05100035 CITY OF CUPERTINO
BUILDING DIVISION PERMIT nC,ONRtfCTUR;INF`,OrR1A"IIIUNS
BUIL DING ADDRESS: PHAN CONSTRUCTION CO INC 05100035
NERS NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
(408) 737-8323
ARCHITECffBNGiNEER; BUILDING PERMfr INFO
BLDG EIPCT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby.inrm that 1 am licensed under proWaons of Chaetae 9(<ommercing
with Sectlan]Ot310 of Diviaion3ofde Budn mdProfeWons Cmdc.andmylicenxla
lefnllfuC=Amieffecg Q ADDITION-BEDROOM/BATHROOM/CLOSET
,2_
2 Lkenm CMM Lk.Y
Dale Com
ARCHffECS DEDEC RATION
Hy Iundeuund my plans ehdl he used As public tncords
L C Licensee Pmfcuional
OatNEmBUILDER DECLARATION
I I unix o1Rrm Net 11. exempt from the Canvacwre License Lew for the
j:00 which a q wan. emit t 7 construct.
t.Maess and improve.
demolish.tluns Ca dc:My reify or county
r-Z which requites a permit re tnnNun,aitae improro,h pcitor repair any someone
Zs. poor at he its ienecc,am dpursuant onlms theapplicantfor Mesnchpermit w Nouse ae La Isutamem
that licensed pursuant 7")of Division
ivionsof 3Ne Conuxwfsnd Pmi faw(LTaptm9 Sq.Ft.Floor Area Valuation
$ that he In sat with Section 70W)of,In sio or of In.Businesslandcu and profess vi Codh)of
Net he la exempt therefrom and Co buts(a the alleged aefnptim.Any violation of '
Sealer 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of 3 jkg$54Akir 0 0 Occupancy Type
not mac than Ron,hundred dollars(35001.
I.As banner e u oner of Ne property,or my employees with wagtheir min compertudon.
will do the work and the suucwre is not intended urofared for Late(See.7014.Budneu
and Professions Code:The Communes License taw does not apply w an owner of Required Inspections
property who Wlldsm Improves thereen,and whodoesanch werkhimselfor through his
own employees,provided Nu inch Improvements are notintanded molfefed forule H.
however.Ne building or
ur Improvement is mid within one year of c prove for the owner.
Wilder w10 have Ce burden of proving that he Ow out build m Improv for purpose of V
uta.).
❑T,As owner of the property.ec.704,Business usi and confessions with licensed ronaacwn w
cong,La threes not (Sec.7014,wnofandnywhoauCoda:)The
vesthowflLi-
roue law dots not apply w an awns of prapeny.ice builds rs anprow Corton.and, O
whence Lace for projects with a convuwrp)licensed pursuant w the Convenors
License am law.
❑Tem exempt under Sec. .BkPCfor Nla won
nu
Data
WORKER'S COMPENSATION DECLARATION
I hereby of orm under porosity of perjury,one of the following declarations:
T haw and will mention•Ccri cae ofConstnuo self4nnicIorWorker.Compen-
.ation,u provided for by Section 3700 of d c Latxr Cade,for Co performance of Nc
work for which this permh Is Issued.
O 1 haw and will maintain Workers Compensation Issuance,u required by Section
3700 of Ne Labor Code.for the performance of Ce work fmmich this permit is issued.
My Worker.Computation Insurance order and Policy nuntsm aan''s p
Center, StwiLl r1)A.II Policy No.:Iyd' lg_ag—fig
CERTI�{FlC EO�PITON FROM WORKERS'
COMPENSATION INSURANCE
(TTksectice need not W completed lithe permit lsforone hundedamlau(SIM)
or Ices.)
1 certify Net in the performance of Ne work for which this fault or issued,l Nell not
'bmpley any pmm.In my manner so As An Wemusubject to ted Workers'Compcnution
Laws of California,Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificata of Exemption,you Moog
become subject to the Worker's Compensation provisions of the Lahnr Code,you must
,J O forthwith Comply with such provisions or this permit shall be med d
deemokh
zt51 CONSTRUCTION LENDING AGENCY
F-t I hereby affirm that New is a Coresuctime loading agency for de performanmN
Ci the work fm which this permit O Wood(Sec.3097,Cl,C.)
67 Q larches Name
.7 z Lenders Address
U Q I Certify that 1 haw read this application and sesta Ndthe show information is
IL coma.l agme on comply with all city and county ordinances and sine laws relating w
O Wilding construction.and hereby authodm representatives of this city m coos upon the
W shove-mentioned property for inspection purposes.
LL (We)agree to few,indemnify and keep harmless 0e City of Cupertino against
rs VI liabilities,judgments,cmu and expense which may In any my accrue against mid City
fJz In consequence of the granting of this permit.
APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date (G �7 G t5 S'
SOURCE REGULATIONS,
16 N Re-roofs
nature ofApplk UCoo a Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thn applicant or fuwm Wilding occupant store or handle hazudou m aurid
An de0ned by the Cupertino Municipal Code,Chapter 9.12,and Ne Rune and Safety
.Section 25532(.)7 ay All roofs shall be inspected prior to any roofing material being installed.
Y. LpNo
Will the applicant or future building occupant use equipment at devices which If a roof Is installed without first obtaining an inspection,I agree to remove
emit luxurious air contaminants u defined by the Bay Ama Air Quality Management all new materials for inspection.
District?
Dye' 4NNo
I hero mad the hazardous materials requirements under Chapter 6.95 ofthc Califor.
nia Health At SafctyCode,Surdas 25505.25533 and 25531.1 understand!Cut lfCo Wilding
does not currently haw a tansm,that it u my responsibility w notify the aecupent of Ne
requirements which mug be met pdorwiuvanCo of 'Ikete of Occup^^ Signature of Applicant Date
OVAC °/a°�du� All roof coverings to be Class"B" or better
0
'uthori agent Data
CA 0 1u
i
Assessor's Parcel Number: 00 -2-
Name
Name of owner.
Project address. 1" 69 "M IT DYZ
Contact person. � Phone. 13i�
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? OY N
Is privacy protection planting required for the project? Y �I
On what floor(s) is work being done?
Brief description of work. Fl tt?X � � BAIMU 5
W '
Code editions:2001 CBC (Y -N)2001 CFC (Y-N)2001 CMC (Y-N)
2001 CPC (Y -N)2001 NEC (Y -N)
Effective 11/1/02
Plan Review Process Work Book Page-g-Revised 8/22/05
CUP RTINO ^.:.
Y
00
Z
Assessor's Parcel Number:
Name of owner. �I1/xV1 yc +.a�ey1A
Project address. lA VY1 M-M24 I- 22-
Contact person. .�1� OAM Phone.
Fax. �a22a2
Net square footage of lot. E4t5 J7
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
• TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? dY N
Is privacy protection planting required for the project? Y O
On what floor(s) is work being done?
Brief description of work. �CIWl�z- � Cif � (I AIAZ
W
Code editions:2001 CBC (Y-N)2001 CFC (Y -N)2001 CMC (Y-N)
2001 CPC (Y -N)2001 NEC (Y-N)
Effective 11/1/02
OFMCS COPY OCT 0 6 2006
Plan Review Process Work Book Page-g-Revised 8/22/05
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D D � MINOR IMPROVEMENT IN TWO EXISTING BATHROMMS * �, T� Ln(o -n
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D z m _ � 19639 MERRITT DRIVE CUPERTINO CA 95014 '��w -nom ty,F`�2s oo jL, n <
D � � OWNER: MR. & MRS. LAKSHAM c a N 0A �. o
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