06060015 CITY OF-CUPERTINO w w=nes•, (} rx• .�',."' a,3«wafi : xs'
BUILDING DIVISION PENT �. Q
BUILDING ADDRESS: , ROHIT JAIN FERMfTN0.06060015
10942 NORTHSEAT. W)
S NAME: PERMIT ISSUE DAM
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ROHIT JAIN
PIKONE: SANITARY NO. CONTROL NO.
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ARCHITECTtENGINEER: BUILDING PERMITINFO
BLDGO C PLUMBELECT =1 0
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LICENSEDOedduRymsf7MpI thereby rrces( m MCprovincesDECLARATION
9(ammoncin` Job Description
�Ztv$ with Sooticn70(kBof DiviziM3aftM BustnessaM Pmfeamns Cadq&ndmYlkcnseu
�„ in full formsandc SIZE FOR SIZE STRAIGHT RETRO-FIT INSTALLATION O
,t: Tkmseclms Last—) Uc.N Cy99cuci
Dam Coa/�Gmraewr yS b1Wf, &6 , r.a• 2 WINDOWS 2 PATIO BOORS
ARCHITECTS DECLARA770N 1—
Iundcnundmyplanshallncusedupublicreccards BROTHERS HOME IMPROVEMENT PAID FOR BL 6/2/06
hL�
Set; Licensed Professional
ty3 OWNER-BUILDER DECLARATION
p I ncrehy&ITtnn that 11. Business
from the Comraau License Law for the
i p c
o following reason.(Sation 7(1313,Busineand Pmfeuians Code:Any city or county
I$ which mqw ont al
ula permit to cmucmr,imprew,demolish,or repair any smclum
!iy prior w its instance,also quirew 0m
s the applicant for such Permit a signed sutemmc
3 < din be is licensed pursuant to the provisions ofthtCommer',License LAw(Chapler9 Sq.Ft. Floor Area Valuation
$ mmmencingwiNsccdon70D0)ofDivtaion3oft Busioe .n4PmfcasiamCAc)ur $4280
r3.. that nc A exempt thend.and the basis for to alleged exemption.Any vioudan of
Section 7031.3 by Any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than Rw hundred dollars(SSW). -
❑1,as owner of the pmpe ty,or my employees wiN wages As Nth mit compensedon;
willdo tha wart.and thesmcwmta Mn mmndeaaortemd furs&m(Sec.7oa.eaircn Required Inspections
and Profession Code:The Coruscate, row
r's License Law dot apply an ownu e of q P
property who builds or impmw Income,and who does such work himself or through his
owe employees,poovidnd tut such Improwmau am not Amused aoRued fesall If,
however,the building or Impnewmm 4mld within ane Saar of mmpletwn.the ewrcr-
builder will haw the Wrden of proving that nc did Mn build or Improve for purpose of
ssb.).
O 1.as awns of the property,w aclualwly contracting with licensed comuacum w
mnstroct the project(Sec.7044.Bushws and Professions Code:)The Coatracmrs Li•
«nsc Law 4.out apply At an ownee of property who Wild,or impmw thtman.W
wet emmets for such projects with a eomsnor(q Iirenmd plvsaln to the Ormctofs
Liccme Law.
❑lamexemphmderSm ,Bft PCfathisreamm
Dam
WORKERS COMPENSATION DECLARATION
Ihereby&flion under penalty of perjury arc of Om fallowing declarations:
❑I Mw and will maintain a CaNRem of Censtnt to self-imurtfurWarker'sCompelh-
satire,an provided fa by Section 3700 of tht(Abse Code,for the performaaa of the
work for wake this permit is Wised.
❑1 Mw and will mainuin Worker's Compensation Insurance,As required by Section
374)0 often Labor Bodo,far ton performance of ale wok for which Itis permit is Issued.
My Worker's Cffmpevaston lnmrula artie and Policy nau�Tmber am:
limier. /r{YC•aff� Policy No.:Aa.p-'GCY7fL)63'dl
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE _
('this secdon need non be mmplema If the permit s Imam hundred dcabm(5100)
or less)
1 certify that in the perfoomarce of the work for which this parm1l is issued.l shall an,
employ any person in my mannerm As in become subject no the Workers'Compensation
Lam of California,Data
Applicant
NOTICE TO APPLICANT.If.after making this CcniOau of Exemption,you should
became Subject to tha Worker's Compensation provisions of the Labor Code,yon mus
O forthwith comply with such provisions or this permit Mill bre doomed mwkcd.
n'�.a v CONSTRUCTION LENDING AGENCY
E-s 1 hereby AM.that them k a construction lending agency for ton performance of
!Yr > the wok fa which and permit 4 broad(Sea 3097,Civ.C.) -
QLcml Name
z lender's Address
U O i ternary that I haw mW sus&pplmetion And mm tin the&bow information ic
LL conm,L lag=ne comply with all city and county oNinsnees and amu laws relating to
OO building eonsuuetion.and homey Authorize rtpocamuta es of ahia city w enter upon ft�U show-mcmiand property for inspection purposes.
(We)agree w vin,indemnify and kap b&r akno ft City of C.,moo Issued'vF,s rA liabilities.jadgmmU.casts And separate which mey In my my&eeme a6&IK,said City
U ire'weseemme of du granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE TI�ON_S_._�/ -
�p z C. Re-roofs
Slgwurt o MIDI( Ht/Cormactor
A21ARDOUS MATERIALS DISCLOSURE am Type of Roof
Will the applicant ser forum building oaupant stare a handle hazardous material -
Bmd by the CupeNan Municipal Code.Chapter 9.12,and the Heath and Safety
,Saton13532(g7 All roofs shall be inspected prior to any roofing material being installed.
IF ❑� 0<
Will the applicant or fuwm building occupant vu equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emir ban anas air comemimnts u dc0ood by tha Bay Area Air Quality Management all new materials for inspection.
Dimict1 __//-
❑Yca p�Nu
I haw read the hmsrdtus maudab mquimmcm under Chvpmr6.95 of the Califor-
mAl-malthk Safety Cade,Secdans25505.25533 and 23534.1 undcrsuls dutiftm bowing
cs not currently,hw-d a unapt It H my responsibility w Mary am occupant of to
requlremen mumbe riorwismanceofaCenilkatearaapan Signature of Applicant Date
Ana' r mmarixa a'gcm am All roof coverings to be Class"B"or better