08010072 CITY OF CUPERTINO
BUILD , PE MIT
DIvlSION CLlN�1tA-C'Tt)It INPOitMATT N
PERMIT NO.
BUILD
2"Y'sIaINDA VISTA PL TBD — TO'BE- DETERMINED 08010072
R'S NAME: PERMIT ISSUE DATE
SRINIVASAN 03/03/2008
7AIOC�H'
E: SANITARY NO. CONTROL NO. -
ITECDENGINEER: BUILDING PERMIT INFO
BLDG EL.ECI' PLUMB MECH
0LICENSED CONTRACTOR'S DECLARATION - lob Description
U UU1 hereby affirm that 1 am limnwd under provisions of Chapar 9(commencing
i with Section 700)dDivismi 3dfde Business and Prof 'ons Cods.and my limareia ADD 153 SQ,RMDL(E) 2 BTIIS
in full force and teff
eFp Do¢�=RR^^lL Conuacm
CHDELLA A
IundcrxanJ my plans shallll hM e used apuhiic mrnrth
�yU
stH Licensed professional
5 OWNER-BUILDER DECLARATION
vit I hereby Affirm that I am exempt from the Contramo's License Law for the
p o fallowing moan.(Section 7031.5,Business and Professions Chadd:Any city or county
e 9 V. which mca.n.a permit to anumaL wWr,Improve.demolish,or repair any wncture
priortoitsissuma.alsomluimstheapplicantforsuchPermitWfileasigeedsutement F[. Floor Area Valuation
< Ilaw he is licensed pursuant to Otic provisions of the Conmmns,
i liLaw(Cosper9 Sq. (�32000
IFG (earnmencDivig with Section 701 of Div3 of Om Swinessund Pmfasions Code)Or Y
that he is exempt therefrom and the basis for the wkgcd csemptim.Any violation of
Sectiam 7031.5 by."applicant Idea permit subjects the applkam to a civil Penwty of A Number - Occupancy Type
aatmamthan nvahandled danas(M). 35608008 8�
❑1,as owner of the property,of my employ=with wages as title sole mmpewtioB,
will do the work,and the stmcsure is not headed or offered f..1. te.7044.11usioess Required Inspections
and Profeasans Code:The Carmelit's License Law does w
rot apply W an owner of 9 P
Property who builds or improves themoi whodmaauchwark himselforthrough his
own employees,provided that such improvements we not intended oral Bred forsala if
however,the building or improvement is sold within ane year of completion,das ownef-
builder will hart dre burden of proving that he did am build or improv for purpose of
ale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors m
camwcs the project(Sec.7044,Business and Professions Cpa i The Canonici Li- '
cense taw does nasi apply W an Owner of property who builds ear improv themm,and
who mintracu for such projects with a mrmance s)licuued purword re the Contractors
License taw.
Olamachro ader See .Ba PCfmdew.
Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decl+fmim .
aw and will maintain a CandOam of Cement 1.se Wnsure for WarkiCampea-
a,im,u provided(of by Section 3700 of the Labor Cade,fm the performances of the
work for which this permit is issued.
❑1 have and will maintain Workers Compenartian Insurance,as required by Schon
3700 of the Labor Code,for the peron ws,of the work for which this permit is issued.
My Worker's Compensate Insurance artier and Policy number am:
Cartier: Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need oat hccmnpkted if the Permit is foron,huntheddwl+m(5100)
or less.)
I certify that in the performance of the war which this i s issued.I shall rot
c to anyprson imam nersoss sub" the 9rke21bmpem m;v�
Laws of Califomi
Applians
NOTICE TO P A r mating Nu ertifiae of Exemption.you shoed
become subject he dm Wallace,Compensation provisions of the Lather Cad,you mux
�,z ford ith comply with such provisions or this Permit wall be dnemcd mated.
z CONSTRUCTION LENDING AGENCY
(-t IWho,aMr.that dem is s cumulated..lending agency,far de perfmmame of
as the work for which this permit is issued(See.309-/,Cb,C.i
W Q Lender's Name
z Lender's Addheas
U 0 1 certify out 1 have read this application and state that the above information is -
correct.I agme to comply with all city and county on inanca and sme laws mining to
0 U building construction.and trmhy,authorise rprewat iwa of Nis city to corer Oman the .,
r W above-mcmianed property for inepcmion purposes.
f~ LL (Wc)agme to save,indemnity and keep harmless the City of Cupenino against
N liabilhief,judgmentecosts and cxpcnsuw ' yin any way amrue againsssaid City •''') n
U z Aconsequence
PLI ANTsof the g s
UNDER�t Tg oSthus Wlt COMPLY WITH ALL NON-POINg Issued by: Date
-0 Re-roofs
Signature R APPliciipoccanuxuar HA_ RDOUSMATERIALS DISCLOSURE D,th Type of Roof
Will the applicant art fusum Wilding occapanlsmm m luadle broadens martial
defined by the Cupertino Municipal Cods.Chapter 9.11,and the Health and Safety
.Schon 25632(+)7
Dyes � All roofs shall be inspected prior to any roofing material being installed.
Will the Applicant or future Wilding occuptn use equipment or denims fabrics If a roof is installed without first obtaining an inspection,.I agree to remove -
cmit ha,aMms air mduaminmu as defined by the Bay Ami Air Quality Mavgcmnt all new materials for inspection.
District?
O Ycs —Nam'—'
I hoveread the haaallous mamriats require motet Chapms 6.95ofde Glifor-
niaHealN&SafctyCcdc,Smdom25505.2553rd2o34.lundcrstandthmilthc Wilding
docXora'uthorldl
dy how a e L these it is res obilis �d`
thc
myhich ran ossa aofamSignature of Applicant Date
open, All roof coverings to be Class "B" or better