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08010118 CITY OF CUPERTINO T j l�gu,k€� 'S ps �a��{T��v BUILDING DIVISION PERMIT �C� .Fwlsl:Tg.� Lf.0©a,.M��TY.�,`',_ BUILgI�c ,�DREgyENHART LN PERMIT NO. .S M SANJAYA BASNAYAKE 08010118 W NEWS NAME: PERMIT ISSUE DATE SANJAYA BASNAYAKE 10343 MENHART LN 01/31/2008 HONE: SANITARY NO. CONTROL NO. ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDGO ELECTO PLO O m O MISCH LICENSED CONTRACTOR'S DECLARATION lob Description u 1 Mushy affirm that l em licensed under provinces Of Chapter 9( m comencing n�o with Section 701M)ofDivision3ofthe Dealt.and Prefessim.Cmm'mdmy[iet—is DEFERRED SUBMITTAL TRUSS CALLS, ORIG #07090036—NO -�rn in full ranee and mfocL Piz License Class Lm.« NEW PERMIT - gF DaW COntracmr eE ARCHITECTS DECLARATION y O I understand my plana shall W used as Public records ao ti Lseensed professional 3 OWNER-BUILDER DECLARATION i f 1 hereby Milan Net I am escmpt from the CMMmmor's License Law for the , O O fallowing mnacn.(Section 7031.5,Bell..$and Pacloss om Comic:Any city ser county $vawhich mquims a permit W alro conc4 aWl.Improve,demolish,nr repair any aaumum ti prior to its issuance.atsa acquires the applicant for such Permit to file a signed Statement met he is licensed Purpronal 10 the Provishms Of the Cofflanea's License Law(Chapter 9 Sq.Ft. Floor Area Valuation $ (commencing with Sodom 7000)of Division 3 of Ne Business and Profauimu Coda)or $0 oy - that he m exempt tbomfrom and Ne basis for the Alleged exemption.Any vlo lion of Section 7dran by any applicant for•permit subjects the applicanua a civil penalty of 3 7 515 04 0 �Number Occupancy Type Se more Nen five hundred icalts a r a per. ❑Lu awns'of the progeny,"my employees with mall As their male compensation, will do the work,and the snome,is not intended"offered for ask(Sec.70th.Buslnua and Professlam Cade:The Contractors License Law does not apply W an"am of Required Inspections property who buiIdaorimPsaws de um.end whodoess"hw"k himself"Nmugh his We cmPloyces,provided Natsuch imp.ve.anis are nm intendetl"oRered forsake,Jr. however,the building or Improvement is said within o"Year of completion.the owner. builder will have the burden of proving that he did not Wild"improve f"purpose of .14.). L26,As owner of the property am exclusively contracting with IlunuA comacu s to construct the pmjem(See.7016,Business and I M etsims,Cede:)The CootracWr's Li. Mae raw dean not apply W an owner of property who Wilds or improvas Ihemon,and who courtroom for such projects with acomenclar(S)licensed pursuant W We Contractor's License Lew. ❑Iamaemplunder See ,Bh PCfm MmaWmn nsr F-( S-�A'tnlnt-ypC'>` D.ta QAt 31 d-t WORKER'S OMPENS ON DEC RATION I hereby affirm under penalty of perjury oro of dm following declendmu: Sat❑1 ham and will for by Section 3nm of Cousem r Code.aura a Woher'aCempert- workfon,us hick this far mi Secuan 3700 of Ne Labor Code,far The PeAannance of dse work for which Nif permit is LLmed. ❑1 have and will maintain Worker's Compensation Insunnco,u raquimd by Section 3700 of dm Labor Code.far the lonformmnce of the work mrwhich this permit Is issued. My Worker's Compemation Insurance artier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Into axtion need not W cmnPleted If the permit Is for one hundred dollars($100) orlon) - . I certify Nat in the performance Of W work f"which this permit is issued I shall not employ any Person in any manners,an W become subject W the Workers'Compensation Laws of Califomia.Dam APPllcant - W NOTICE TO APPLICANT:If,after making this Ccnirmadmn Flffi ton,you should become Subject W the Worker's Compensation previsions of the Loh"Code,you must .J O forthwith comply with such Provisions or this permit shall W doomed nevokc 1. z y CONSTRUCTION LENDING AGENCY - [-+ Ibotchy affirm Nat Ncm its comwction lending agency for the Performance of F4> the work for which this Permit is Wood(Sec.3097,Civ,C.) W Q Lender's Name jLcndcr's Address VQ I certify that 1 have and this application and sum Alm.the Sve infman medh - w ~ earn l agree 10 comply with all city and cOWIy ONinanRs and soon lewd totaling t.0 04r..')' building construction.and bomby aumorire tcpmsomadvao of this city to enter upon the above-menudgm Progeny for inspection Purposes �y a (We)agree to taw,indemnify and keep harmless the City of Cupertino against yr rn incommaiumdgmcnhe costsSwung and eaPensmmay in any way aecruc against said City V AcPLICANce of DERST ng of this Permit. y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bS � Date SOURCE REGULATIONS. Fw It- S &^_S AI)(y XL f - a) 31 p c Re-roofs S4-mare of ApplsrznLVOMIr ami I films HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tiro applicant or future building"cupam stem orhandle hams dour material AS&food by the Cupertino Municipal Cad,Chapter 9.13,an!mar Health and Safety otic.Section 25532(a)? CYu [�gNa All roofs shall be inspected prior to any roofing material being installed. Will thea Resent or future building Seca ant nm If a roof is installed without first obtainingan inspection,I agree to remove PP g e Wuipm mflity devices P DimIL ca erdnm air conuminanm u dcOncd by the Bey Ame Air Quality Mamgcrncnl all new materials TOT inspection. QYcs No I have read the heraNnm materials roquimmenm under Chapter 6.95 of the Ulf., aria H"Ith&SafctYCo .S=-25505.M533and25534.Iundcraand Nmifdm Wilding does iter cmmnrly bew a meant.Nu it is my respamibility m notify No occupant of dm aq�renhwtueh must Wmel prior Missuan¢oI CFinaeem of Deeap.my. Signature of Applicant Date Owner orlla//(CJuLt_�Jhari0.dagen �✓� hY, ) "-� Date All roof coverings to be Class°Bar or better