is inued.
0 1 haw and will maintain Worse's Compensation INurana,u mluired by Senior
37M of the Labor Code,for the peRorman.of hd soh An which his permit is(tamed.
My Wormes Compensation Insumm artier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dissection recd out N completed Hhe Permit Is(o one hundred druers($I00)
or lest)
I cutfy that i foosanee of he wart for�Itieh this permit u issued.I ShS11 not
employ any rano any mmnersoum ohde mbjul ( n'LmnWnuOon
Laws
orC fomi 1 elm
Appllcsnt '
NOTICE PLICA :If. RAms nglT c cof Exemption.you Should
become subject in the Workeer Compensation provisions of he Labor Code.you muss
.J 0 foMwith comply with such provisions or hs permit$hall be domed rewtad.
'�= CONSfRUCrION LENDING AGENCY
i= 1 hamby afrnsn til them u e conatro lien hnAing Sgarry for IM Pcrforranm of
(yi 7 he work for which his Permit ta isium(Sec.3097.Civ.C.)
GQ Iandels Name
]Z Lender's Add.
U Q 1 certify het 1 new mW his application and stale he he above information u
f cared I agree to comply with tl1 city and county ordinances and sou laws minting m
pU building construction,and hereby auhhome«premmives of his City to muer upon the
[L7 above-mentioned pmpeny for inspection purpoce.
(We).,me to new,indemnify and seep hemleu he City of Cupertino egaiot
y liabilidesjudgmens,cou and Separates which may in my way ancrue agilNt$ald City
in conseq arches,grendng efhisperm
., APPL�NT`UNDERSfANDS A r}LL COMPLY WITH Al}NON-POINT Issued by: Dale7•-
SOU CE RE ULAT N^. ah (^[�31 gap
S"�fJ�— Re-roofs
sign pts mC net mer DD
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanumre arhandle beandou material
Bred by he Cupertino Municipal Code,Chapter 9.13,and Use Health and Safety
.Section 25532()? �/ All roofs shall be inspected prior to any roofing material being installed.
[:]Y. fb No
Will ha applicant or T1s re building accupam use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
Id
bacani us air contaminants u defined by he Bay Arca Air Quality Management all new materials for inspection.
ict?
0Ycs No
Inammulhehaurdnus eterials requirements under Chapter 6.95 of the Califor•
ealth Safety CmS'Secdmu25505,2 aru125534.1underutandhatifhc building
an$ cu ntlY he •tenant. t Its y Nubility m modify the occupant nr he
rey mcnbwnichmuubamet ran a of aCermRcateof SignatureofApplicant Date
2 All roof coverings to be Class"B'r or better
O e age t Dae