06090071 CITY OF CUPERTINO ..r'2a, a�nF Tz->� ""���'�' 'j"'j�'�
BUILDING DIVISION P];1 T VQ3A+y C EINFO
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BUILDINGADDRESS: FIROZ PRADHAN PERMITN006090071
I1 10896 LINDA VISTA D
II R'S NAME: PERMIT ISSUE DATE
FIROZ PRADHAN 09/12/2006
PHONE:. SANITARY NO. CONTROL No,
ARCHITECTIENOINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMBO MECHO
o� LICENSED CONTRACTOR'S DECLARATION
Job DOSCrIpI100
I 1 kmby affirm WI I am licensed under provisions of Chapter 9(commencing
with Sudan 701110 of Division 3o the Business sed Profcssiam Code,sued my license is
y In full fafieand affect. REMODEL-2 BATHROOMS,. KITCHEN COUNTER TOP
8z LiceoaM °n` c"meter CABINETS, STRUCTURAL PLUMBING
le
ARCHITECTS DECLARATION
i < 1 understand my Dues shall E used as public
unds
y
0 Licensed Pmfnslonel
y OWNER-BUILDER DE Ce Contractors
0 Z I beaky alarm that 1uusin from the fesntrnal Co License Law for the
:0E o fallowing recon.(Suwon 7031.5.Business and Profestiam Cale:Any oily of cwmy
which¢ Moore quires a permit w construct,ales.Improve,demolish.or repair any et¢
4$« pnorm its isswnee,aho requires the applicant formch permit to rile a signed statement i i Lost he is licensed pumsanuo the provisions of NFl
e Contractor's License law(Chapter 9 Sq.Ft. oor Area Ill$t]dd 5
I I-0 (eourmendng with Sudan 7000)of Division 3 of the Business and Pmeniom code)at
$ that he is esempt therefrom and the beau for the alleged esemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne apPleanl10 a civil penalty of pp N Number Occu-1
not moa than five hundred doll¢(ism). 3 5 614045 . 00
❑1,as owner of the property,Or my employees with vegeta u their We compensation,
will do Newark.and The macs.bond toormedmonead fmads(Sec.7044,Business Required Inspections
and pmdcWom Code The Consensuses License Law does sot apply w an owner of 9 P
property who builds art impresses Neaan.sed who don such work hima d f w through his
own employees,provided than such Improvements arc not intended oroffe rad for We.IL
however,the Wilding or improvemutt ismld within one year of comp,don.Ne owae,
builder will have the bond,.Of proving that he did set build or improve far purpme of
sale.).
❑1,as Owner of the property,am exclusively contracting with licensed convectors w
caeswct die project(Sec 7044.Business used ProfeWOM Cade:)The COMMMM`s Li-
c,nse Law docs not apply in an Owner of property whe builds,or improve Iheaon,and,
who contracts for such pmjeets who aeoutraeaaNU licensed P=esnl W de Comacter's
License law.
❑Ism nempl tides B&PC(a,Nu moon
Dam f
WRIKE AT70N DECLARATION
1 hereby aNtm a r penally of pejury one of the following decimations:
❑I ham and will maintain aCeNfiam of COmWd to uhf-Insure ImWerseYs Compete
mass,as provided fon by Sudan 3700 of flu labor Code,for the performance often
wart for which this permit is named.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700 of tie Labor Cede.for that performance aide work for which this permit Is Wiled.
My Worker's Compensation Insurance carie and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITh mien need Out be cmnplesd'dthe permit Is fwOne hundred dollars($100)
or less.)
1 certify Nat in the Performance of the work Ion which this Permit h issued.I shall not _
amployanype..in my mearerm t beco ,s b%clwlh ark, ompensaaw
Laws of CelifamiL Data
Applicant
NOTICE TO APPLICANT:IL sMr making this I cam F,aan non,you should
become subject w Ne Wohcls Camp,wdon provisions tie Iabw Code you mon
.J O rOmwith comply with such pmWioes or Nis,permit NN be deemed invoked.
„zn4CONSTRUCTION LENDING AGENCY
'Ter Iheahy affirm Nal mere is a constmctlnn lending agency for the performance of
a> the work fon which Nis permit as issued(Sec.3097.Civ.C.)
WM 0 Landes Namc
z Landee.Address
U p I canify that I have mad this application and man Nm the above information is
It, ,ossa.I agree M comply with all city and county ordinamceu and me laws mladng 19
DU building convection,and hereby authorise reproustatiws of this city to enwr upon the
a shove-mcnd.nod properly for inspection purposes.
(We)agree to saw,tourist fy and keep harmless the City of Cupertino against
fn liabilities.Judgments,costs it..Pa.=which may In my way aecrue against aid City
U in APPLICANT UNDEor the RSTANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date �6
SOURCE REGU NS.
06 Re-roofs
Sigmem.of App' tC Data
x esus MATERIALS DISCLOSURE Type of Roof
Will the appli for fww building occupam moa or handle heecommus maenal
de0ned by the Cupertino Municipal Code,Chapter 9.12,and site Health and Safely
Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
Will the applicam or future handing Occupant can equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air ccnamimnts ss dcOned by the Bay Area Air Quality Management all new materials for inspection.
D s ncR
El Y. QNa
I hew mad he humorless mamdalsaquiamcnu under Chapterd.95 idiom Calder-
niaHcalh,kSafetyCede, ctiaes25505,25533an175534.lw&nundthmifde building
Jan net cuneml�Omu,-5r,
ant, It h my responsibility w nadfy the outpost of the
requirementteismance.fkcealrwaeafocapaney. Signature of ApplicantDate
Owner=wthwAll roof coverings to be Class"B"or better