06040083 CITY OF CUPERTINO WT
BUILDING DIVISION PERMIT .,�ONTRAC 0R NTORMATION`
BUILDING ADDRESS: , GAUTAM SINHA PERMIT N006040083
18824 RENDERGAST AVE
OWNER'S NAME: PERMIT ISSUE DATE
GAUTAM SINHA 06/09/2006
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT 0 PLUMB O MECHO
ipa LICENSED CONTRACTOR'S DECLARATION Ib Description
1 barely alBm dust 1 am O
licensed under provisions of Chapter 9(Commencing
with Section 70M)cl Division 3Offiie Business W Prafoulone Code.W my It"=Is
in full force andeffea ADDITION 481 ' -MASTER BEDROOM/BATH/2 CLOSETS
;qz ucemcCan ue.a
Dam ContractorSANITARY/SUNNYVALE
'
gq ARCHITECTS DECLARATION
i 2 I understand my plans shall be used as public recnnh
C.
Licensed Professional
OWNER-BUILDER DECLARATION
11 hemby&IR.that I am exempt from the Contractors license Law for One
i a o following mason.(Section 7031.5.Bum.and Professions Coda:My city er County
S$ which requires a permit to enmtrum,altar.Improve.demolish,nr vpeir any suueture
.zi prior to its issuance,also requires the applicant for such permit in file a signed Comment Va ®!3111
C that he is licensed pursuant btire provisions ofNL
eCoombr'scenselaw(Chapmr9 Sq.Ft.Floor Area
i (commencing with Section?EDD)err Division 3 of the Business and Professions Code)at
9 that he h exempt therefrom and the bub for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the Applicant 10 a civil penalty of PN Number Occupancy Type
not more than five hundmd dollen(5300). 3 /7 33050 . 00
❑I,u owner of the pmpeny,m my employm with wage u th k ole compcnmdon.
will do No wart,and the saumnre h mtlnundod orofferead fortale(Sec.7014.BusinessRe aired Inspections
and Profession&Cade The Conbxaces Lkeme Law dm not apply ban owner of q P
property who builds or improve duereen,and who does such work himself err through his
own employees,provided duvsuth improvement are notinu rded or offered forum.Ir.
however,me building or Improvement is sold within am year of compbdan,die owner.
builder will have the buNen of proving that he did not build or Improve for purpose of
tale.).
❑1,as Owner of the property,am exclusively Contr acting wish licensed me==to
Wustmel the pmlem(gee.7044. usineu tad Profasdam Code:)The Conmaetars u-
canse law dote not apply b an or properly who Guilds or improwa duerten,tad
who contracts for such prole ide a cammenor(s)Becamd punuul b the Campuses
License raw.
❑1 ora tempt under See. .B k P C far this retro
Oww
Data 6 O
ERS COMPENSATION DECLARATION
1 hereby&Bim under penalty of perjury am of dee fallowing decimations:
m.and will maintain•Cvtifcea of Consent to uhf-inure fm WarkehCamper-
radon,as provided for by Section 3700 of du Labor Cade.for me performance of me
work for which this Permit is issued.
❑1 have and will maintain Wor aces Compensation Iruurance,as required by Section .
3700 of dm labor Code,fm due perfamusmaf the wok fm which this permit is issued.
My workers Campensvlan htsunncc wrier tad Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE _
(Ibis sermon need not becomplounl Dthe permit is foram hundred dawn($100)
or les)
I certify that in the perforen of the work far which this Permit b Wood.I Shall nm
s employ any penan in any an ermubb o uP'tt 6me brkcn'Coreperaxtlon
laws of Califs .Dau
Applicant
CE TO Ife NT:If,after making;orb CrniOam of LabrCodyouehmb
become hsubject comp y it Worn pr Compensation provisions of the reeds Cade you muss
0 O
forthwith comply with such provisions m orb Permit shell be deemed rwokW.
z y CONSTRUCTION LENDING AGENCY
[r Ibembyaliimdo them is a construction lending agency for the performance of
C> the.,it fur which this permit Is issued(Sec,3097,CW.C.)
1174Lenders Name
= M Landers Addmu
U0 I cWfy dust I have mad this application and roc mal the above inbmadun is
IL H Comct,I agree b comply with All city and county ardinsme endemic law$rtleting b
0 U building construction,and hereby authorise mprescratmsn(thin city to enter upon the
W above-mentioned pmpery for inspection Purlwsu.
y Wa)agree to save,indemnify and keep hermleu the City of Cupertino against
ti to liabilida.judJUNRSTANDS
sus andexpenset which may in any way attrm against mid City / /—
U in consequtnnoting of this permit.
.. APPLICANAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERENS. Q / �/ O
6 6 Re-roofs
i u hieanucoaur torr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building Occupant Ran or handle hanummus material
as defined by the Cupertino Municipal Cade.Chapter 9.13,and dm Health and Safety
Cade.Section 25533()7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye ONO
tl
Will duc applicant or future building accupant use equipment m device Which
If a roof is installed without first obtaining an inspection,I agree to remove
it'cw air mnuminanu u dcOmd by the Bay Area Al,Quality Mmgment all new materials for inspection.
'til
OYe ON.
I have tad da mtsmamdabrequirtmcntsumkr C7upur695o(du Canfor- -
rieficalthAt Slc1yCd§a Section:25505,75533tal75534.l undcnund duvlf0<building
doeortcumndy sat Ldm IIbmyms ihhlitybmdfytitaccupmlofine
requiremenow' muRkmelpriarloiuuaneeofaCe nyvo� a / Signature of Applicant Date
o ,u ariacd agmnt Dam. All roof coverings to be Class"B"or better