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03040067 CITY OF CUPEwrINO x�k a.0 BUILDING DIVISION PERMIT CONTRACTOR INFORMATI©N �..s* ....,?;m y -Tg€ sm-�.dS'f 69 4,, BU ILDING ADDRESS: PHAN CONSTRUCTION CO INC PERMITNO03040067 10404 MENHART LANE 'ER'S NAME: 870 S WOLFE RD PERMIT ISSUE DATE ANBUKARASAN TAMIZHNIANI 08/14/2003 NE: (408) 737-8323 SANITARY NO, CONTROL NO, ARCHITECI'IENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +00 LICENSED CONTRACTOR'S DECLARATION Job Description u F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing oP `uf with Secrion 7IXID)nf Divii on Sof Nc Buyttc.s and Pmfessinna Code,ane mylicensc is +�d in full fom2agdeffen. _ ,/ �-- —b ADD 1362 SQ. FT. /REMODEL/STRUC�ALE® )M4 LLiDiiacr�eense Cl s Lic.M +� ARCH CT's RATI Fz IundcrstanJmyplamshallMused apublic records JUL 29- 2004 eyU o Licensed Pmfcssional OWNER-BUILDER DECLARATION BUILDING <I 1 hereby affirm that 1 am exempt from the Contractor's Liecnse Low for the O pOH following reason.section 7031.5,Business and Pmfcxsions Code:Any city or county COO 2 LL which requires a pctmit to Construct,alter,improve,demolish,or repair any structure8300000 Q!i Pim to its issuance,also mquims the applicant for such Permit to file a signed statement that he is licensed pvrsuom to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation s- (commencing with Section 7")of Division 3ofthe Business and ProteanCnde)or 37516005 . 00 w- that he h exempt therefrom and the bash for the alleged csrmption.Any=of Section 7031.5 by any applicant for a pesmir subjects the applicant to a civil penalty of APN Number Occupancy Type not more than fire hundred dollar.(S500). P Y YP ❑ Las owner of the property,or my employees with wages as Ncir auto compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Businea onU Professions Code:The Contracmri Licmae Law does not apply to an owner of 102 - PIERS e 1 d Inspections properly who builds or improves thereon,and who doessuch work himalf or through his own employer,provided that such improvements are not intended or offered for ale.If, 103 — UI'E'R however,be building or improvement is sold within one year of completion,the owner. builder will haw the burden of proving Nat k did not Wild or improve for purreaa of 104 - REBAR ate.). 105 - ANCHOR BOLTS 1,as owner of the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li. cense law does not apply to an owner ofpmpcny who Wilds or improves 0mmon,antl 202 - UNDERFLOOR PLUMBING who comncufor such projects with a contncmr(s)licensed pursuant to tW Contractor's u«nae Law. 203 - UNDERFLOOR MECHANICAL 0itrmexemptunderSec. BkPCforthismoon 204 - UNDERFLOOR FRAME Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION301 - ROUGH PLUMBING I hereby atfrm utitlefpenalty of perjury one of the fnnowing aeelarauons: 302 — TUB & OR SHINER aw anwill meimelna Cenificvm of Consent sclfimum for Worker's n. ¢inion,as provided for by Section 37M of the labor Code,for the performance of the 3 03 - ROUGH MECHANICAL work for which this pmmit is issued. 304 - ROUGH ELECTRICAL ❑ I ban and will maintain Workers Compensation Insunnec,so required by Section 3 5 — FRAME 3700 of the laborN Code.for e performance of one work for which this permit is issued. My Workers Cnmpenation maursaearr Policy number am: 306 — HOLDOWNS Ca 'cr� Policy No.: 124 U— UO3 307 - INSULATION CERTI CATE t EXE.MMON FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (Thisscction need not keompletedifthepermit lsforonchundrodaollem($100) 309 - EXTERIOR LATH ortas.) 310 - INTERIOR LATH I certify that in the performance of the work for which this Permit Is issued.I shall not 311 - SCRATCH COAT employ any personet ss m b in any manner seom become subject to the Workari Compensation Laws of Califmmia.Date Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.If.after making this CCnifilale of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject tr the Worker's Compensation provisions of sk labor Chile.you must Jz forthwith comply with such provisions or this Permit shall kdeemed mvoked. 502 - FINAL PLUMBING ENERGY ? CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY p hereby offirm than LJUCM is R cOmintorefirm lending agency for Lim Performance of 504 - FINAL BUILDING ENERGY C > the work fur which thispn.it isissued(See 3097.CN,C.) 505 - FINAL ELECTRICAL lk7 Q Lendca's Name a LmaerSAUams 506 - GAS TEST U O I anffy that I have mad this application and some that the aWw information is 507 - FINAL PLUMBING ry (~ correct.1 agra to comply with all city and county ordinances and state laws relating to pU buildingconstrucrion,andherebyauthmriaemprescntaiiwsorthiscitytoenteruponthe FINAL MECHAN CAL U above mentioned property for inspection purposes. Q 9 F I (s j.agree to cove,osts andcmm(y and keep hvmlcss the City of mCupertino egotist /T� lZ incorlequenc of ts.obe gramind expenasmiwhich may in anyway accrue against old City A NG a't/5/� U 7, APPLICANTCUNDERSTANDSthis AND WILL COMPLY WILL NON-POINT Issued by:t. 5 WORKS Date SOURCE REGULATIONS. Re-roofs alum of Applic V n a Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuwre building occupml nom or handle havarUuus mamdal defined by the Cu Municipal,Code.Chapter 9.12,and the Health and Safety Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yea I(p`No Will the applicant or future building Occupvnr use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hnrardous air contaminants as di by the Bay Area Air Quality Management all new materials for inspection. Di ict? 0 y O1N0 I have mad me hanrdeus materials mquimmenLiunser Chapwr 6.95 of thc Califon nia Health&Safcly Code,Secuons25R)5.25533wd25534.lundersnndthatiftM Wilding mam c of curenily have a tenant that it is my=Wnsihil'ny to nndly tk wxupant of me menta which must be met prior an issuance of a CenlMate of Netayolocy. Signature of Applicant Date tlt�n�cr or authori'rc� agent�. ..X��/V/e All roof coverings to be Class "B" or better ac