06050018 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -INFO
CQNTR!�CTOR, RMATION—,
BUILDING ADDRESS: 11"INC,06050018
7495 PROSPECT RD
0 NER'SNAME: PERMIT ISSUE DATE
SRIVIDHYA GOPALAN os/24 /2nne
PRUNE SANITARY NO, CONTROL NO,
ARCHITECT/ENGIl,[EM BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
go LICENSED CONTRACTOR'S DECLARATION Job Description
I amb,affirm that I sed darsoll dook,provisionscof Chapter 9(commencing
with Section 7001b).(Divisum 3.fLbO Busamead and Pniessitiou Cddk.md my license I-
is fail fares add effect. REVISION-STRUCTURAL , CLOUDED DETAILS AT FLR FRAM
Lien.Ons Lic.#
:;:n Dam.Contrimum. ORIG PERMIT 405030206-NO NEW PERMIT
-2 ti ARCHITECTS DECLARATION
W I understand my pins shall he used as public records
u.t; Lmmmd Professional
0
in OWNER�BUILDER DECLARATION
I hereby rofflors the I no s.."from tho Counselors Let..Law for the
'7031.5,Bousums,add Profession.Code:Any city.1 coust,
C C following reason.(Section
which acquires.Permit to construct,aler.improw,dcroolin,or repair my someone
pd.,u,its isnumou.sisOnspiods ft.pplicard mor such permit 1.file.si,ricii ludmin,
that Ito is licensed pursuant to the provisions ofuld,Contraturr's Ueense Law(chapter 9 Sq. Ft. Floor Area Valuation $0
(commencing with Section 701 of Division 3 of the Butmossand Professions Code)or
that he is pt therefirom add the,basis for the alleged eximython.Any vichadon of
Suction 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APNNumber Occupancy Type
Out mom than frod hurdied dollars(!1500� 36615053 . 00
[J 1,as Owner of the Property.Or my moplo,ccs with wages as dean and coorpenduatim,
will do the work,and the structione is not intended or offered for side(Sce.7W.Busaided
add POfmio"Coule,The Citnuesidn's License Lia,added an[apply In an Ovoiser Of Required Inspections
property who builds.,inspecons thencom.add witiodoeanch work himself.,through his
own employees.Providod quit such arprommandut are notfintended"Offired for sathe If.
however.the Wilding at lorprommead,is mid within one year ofcompiction.the ounder.
builder will haw ths,burden of proving quit he did ont Wild or improw for purpose of
.1. 0
kOwner of the pon,on,,am excinsively contracting with licensed carturacticars ut �s
adet the pmjca(Sce.70",Business and Fdofesums Code)The embodiers Li-
c Lues Lkw�
ome Law does not apply... of Property wito buffoon,impromst thencon.add,
whoommucts,for such prrijects with a condactuds)licensed pursuant W dom COmmisda'$
M1.emeop,under Sco. B&PCfearildisousm.
Dam
WORKER'S CM!!�NSATION DECLARATION
I hereby afford under penalty of pospay 0.Of one following dedisididdims:
0
sation,as pmvidcd for by Section 37M of this Later Could,for the performance of ild,
work for which this permit is doesed.
0 1 have and will maintain Worker's Compensation Immunct,as acquired by Stotion
37W a(the Labor Code,for did orporromance,of the work for which does permit isiwd
My W.rime,Ccurnpormandion Inse.card.and Policy munbe,mc:
Canrier. Policy No.;
CERTIFICATE OF EXFMPTION MOM WOMERS'
COMPENSATION INSURANCE
(Thus scoution used notaccurnplited iftlic permit lot i.e.hundred chaddis($100)
or It..)
I century that in the pedfand:cc of th, h h this pormit is issued.I mail no,
employ any,comen in my jccl.one worlmrs,cormaudderme,
Laws ofCaltromia.Dow 10 __&�
Applicant— am I;-- - — — I
NOTICE TO APPLICANT.if,itfucriiiWagilhis Cortilmate of Exemption,you should
become subject in me Wedur's Compensation provisions of the Labor Codi,you a=
z forthrivius comply with noted provisions"this permit mail x denied revalued.
z 0
C7 CONSTRUCTION LEtODING AGENCY
5: 1 undby afrind thas them It a commictim leading agency for the performance of
on work rot which thint Permit 6 issued(Sec.ON7,Cry.C.)
W F Leschur's Name
CL Lenders Address
Z) z
U C) I cenify that I ham read this application suall sum that do above Information It
U. correct.I agree to comply with all city no county ordockscos and state laws testing in
building construction.and hereby moloorin orprescriUdws Or thiS City to enter upon the
nove-romionod pord,crty for ins,tcuon perfidious.
(We)agme to sam.indcmni fy and keep harroadmis the City of Cupc�rdrm against
Liabilities.judgments.costs and expenscs which may in any way see=against mid City
U Z in c.aacquerico of the, If. offfis*Z"
APPLICANT UNDERWANDS AN LL OMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. Issued by: Date 7—
Re-roofs
Signature OfApplicdnt/Cortnwtor�� Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thic applicant or future Wilding occupadi,sume orlindle hasommus unions]
as ch,flned by the Common wipal Cocle.Cho,ic,9.12.add the Health add S.Auty,
Scott..25532dd7
0y. 1. All roofs shall be inspected prior to any roofing material being installed.
Will the aMlicant or(own Wilding accupon me,equipment or dcvdcar which If a roof is installed without first obtaining an inspection,I agree to remove
door loo,ommus air condition:�un defincil by the Bay Area Air Quality Management all new materials for inspection.
Deadell
0y. No
thal res,Jdathdommusaost, Is.q.i 0 andc,Chapte,45.95afthoOdifor,
c am
ro.1-1calthAc SafenyCiamSmoonan V2ZI433
does not.wournly how. t,that ma ilidily I. of,ft e.P.L.1 th.
man it
requirements which anst x met Pd. a Ccrufm Occupancy. Signature of Applicant Date
FI-112- ? ��/
Owner or a Und,17,cal agent 4L:�'k Dam All roof coverings to be Class "B"or better