07110146�Oy
[[F
C
D
kLLt;
O�
5=rte
FFO
z
Z 0
W �
G Q
�z
UOU. _
OF
F4
Uz
CITY OF CUPERTINOx+
BUILDING DIVISION PERMIT
�XONTRACTOR\INRORMATION,
BUILDING ADDRESS:
PERMIT N0,
11305 TERRA BELLA DR
TBD —.TO BE DETERMINED
07110146
W NER'S NAME:
MI
PERT ISSUE DATE
SAYAN LAHIRI
05/05/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHTfEC MNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
LICENSED CON71RACTOR5 DECLARATION
Job Description
1 thereby mf0rm that 1 em licensed under prevision olCWpter 9 (commenting
p
with Section 7(()()) of Division 3 of the Business soul Professions Code. and my license is
CONVRSN (E) FAM RM INTO 2ND DWLNG UNIT; FAM RM, FAM
in full Tome and effect
License clast Lk. R
RM & (E) BTH RM RMDLD
Dow Contractor
ARCHITECTS DECLARATION
1 undersand my FAA Shall W used as public reemils
Licensed Pmfeasimid
OWNER -BUILDER DECLARATION
I hereby IT,. that I am exempt from the C.m acrers License Law for Ne
following meant. (Section 7831.5, Business aM Prefessom Calc: My city or county
which mti.n. a permit m cnnacro" Slue Improve, demolish, o ¢pan any Structure
prior in in income., also needs. the applicant fursuch permilto Glc a signed satereem
Nat he is licemcd pursuant to thc previsions of the Contractor's Liamc Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business Md Professions Cade) at
$12500
Wt W is esempt therefrom and die basis for the alleged exemption Any violation or
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
p�I Number
Occupancy
P y Type
not mom dom row hundred dolt. WOOL
35625010.bb
❑Lasownermf the empkym withwagesntheiraskmm.
ft simc,omy
Borne
will do f esions and e; The Imre WWI es License
or offered wdocs not apply 70an,owni r of
and Professions tracmra Llame Law dans not appy lf an owner of
ons Code: The
Required Inspections
wh ves
enywhabuilds orimpmva thimprove who dnessuch work himulfor
own forsahhu
not intendedoroBemd for sale B,
sewnemployees,lding
or i prsuchimProsementsam
however. the building improvementg Ne owner -
within ane year or mprove
ee thus for
builder MB have Ne burdee of proving that W did cot build or improve for pmrytu of
sated.
1, as owner of the property, am eat atimAy contracting with licensed mm corm a-
constmct the project (See. 7014. Business and Professions Cade:) The Contractors Li.
.
sena Law does tat apply to M owner of property who W ills ar improma thereon. and
who contracts for such prejeeU with a eOntracbf(t) hrened pursuant W NC cWtudcuse,
Licensee Law.
❑ I am.s or under See B & P C for Nis n
caner t1M `^"M.tn+`rs. Dau
1 RKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
.
❑ 1 have and will maintain a CesaBmm of Consenuo Ulf -insure for Workcri Compcn-
sslion, as provided for by Section 37M of Ne Labor Code, for du pertormance, of the
were for which this permit is issued.
1 hath.' Slid will maintain Workers Compensation IM1NMce. as mqulRd by Section
37M of dNc labor Code, for the performance of the work for which this permit is trued.
My W.,WS Compensation Inwrsna carrier and Poliry nmmWr tie:
Carrier. Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Musuction need not W completed if dm permit is Intone hmdured dollars ($100)
or las.)
1 certify that in the perfnmznec of the work for which this permit is Aimed, I shall not
employ anyperson in any manner u as t�bc�r65rs��0.lo the Workers' Compensation
Orhr'
lawsa(Califam' 1 J
ApPlieant A N t_ N
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you Should
become subject m not Workers Compensation provisions of Ne labor Code. you most
forthwith comply w'in such proven.. or this pllahhall W deemed revoked.
-
CONSTRUCTION LENDING AGENCY
1 hereby af8m than Nem u a consuuctinn tending.,me, for the performance of
du were for which this Permit is named (Sec. 3197. Civ. C.)
Lender's Name
Lenders Address
I certify that 1 have mad this application and Stan that du above Information Is
corm¢ I agree IS, comply with all city and county aNimnoa and state laws mladng in
building con arnedon, and hereby auttorim mpmacntativa of Nu city to enter upon the
above-mentioned presently fm inspection purposes.
(We) agree no save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and cxXWcS which may In any way action, against Paid City
in consequence of the granting of this Permit.
APPLICANTyNDERSTANDS AND WILL COMPLY WITH
ALL NON -POINT
SOURCE
Issued by: Date •--1
RE IlAT10NS. A -
nW/A.VU�.�'�n /�/
Re -roofs
I X 0
Sgnazum of en olllOmmr x D ole
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will Nn, appt or future building occupantazom or handle hamadoas material
an defined by the Cupenim Municipal Code. Chapter 9.12 and the Health and Safely
eode. Section 7.5532(q?
C] Y. 2-a-
. All roofs shall be inspected prior to any roofing material being installed.
Will Nn, applicant or forum building occupant tau equipment or Win= which
If a roof is installed without first obtaining an inspection, agree to remove iection, I
P
emit harvdms air conuminam as JeGad by the Bay Area Air Quality Management
all new materials for inspection.
District?
D Ya Q'fJm.
1 have mad the hvardoa material, mquimmmu under Chapter6.95 ofau Cxli(or.
nk Health&Safety Cade,Secdos5505,25533er 5534.1undrn=dNuifdm building
does not to nay hoc a ummt that it u my reryo sihdity k notify the =Want of the
.ocher en which ..be mel Prior aq. 4. Cenifeate of Oceupo .
SignatureofApplicant Date
0R
All roof coverings to be Class "B" or better
Owner orauthm agent D