08070079 IIU
ITY OF CUPERTINO
BUILDING DIVISION PERIVIITONTItAGTQRINk'QRMATION' a
PERMIT NO.
LQlyo�tDQBU Est:RCHARD SPRING CT TBD — TO BE DETERMINED 08070079
NEWS NAME: PERMIT ISSUE DATE
MR. NARENDRA PATIL 07/14/2008
PH(NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u p 0 LICENSED CONTRACTOR'S DECLARATION O O
aro F°C 1 nmeby affirm Net I am themand under Previsions of Cloquet 9(commencing Job Description
�ZW with Section 7M)of Division 3ofde Businessand Pmfeoiam Code.and my keens,is KTCHN RMDL(NON—STRUCTURAL)
<< n full fame and cff
-qz Licemo Clan Lic.0
Dam Comnnor
e� ARCHITECTS DECLARATION
e I understand my Planar shall be used ss public mcmd.
6
10 Licensed PNfCSt10ne1
OWNER-BUILDER DECLARATION
f i hereby aRm thxt i ace aempt from the Commenor's Recuse Law for than,
C ,
00 following mason.(Sada.71D 1.5,Business WPmprofessions Calc:Any city or county
which require a pmnit m erste.,sines.improve,de onsa repair mY rectum
_i y prior m s l iouvud pmeau to
e,Ne atmos afor such pe reit m ict a.uw(chapter
F < thoshmminwitmmantm)BofDiuotuofNCGmusinmrll3ttmelsw(Cmic)or Sq.F[. Floor Area $10000 Valuation
y� (commencing with Section 100 d of Division 3 of Neeged Business end on.Professions Cade)or
Q Netto u exempt any arom tab Ne naso for the aibecE exemption.Any violation of
not on them bytrydreddoapplicant forapewitcobjcaatheapplicantmadvilpaWtyof Number Occu ane T e
nm ream mm five na.ama aallua(ssrKO. 36654031 VV' Occupancy YP
0 1,ae owner of the property,or my employees with wages a deo sole campenssdon,
will do the work and the suumum u not intended oralfened for sake(See.1We,Business
and Professions Code:The Conor se's License Law doa net apply to m owner of Required Inspections
property who holds or impmtea thereon.and wm e n cs such work GmvJf a through his
awn employee,provided that such improaemmu ase not imendcd oroffered for sale IL
howew.the building or imprm momt is cold within one year of completion.me mvne-
builder will have the burden of proving Net le did no,build our improw for purpose of
ale.). .. ..
❑1,ss owner of the property,am exclusively contracting with Hamed commacmq Or
rnrmtmst Ne pmjce(Sec.7044.Business;and Pmfasime,Cade)The Contr,eora U.
nerve Law does not apply m an owner of property who builds or impeorres Merton.cod
who contracts for such pmjecu with a contrsmr(.)licensed pursuant to the Contractor's
Licata Law.
❑I mm aempt under Sec .B B P C for Nu rtacon
m Dae
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaetiaes:
t1nha.e and win maintain sem ri.m of convent th self-Insure fewort e.compea
,so provided far by Section 3700 of the Iabor Cale.for the performance of the
were for which Nit permit is issued.
0 1 have W will maintain Welter'+Compensation Insurance,as t,uired by Semon
3700 ofineLabor Code,for Ne pcdormmro of the work for which this permit is issued '
My Workers Cmnpensston Inuurma carrier and Policy number art:
Carver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITuxcdm need at becanpleed if the pewit is feanehum bed dollars($100)
w less)
I termly,Nos in the performance of the work for which this Permit is issued.1 shell not
employ an,,mom ire mY the Workcn'Canpemation
Lawnof Cuifamie.p,p�atq 111sf/0Y
Apvlleast y(. 1L V 1«
NOTICE TO AAL ICAND IL after making the Cenificam of Exemption,You should
become Subject Or the workers Compensation pm inions of the Isbm Cede you mus
.J Z forthwith comply with such pmOdOM a this permit shall be deemed mated.
'Z O CONSTRUCTION LENDING AGENCY
F I hereby aRm dm Vert is a construction lending agency for the Performance of
C> the went for which this permit b issed(Sce.3097,Civ.C)
Qlender's Name
Z Lender.Address
U Q 1 certify that 1 have read this application W sum the the abase information is
IL camtst41 ager¢m comply with all city and county omineees and sum lam relating to
6 building construction.and hereby amboden represenutiset of Nu city to merupon the
[I] shove-mentioned property for iapectum P.,esum.
a (We)agues m rest,indemnify and kap haroulearsm the City of against
s id City
y liabilities.
(We)
judgments,eau and espouser which meyinmyse City fCagunur.SCity
()Z APPLnIC of ERMAN"IfDS the D WILL MPLY WITH ALL NON-POINT Issued by: Date �—
SOU C E in / —( —OL
Re-roofs
Signmum of Appilan ren « m Lid
US MATERIALS DISCLOSURE Type of Roof
WIII tic
as defSec by thColeecnao fMoruummctbpal Code.roChChaptertrr a9.12.anMnddate hH.ILh andmamriu
Well,
.Section 25532(.)7❑Ya Dd111yyyNo All roofs shall be inspected prior to any roofing material being installed.
//`` If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant m future quilting occupant tae equipment or devices whim g P
cr holutrdoa air cammimu ss mdefined by the Bay Arta Air Quality Management all new materials for inspection.
❑Ya ON.
I have read the Nreadea smaeriila requimmcros under Chapter 6.95 of the Califor.
ria Health&Safety Code.Sectio.OM,25533 and 25534.IeucrsuM Wt if me building
e cot
doM em n tit u respemNilhy Or notily the mason,of the
myuirtm wit' prior ala Cmtifeam of OtI ell a
Signature of Applicant Date
o nerar,mthori a ,gent Do All roof coverings to be Class';W'or better