07100188 CITY OF CUPERTINO �s�,. ry m+t.+ M«�1rxlll;p€`�T"��{y�
BUILDINCDIVISION PERIVIIT "§0NTRWG 0L�.�1f�✓C���
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BUIL 1 PERMITNO.
gI�7�RZICH PL TBD — TO BE DETERMINED 07100188
NER'S NAME: PERMIT ISSUE DATE
SUBASH & SHANTHA 02/01/2008
PHO u^ _ - . , SANITARY NO. CONTROL NO.
ARCHnECT/FNGINEER: BUI[DING PERML MFO
UMB MECH
3Gp LICENSED CONTRACTOR'S DECLARATION
M1 hereby affirm Jul 1 am licensed under provisions of Chapter 9(rnmmencing Job Description
with Sued..70(10)orDlvA..3ofJmBusiness.4I'mrauiurnCode,and mylicense i. SFDL ADDTN, 90 SQ PORCH & ENTRY, BUMPOUT GARAGE,
is fall farce and.fleet
License Cleat Lt..0 KITCHN EXPANSN
a Duo: Contractor
ARCHITECTS DECLARATION
1 understand my plana shall W used as public records
SG Licensed Pmfcssianel
m OWNER-BUILDER DE Contr ON
E 1 hereby.nim that 1exempt from thee Canmcmrs License taw for ft
i o o following moon.(Sado.701.5,1.L5,et, a,a and Pm(esalons Code:Any em of county
$iai which mquima a permit mon
construct bar,W porem
,dealtsh.or repair any structure
_zm prior to its issuance.alw requires the,Applicant for such Permit to file a signed suo:ment
and Ise I.licensed pursuant m Lim ramlaime fthe ConuactoM1 License Law(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commememgwithSued.7000)ofDivtsian3oftheBusinessandPnef.l..Code)or 595000
that k u exempt therefrom and the bait for the a leged asempdoo.Any violation of
section 70315 by atty applicant fora permit subjects the applicant to i mil Penalty of
act pa.Nan Rve hundred dollars(m), 36205037q14T Number Occupancy Type
1,u ownv of ale mopmry,or my wplaym with saga u Neh cele mmpewJon,
and Pr Ne wort,and Jte he Con 4 not Intended ora w ma(mule(Sec.70th.Butircas
Ona errywh bat calm The Canhsetera Licenseadman u«moa anaphia f nd swim or Required Inspections
maPere whoe.proorimPm e.Nen..,andwhoda outmh work MmwrmNmugh his
hwvem,the,tinkling
Iduo such imPmve.mtt tie not ear of tl aroRnW for tale,n,
however,Nemm ftmbupmwnmttshatdwithinasyrs or mmove fardrcmvnm-
buildmwin have Jct When Of proNng that k did tet build a improve Ice purpose of
sale.).
Owner of the Property am exclusively connecting with lianmd comseurs m
..trod the project(Sec.7014,Business and P ficur ions Code:)M Cootreur's U-
orae taw dao not apply an an owner of pmpeny who Wilds or impows Merton,and _
who contracts for such projects with a cannacmr 1liunded pur,aanl to dm Cantram.ra
Lleenu Law.
❑Ism exempt unkrSm ,B&PC I.Nisto n
nu Dam .. .
WORT COMPENSATION DECLARATION
1 hereby affirm r Penalty of perjury ane of the fallowing declamations:
❑1 haw and will maintain a CeNOau of Consent to self-imam for Workers Campcn-
,alio.,as providad fm by section 3700 of the labor Code.for the pmformaa of the
warts for which Nis permit is iuueN
❑I have and will maintain Workers Compensation Insurance,as patched by Section
3700 of Ne labor Cede,for the perfomam of ale work fm which this permit is load.
My Workers Compenuoion Inter.ani.and Policy numem ate: ,
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA71ON INSURANCE
frets section aW an,k completed Ifum Permit I,foram hundred dollar($I00)
or leu)
I artily then in the Performance of tk wort for which this pc it I. atl.I"I not
employ any person in any toaster an sa Nbmm bjm hili Y Ycompensation '
Lawsof Calif..u.Dam `> ,
Applicant
NOTICE TO APPLICANT.If,after making this tam of Exemption,you should
Intend subject N rite bother's Compensallon viuoa of the labor Code,you muss
.J z forthwith comply with such provision or this Permit shall W deemed mmked.
O CONSTRUCTION LENDING AGENCY
F+1 I hereby affirm that Nem is contraction lending agency for the performance of
fYi > the work fur which this permit Is tssad(Sec.3097,Civ.C.)
MW Q Lender's Name
7 z L..dce.Addis.•
U f7 I sonify Nn I have mad this application and sum Nat dm aWw information Is
IT. !' comet I agme N comply with all city and county aNinaaea and sum laws relaJng to
.0 Wilding construction.and hereby authorize tepresenoauweS of this city m enter upon ale
Lit above-mcndaned Property fm indication purposes.
G (We)agme to use,indemnify and kap bumleu the City of Cupertino gonial
h Imleilida.judgments,cath andexpenua which may' any way amus Against laid City
U z in areata t.o of the grudng of a permit
..i APPLICANT UNDERSTANDS AN W MPLY WITH ALL NO7-O T Issued by: Date '
SOURCE REGULATIONS. .(fQ
Re-roofs
Signature of AppliaData
HAZARDOUS US MATERIALS DISCLOSURE Type of Roof _
WIII the applicant or Muni Municipal
building eavp+m core Or handle Health an material '
es dcBned by de Cupertino MuNnpal Cade.Chapter 9.1;and the HuIN and Safety
.Section 25532u)? a .AIL roofs shall be inspected nor to an roofing material bei. installed.
pros N. P P Y g g
Will the applicant orf �re building Occupant use equipment or nlevlaa which If a roof is installed without first obtaining an inspection,I agree to remove
emit huommus air contaminants as defined by the Bay Am,Air Quality Management all new materials for inspection.
District?
❑YesNu
I have mail Ne laces smaterials rtquiremenu under Chapter 6.95 of the Caliper.
MaKcal"safmy@dc, d 505.25533 and 25514.1 unJcmund NU lfdte Wilding
does not currently haw t el It m my responsibility N notify dm mcupanl of Ne
reepronncns which. i prior m issuance of.Ccniri roe posey. Signature of Applicant Date
!V1 o6
Ownermum gist Data All roof coverings to be Class"B"or better