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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CUN:TRACfQR TNP'IYMATItQN
4.[`.,.41"62'i C ,.Gw,i rof
BUILDING ADDRESS:
CMS BUILDERS
P"'IMITNG06080257
11218 STAUFFER LN
OWNER'S NAME:
PERMIT ISSUE DATE
PARTHA BHATTACHARYA
174 N 2ND ST
08/30/2006
SANITARY NO. CONTROL NO.
(408)370-9870
ARCHRECTIENGINEER:
BUILDING PERMIT INFO
9LDGQ ELECT PLUMB
lm 0 lECH�
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
I Mmby silicon that I am licensed under provisions of Chapter 9 (commencing
with Sachem 70M) of Division J of ew BusimnaaM Prefeasions Cock. and my See= is
to full fume and effa
QYdo53
KITCHEN REMODEL NONSTRUCTURAL, ELECTRICAL, PLU
gazwr
NEW
D.,nmt c enc Ms
ARCHITECTS DECLARATION
I undersland my plans shall M used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 be+eby sprints Net I am ascmpi room tia Contracler's Lieensc Law for the
fallowing mann. (Section 7(D 1.5, Business and Professions Code: Any city or county
which requires • permit w cmusumseL sism impmw, demolish, or repair any mueturo
prior w its issuaae. also rtquims site applicant for such Permit M File a Signed wwmem
Law fehaptw9
Sq. Ft.F7OorArea
Valu$.®8500
malMknwnsedpursuant inMeprovisions ofinecomracwraLicance
(commencing wills Sadao 7000) of Division J o(the Business and Professions Code) or
Ihsl he is esempt therefrom and the basis for the alleged mesupdon. Any molWon of
qpN Number
Occupancy Type
Section 7071.5 by any applicant for a permit sebjecu the applicant M • civil penalty of
not mom Nan five hundred dollars (5500).
3 6 6 09046.00
❑ L as ownerk, tie Copan,. a my employers wage as ile'v sok
Required Inspections
q P
the work, sad .. 044, Business ss
Law deal oat apply lf rt
he ,Cola tatkwnamwawrms an[apply7a,,mvmmt of
and Code. TM CanVCwYa
Na
ndwWLicense
rough is
ldsor Measaueh.role hivwJfor through his
propcnywho MildsorionprowsIh
Property who
haan.sodwhe
own a moReeed for sale
the such itsprowdwit in not ear
ori m a forst. the e.
Me Wilding improvement 4 td within am ofc
however. Ne building
however.
wild improve use of
builder will haw IM burden of proving that he Sia not build w improve for purpose of
u h
role.).
0 1, as owner of the property, am exclusively contracting with licensed comrsnors m
construct the pmjeo (Sec. 7044, Business and ProfeWom Cade:) TLe Commoners U-
ceve law does not apply In ms owner of Coupon, who builds ar improve thereon, and
who contracts for such projects withaconuacwr(s) licensed purauam w the Conmim s
License Law.
0 1 atn exempt under see. . B tit P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby Nims under pans ry of perjury one of ti. following declarations:
1 have and will m into a Codriasw of Consent to mlf-imamfar Worker'sCompen-
Union. as provided for by Section 3700 of the Labor Code, for the performance of Ue
work for which this permit Is issued.
haw and will maintain Workers Compensation ksurmem, as required by Section
700 of the labor Cade, fw the pedoramee of the work for which this permit iS issued.
My Wmaces Gay/gpe1W_dan �r/as�yt�p Praise Na Polley nWnher K:
Grtio: YYOK 7`s••.ef Policy No, 47/1-00"t— _(
.
CEATIFlCATE OP EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
-
frhis M n. steed out M completed If the Council is (want hunmeddollars (SIM)
or less)
I certify, that in the performsece of the work for which this permit is isssed. I shall not
employ any person In any man term as w became subject w the Worker' Compensation
Laws of Califomla. Date
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject as the Worker's Compensation pmvisioas of the Leber Code, you mum
comply with such provisions w this Pemmit shall be demand revoked.
CONSTRUCTION LENDING AGENCY
1 hereby attune that them Is a construction lending agency for the performance of
the work for which this permit Is issued (See. 3097, Civ, CJ
Name
Lenders Address
I certify Nm 1 have read this application and state that the shove informNun IS
l agme to comply with all city and county ordinances and state laws misting to
building construction, and hereby authorim mprcmnutivo of this city w anter upon the
for inspecuon
aMvc-mcnuancd property purposes.
(We) agree to ase. indemnify sed keep harmless the City of Cupcnino against
liabilities, judgments. cam no expemms which may in any way Me se against mid City
inconsequence of the grutan f this permit.
Apia ICA DERST s ND WILL COMPLY WITH ALL NON -POINT
^
Issued by: Date /v v
SOUR ono
.y 'e 3C7'Of
Re -roofs
Type of Roof
Si�umof Appli omacier Dam
HAZARDOUS MATERIALS DISCLOSURE
Will dor applicant or future building oavpmtmme or handle huallov material
as deRncd by Oe Cuperttao Municipal Code. Chapter 9.13, and the Health and Safety
Cade. Section 75537(1)?
BNo
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
PIt❑Ya
Will eco applicant or future building oaupant um equipment or devices which
hanrcnv air conumtvnu as dallied by the Bay Area Air Quality Management
all new materials for inspection.
District? T�u� /,
O Yes Y"'
Ihave mad the mala yuimmcnts under Chapterd.95of the Califon
nie Heelth,k SafetyC05 573 and 73734.1 unYkrstsnd thmilee builJing
NWIC47
done mat M t mymmomiMlitywnotiftieocMpamofthemqulmm
aIsaumaeofacerGflumodOccupaay.
Signature of Applicant Date
1 q
..'�Do`�%.G
All roof coverings to be Class "B" or better
Owner oraw��a agent