08060138 CITY OF CUPERTINO '� s=ag 'T3a�.f '*^
BUILDING DIVISION PERMIT C01rITItA=""OWNFORMATIONV,
BUI I G DRESS: PERMIT NO.
�1.�4� PENNINGTON LN RJ HAASCONSTRUCTION CORP 08060138
"R'S NAME: PERMIT ISSUE DATE
KAMAKSHI KODUR 12226 SARATOGA-SUNNYVALE RD 07/14/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 725-0300
ARCHLTECT/FNG(NEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am fi B u provisionsfof Chapter 9(my l c=is
Job Description
rithSmtim]IXp)OfOivi'onJa(theBudnessaMProfatiovCQodeaMmylicenso DEMO;RMV EXTNG RF& SOME WALLS, MISC.
a N in full font ata effett ! O • •�
�2 Ucenu 1 tic.g '
CSDECr
CHfIbe use DECLAR
s
U 1 undcrsuml my plata ahatl be used u Public records
0G Licensed Pnafessional -
c3 OWNER-mrapt fr OECe Conn ON
c 1 hereby.(sero that 1 1. Main from dm Conon CoLicense: c Law for to
p o following recon.permit
t ]IDL;Business and ROfessien Code:Any city or county
3$
which regvima n permit ac eewro a aper.Improv,dwmW,or repair any sueeturo
_Z< Prior to iuissuadpunsuntto the thovisio antsof for Such pener's Lieeasigned w(awemem
E ththat(coheacingwitpursuantrotheprovision3theConuxtrfndPrmLaw(Clodc)9 Sq.FL Floor Area $7000 Valuation
y d ommeming with Sersim t and t f Division r of the alleged
Baseness end Profession Code)of
`<s Nat he u exempt thuefrom utl the thou for the alleged eumptim.Any violation of
Section 70313 by any applicant for a Permit subjects the APPWSOI an a civil penalty Of 36204031 .ENumber
not mm than fn hundred dollm550 . Occupancy TyPe
❑1,u awns of ate Property.or mY cmployev with wags u Nap ale mmpevanim,
will de the work.and to arumum IS not intended or offered f nteale(Sec.]014,Bodnw
and Profession Cade:The COnum
acrno
s Li..Law clear t apply to owner of ownof Required Inspections
property who builds or improns therm.,and who does such work himalf or through but
own amplayca,provided that such improwmmu atenotinlenaW araffered forsak.IL
howevcs the building or improvement USold wind.ane year at completion.the awner-
builder .will law da,burden of proving That he did not amid or improv far pup=Of
uuJ.
0 1,u Owaer of the proper,w voluffnly communing with EcemW commemm t
conauct the project(Sec.]Oda.Business and Protestations Code:)The Conmumrs U.
cc=Law docs not apply to in owner of proper who builds or improver thereon,ata
who conmcu far tech projena with a mnuxbr(s)Iicrnad pumas to the Contractors
License Law.
am comp,under See .B&PC fm the mum
-r Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury dao of the following declaredov:
1 n.w aM will mainuin•Cestifi^r^of Covent w ulf-iiuuu fa Workers Compere
avian,
workr provides for by Sermon 3]000(the lather Cede.fur the performance of to
far wNch Nu permit is ivuN.
❑1 ban and will maintain Workers Compensation Insurance,u nyuimd by Section
3700 of Ne labor Cade.far the Pefformmec of to work for which Nu Permit uQissued.MY 1
Cori m*m' Com •' t nmranm arrierra ry pry �r Me:
CbXTIFf TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Into scetion reed an,be cannplcted ifft Permit is forane hum&edde0as(SIM)
or leu)
1 certify Na,in the performance of the work for which this Permit u issued.I"I not
employ any Perron in My..a, u to become subjecta the Wortcn'Comparcomm
Laws of Califomia.Data
AppOom
NOTICE TO APPLICANT:IL alar meting this Certificate of Exomplion.You Should
became subject to the Workers Compensation pmvuion of the Labor Code,you moa
.J O foMwid,comply wit such provision or this permit shall be dcemed revoked.
Z 'r CONSTRUCTION LENDING AGENCY
► Ihereb affirm that Bert u aronmvninn lendin
f'-' Y f agency for the perfutmance of
C the work for which this pemti,Is issued(Sec.5097,Civ.C.)
QLanders Name
� z Landers Adarev
U Q I cannily that 1 ban mad nds application and sou Thu ter&bow information is
g4 ^ mmtt I.gra to comply with all city ad county or iaances and sat¢laws uluing to
.� SU' Wilding construction.and thereby mtorize mptewnutiws of this city to enter upon to
r 4 slew-mentioned property fm impectim proposes
(Wer)agree to un,indemnify and keep humless the City of Cupertino again,
r�r IA Iiabilidv,judgmcnm.costs andeapenra;which may In say way Scene a.(Said Cry
U Z in conwqurtee of the granting of this pumil. !
r—' APPL UNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7�� C
SOURCE RE U ,� ,` _tel
C�JOa Re-roofs
Sig..OfAir,lialm4COldramor Data
HAZARDOUS MATERIALS DIS SURE Type of Roof
Yv ON.II the applicant or future building acmputslom or handle haurdous material
linby the Cupertino Municipal Code.Chapter 9.12.sad t e Halt and Safely
..Section 2ss3z(.)]
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applim,or infuture Wilding by
B sax Area
Air em Or devices which Pe g
Dist huardnv air conuminuu u defixa by the Bay Arta Air Quality Managcmen, all new materials for inspection.
District?
❑Ica ON.
I ban real the hsuNov mauri isrequimmmu under Chapterh.95 ofthe Calitm,
nia Health&Safety Cada,Seetiov 25505,25533 and 25534.1 undcntnd dwifte building
dialamcancludY Tun• e this a o my,.,.bi ny to notify de aoeupan,Of the
requnre metpiarmissuanmef ertif eof1czmI- a Signature of Applicant Date
owner orautha cam V DateYV All roof coverings to be Class'%?."or better