08010102 CITY OF CUPERTINO �mxkazr ,tf�
BUI LDINC DIVISION PERMITCONfiRA, °FSR ZNI''OT.LMA7.'IN
BUILQII�G�S 6""LINNET LN FEMEX - PERMIT08010102
HER'S NAME: PERMIT ISSUE DATE
W
SAMEENA BAIG 1461 BURROWS RD 02/12/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 879`0800
ARCHITECTIENGINEER: - t BUILDING PERMIT INFO
BLDG ELCCT PLUMB MECH
3a; LICENSED CONTRACTORS DECLARATION l IObDesCiDescription
1 hereby affil m Net 1 am licensed under provisions or Chapter 9(commencing P
wish Section 7")ofDrvisimn 7ofmc Business and Profeuiona Code,and my license is DEMOLISH EXSTNG SINGL STORY HOUSE
in full To=and ellen.
i n? License Clan Lie.
Date Cosmonaut
`
ARCHITECTS DECLARATION
i 1 understand my plans Nall be used Is Public records
y o� Licensed Pmfessiwal
OWNER
that
DECLARATION
<E I hcmhy e1Rnn that i am eeempt from the Convenors License Law rot the
00 following now,(Section 701IS,Business and Professions Cole:Any city ar only
SE! which minim a permit w construct.alter,improv, emol W,or repair soy svuaure
Se prior o its issmn..ala mquirca themplicant forsuchecophwfileasignedmtemem
< that he is licensed possum to Ne provisions of the ContacturaLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)or Division 7 of the Business and Professions Cade)or $8000
Y Nu he is exempt thmalown and she basis for she alleged uemptlan.Any violadis of
Section 7071.5 by m, a permit subjecume applicant to a civil penalty ofNumber Occupancy Type
not mom than 0w hundred dollen WOO). 316 4 7 017 d
0 I.u owm4 of t pmpwy,w my mployeu withwage u Neo ole compcmadm.
and
dothework.endthe swctu.unotlnsMede Lawdsetad,apply
to
owner of
and Pwfasiobu Gale:The Conductors License law dam oat apply lf rt owner of Required Inspections
awn enywho buildsviirepmts thrown,andwhat daosuchworkhimselfedthrough his
awn ogees,provided that such improvements an net ear o ed moaeeed for mover.
Wild.,theave the as,Improvementof ptnenatsseid diinomyearofmmovefordssolus-
buiott will have the harem of poNng that he did ma stile or improv for purpose of
I.as owner a the property.am eaelmively...=I,wish Bcemed c nuaisma to '
constrt she project(Sec.7014.Business and Profestiom Cade:)The Cmttene's U-
euc
ease law does not apply to an owner of property who builds or Meow thereon.end
who contracts for such projects with a comacmr(O licensed pursuant an that Contractors
4mic.Law.
❑l and aemin order
,Siitite`.� � .B d P C for thus recon
water TC`/fJ T Date 2� f
WORKER'S PENSATION DECLARATION
I hereby affirm ardor peulty of perJury one of the following dencurations:
❑1hawandwillmainWns Ce fiO mo(Couentwself-imamfmWadesCompen-
atien,u provided for by Section 7700 of the Labor Code,for the performance of the
warn for which this permit is issued.
❑i law and will main am Wormes Compemadme Imuran.,as required by Section
3700 of tite Labor Cade,for the performance of the wad for which this permit is rumA. '
My Wmbers Compensation Imummn carrier and Polity,number am:
Cartier. Poll,No.:
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusedice teed net be completed If tis Permit is two=hundred di lIsm(514)
or lest)
1 certify that In the performance of Ne woe for whichthis permit Is issued,I shall not
employ any person in my mann Is
W bcmmaanbjecwe9v�dem•
lm Core!xdon
Laws of California.Date
Applicant
becomeNOTICsubject
APPLICANT:IL oiler mudding thv Certificate of Labor Code,
you should
bcehwi hco mt y the Wohcrs Compensation or this
pmdsiam of sho Labor Code,you mull
,QO forthwith comply with aces proWsiom or wit permit shall he rimmed revoked.
Z" CONsmuc ION LENDING AGENCY
[-..N- Ihereby M.that Here isacnnstractirm Inner.,sgy far the an.perrarmof
lYiti the woe fur which flus Permit is issued(Sec.7097,Ci,C.)
4 lenders None
.7 z Lender Addeo
U Q I certify that I Mw read this application and was that the above information Is
ty F torten.I agrm in comply with all city and county ordinances and sole laws mladn,in
QU building construction,and hereby lushoria lCpreaentstives ofthis city in enter upon the
fi] aho d-mentiamd pmperty for inspection purposes
Ly,y (We).,tee to are.indemnify and keep harmless the City of Cupertino against
art VI liabilities.judgments,costs and experuu which may In any way acme against said City
U Z rat c...imenac of the granting of this permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 �&o Date
SOURCE REGULATIONt$}..����ArL-4-Signature of Appft.nucoddomser Dart, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tho applicant or future Wilding=opal store w handle towards material
as de0md by that Cupertino Municipal Code,Chapter 9.11,and tie Health end Safety
ode. @
Section us71(.)?
❑Yes No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant m(alum building occupant sew equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmndnns air contaminants a de0rsed by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
1 hew mail the huallous materials requirements under Chapter 6.95 of the Called.
nia HcAO A SafmyC me Sectiuu V5505.25533 are 25534.1 untlenuntl the if the building
tom rot cwremly haw a.4 them it is my responsibility in mtify the occupant of use
requlremcnu which mmt W met prior W issuance of a Cenlrcas of�apamy.7r a) Signature of Applicant Date
Owner or asharuc t ? DateAll roof coverings to be Class"Bt'or better