08060109 CITY OF CUPERTINOr
BUILDING DIVISION PERMIT CQNTRACTOR INk'ORIt'TAT IO.,,N�
BUILDING ADDRESS: PERMIT NO.
1.0120 SANTA CLARA AVE TBD - TO BE DETERMINED 08060109
NER'S NAME: PERMIT ISSUE DATE
SIDHU RONJIT 06/16/2008
PHONE; SANITARY NO. CONTROL NO.
ARCHITECTfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iso Zp LICENSED CONTRACTOR'S DECLARATION Job Description
1 Mmby affirm dal 1 am licensed under pmvWow of Chapter 9(nmmcnctil P
ZZ ideSection1000s)ffofDivision3afdmBusircss» Profeui awmyliccnmle REPLC WC7DWS LIKE4LIKE NON-STRUCTRL
n=N in full forte andO � g -
j�Z Lmcens Ql / -
C� Date Contra=
ltwv_ 011—
A CHITECf'S DECLARATION
I ardenuand my plans Mall be used as Public recaftls
�au
50� Licensed Professional
OWNER-BUILDER DECLARATION
I 1 hemhy a?rm Nn 1 am ucmpl room dm Contrenos's License law for the
C
00 following mason.(Section 703 1.5.Business and Profeaiom Cole:Any city or ce.my
ISP which requires a permit an cormuvct ober.Improve.moolW,m mpair any sauclum
-i prior at is inumce,also requires to applicant forsuch permit In file a signed statement
mal he is licensed Pursuant to to proviemw of to Contracmrwem
ce,Law(chapter 9 Sq.Ft. Floor Area Valuation
ayl (commencing with Section?000)of Division 3oftheBusiness tabProfessiewCode)or $3700
a`3— mat he in exempt therefrom and the bwk for the alleged exemption.Any kileda.of
Scedon 7031.5 by any applicant for a permit subjects the applicant or a civil penalty of �p� tuber Occupancy
mol mart than Rw hundred dollars(SM. 32624013 .4Mjb P Y Type
I,as owner of to property,or my employ=with wages as theb sole compensation,
wiR do the work and the suunure u not Wmnded or oRemd for sale(Sec.1044,Business
and Pmfessions Cade:The Om actor's Litems Law d=nor apply W an owner of Required Inspections
property who builds orimpor.thereem.mclwha doessuch workhimrlfwdwugh his .,.
own employos,poorksud mal such improvements are not intended so@teal(tae sale If.
however,the building or improvement is sold within am year of completion,the owner.
builder will haw the burden of proving that Ice did no,Wild or improve(m puryose of
sale.).
❑I,as owner of the properly,am exclusinly contracting wire(mens, coma on an
comtmn tie project(Sec.1044,Business and Pm(asshms Coded The Conbaaos's Li.
cewe law dm nal apply in an owner of property whet builds or improv thereon.and
who contacts for such projects wit a mnuanar(s)licensed puruant in the Conuanofs
Li um Law. -
❑1 ort exempt under Sec .B 9 P C ror ids mason
nu Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following deeleafi=:
O I have and will maintain acertifinm of cement to self4rocure forwarke'sCampers-
sation,as Provided for by Scedon 3700 of the Labor Code,for the performance of dm
work for which this Permit is issued. .. ..
1 haw and will maintain WorkeM1 Compensation Insrame,as required by Section
3700 offt labor Code,for to performance of dm work for which this permit is issurA.
My Wakens'.Compensation lnsu.carrier and Policy num p� �^
Carer. Z 22 zO y No.: s& a.w�
C FlCATEO'F EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thtssemi in reed nnlbecmnplemd V the permit Is fornexhunmed duRars($100)
or Iwo)
1 certify that in the performume a me work for which this permit is mooed.I shall not
employ..,person in any manncru as In become subjm in IK Workers Cneopco mon
Laws of Califomia Dam
Applicant
NOTICE TO APPLICANT.If,a0er making this Ccnifmnm of Exemption,you should
became subject an the Workers Compcwtian provisions;of dm Ichor Cade,you most
.0 z TaMwide comply with such pmvidow or mu permit shall be,deemed novated.
.za O CONSTRUCTION LENDING AGENCY
I hereby affirm that Wert is.constoonfnn lendin .Frk,for the peAcrma.ce of
Tyr me work for which this permit a Wood(Sec.30)7,Civ.C.)
600. Lenders Nunn
.7. z L=dce3Address
U O I terry that 1 Mw mad ads applkation and sate that to above information is
Drs F cremm.I agora to comply with all city and wanly aNlm4mta and state laws relating in `
0 U Wilding cou mcoion,and hereby amhmixe ropmunudv of this city in enter upon tie
F
show-mendond ProperY for inspectionnse
purpa y (We)agree In ave,indemnify and keep humlea the City of Cupertino against
Ter liabilUmajudgmona,c/S'ANG
vw whichmayinanywayacrneagaiwlaid Cit, /
of the
U Z APPLLICANf UN ERtWILL COMPLY WITH AW.NON-POINT Issued by: DateSOURCEREOU TIO
O Re-roofs
Sig.atumet( lino amaumr te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant room mh uallc haardow material
as defined by the Cupertino Municipal Cade.Chapter 9.13.and Ik HWM and Safely
.sectio.255324>1 AN. All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining inspection,I
Will to applicant or fa=rt building occupant use equipment or @vi=which g an agree to remove P
cemil I molmor air contaminants w defined by tint Bay Area Air Quality Ma.agcment all new materials for inspection.
Distric❑Yw RIO
I haw mad the haallous mru13 am..under Chapter 6.95 of the Calif=.
nice Hcsh"Safctyccdc.Sectio �'15505,25533uW 25534.Iwticrrtand mnifde building
d=oat carrend hast a ten mat n u on }wpomihilny to nasifY of dm
mquim.is ch must a riormi ma Cern Signature Applicant o� b� g PP Date
Ownerar.atharisdagem Dam All roof coverings to be Class'%¢"or better