00070041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: I'ERMI"f No.
OWNER'SN'T9639 MERRITT DR CUPERTINO PLUMBING APIIICAlllt) IA.L1pK041
JUNE. NARAYAN LAKSHAM 10297 S DE ANZA BLV SANI1Al '67/1.0/GINI/.I IL11 o
❑ AHCHIT'E'D,3NGINIiIiR: YJ ❑1111.UIN0 I'IiRM11I'1'INFO
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(408)283-0618 BLDG ELECT' PLUMB MBCH
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S H j LICIiNS1iU CUNTRACIY)N'S UEChARA'IION lob Description
_C I hereby affna then I am licensed under Pmvisinm of Chapter (commencing
F�tm will,Sceunn 7001 Division3of,belhuine,xmtd Pmrexsinns Clair,andnry Bream
¢y<J Lin fu11tmeu I�f I_
d O u Liacnxc Clens Y Lic.ro_
3 u v Date .'s UF.CI�ARAI'IUN
IoProlayrill 1 md1n.nsnlns n1mree,rn, REPIPE
ypan.s pu
+YI S C<O LiccroeJ I'mtexsionn ^/
Oat IEW IeU excitant
fa OIiCe Coli f10N 7 .
u 1 heaby affirm that I am exampl from Prof..im.Clot License I.w for the
C G a whichfoll—angdics.(Section JI1316.B did,ill ..I.d Binns Cndu:P.ny c; y Int, m
F C when reyuircs a pennil m cnrowct.alar,in,prwe.Jmnall,b. fi rcpmr:nry tal
�5$ pdonniu issuance vho myuiaS me aPPlicam for Cohpennit, ,cowgmM starcmcm
mormuinvn„mdnllo:mmmp,eprswivisin3oftheusitilandVamsdansnpar9 _ Sq. FL Floor Area .Ilion
(cmmns he is ravish Station on and Division 3 of the❑mines.and I'rofesny vi Gafej
nr shoe he camp,thercfmm;end the naris f r Inc alleged excmptinn.Nry violation
of Section a than
5 v any marked
dollars
u pcantit subjeutx me applicant n.n civil Iv7mlly
ted ria more m.n fisc n.ndred aon.r.us(w). APN Number Occup��,cyOType
01.a sol ofthe property.ornry employees with rages a,their.ale c1...sensation, IDD ftOU
will Jo the work,and the samentoe is nor intended ter offered for sale(Sec.71W,
Business and sion.Code:'Ile C.mracmr'.s License Law does not appy',)an ;31.635002, hquired Inspections
owner of property Who builds or improves ta
beon,and who does such work himself
or through his own en,pinyces,provided that Such improv oil am not intended or
offered far,sale If,however,the nuilding Or improveoll is sold within one ycur of
Iimpletion,the owner-buildr,wi 11 have the burden of proving then he did nal Fund or 2202 — UNDERFLOOR PLUMBING
mprove Isr, I,,,of sate).
01.asiwnerofthenrnpeny.atnexclusi•elycontratingwithlicensedcontractorsto 301. — ROUGH PLUMBING
mshort me impact(Sec 7044,Ra,racsx au1 poll...inns Cal The Cnnu't"Ous, 2 —
Livenw,Lawd«anotapplyto:maw net Of property who builds orimanorstheson. 50G FINAL PLUMBING ENERGY
tend won coamas fill solo proj,l with a c.nhactmol licensed pursuant m me 507 —, FINAL PLUMBING
C....won,umese I.w.
❑1 am exempt under see. .B h P C for this rcacon
owner Dae .
WORKHR'S COMPENsA'noN DECLARATION
I hereby affirm under penalty of perjury one of the following dcclaratione
1 It.,,end will maintain a Ccnilicme n1Cousin,e,self-inwrc for WodmLs
mpensalion. as provided for by section 3700 of the Labor Cole. for the
'lluoanm or the work Ills which this permit ix is...it
❑1 Love and will maintain Worker's Cmntwnwtion Insurance.os required by Section
379)of the[.bill CWe,for me performance of the wild for which this permit is
d M k Com tis 1 cec dPolicy number nate:
ka*rCa�FyM nwi lYocy No _K)1)-7v3Q�t/ ,
LFR'I'I C< nT 'PION OF EXE....TION FROM WURKCHS' I—
COMPENSArostINSURANCE
flbi,Icv i�aa uead not ha mmplacd it permit is fora..hundred dollas
IS 100)or leo.)
I certify tha In the pert'ormmtre of the walk lar which this permit is ixxucd,I
shall no,employ any pv..in any manner so as It,become oll m,he Workers'
Conq,covid Laws of Caldianin.Date
Applicant
NOT ICE TO APPLICANT:IL rifer making,his Cri ifcaa of Exemption,you should
account dobject n„hc Workcr's Companxa(av pn,vision, it the Lubar Cod ,you must
Q
forth, provsio
hwill comply with such in al pe.,I shall he teamed rival
F0= CON STRUC PION 1.17NDI NO AC,ENCY '
a ' I hereby affirm that thea is a construction lending agency for the performance
of the wink for which lhix Penni,is Ixwctl(Sc,.3097,Civ.C.)
y Q 1,.dell's Name
.= z Lcndcr'n Addrees
V 0 1 certify that 1 have mad this application and state that the amiva information is
rtes P n rrnn.I agree m comply w'th;ill city and county ordinances and state low.relating
U m annsm¢tion,and Silva,aid, Eau prescnativcx it hi,city to enmr un
po
r; thanding he aMwc.montioned print for inspection purposes.
Or (We).911,usns,Inden Ill,and keep Ireollcs,me City of Cupertino organist
!) f p.judgment,lolls,and expenrs which may in any way accrue ug.ina said
C� z, Ct 'n con. q itcc f t c F ,g o!mis pcnnit.
A 1) D LL COMPLY WITH ALL NON-POINT Issued by: Date r f V
-1 O—o0
Signature of APplivi Coat taor Date RC-roof:' .
HA, ()US MATER1AIN DISCLOSURE
Will me appbcam or heare Fmddln,anvpunl doll ter fill h.oo a.s n,aodal 'Type of Roof
as defined by me Croatia Municipal Cale.Chap¢r 9.13,and the Ill and Safety
Code. z 25532007
OYcCN
All roofs shall be inspected prior to any roofing material being installed.
WHl the call]lamarl,mmmbmudingacctiaa. use c,uimo to ,,de,iceswhich If a roof is installed without first obtaining an inspection, I agree to remove
emit hzmMo.,air conn) meas defmod by the Bay Area Air Quality Matagement
Di,tdel7 all new materials for inspection. Applicant understands and will comply with
13 Yc, 0N all non-point source regulations.
I hove read the buuanlnus par,ias na uirmnoms under Clwpar 695 Of the '
California Health k Solely Code.Sell....25505,25533 and 25534.1 under tand that
if the building are,not conemly have a tenant,that it is my resrymsihili,y m nrnify the
cu,sm of the rcyuiremenw which ,last be incl prior,)ISsuunce of a Cenifuvm of
Occupon, Signature of Applicant Date
Owner or anloorncl.,car Dae _ All roof coverings to be Class 'B" or better