08070186 IV jNFORMANn
F 'UPERTINO
CTUIOLDINCGE) ]SION PERMIT
iiESS
S: PERMIT NO,
VIA CAMINO CT TBD TO BE DETERMINED 08070186
E R-S ME: PERMIT ISSUE DATE
AS iNIAO K AGARWAL 08/29/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTfENGINEER; BUILDING PERMIT IN170
PLUME MECH
80'z LICENSED CONTRACTOWS DECLARATION
I Acreby afffien that I Am licensed under Provision al'Chapter 9(mmmencin, Job Description
witit Sectioni 7(a)(i)m"Division 3 ofthe Busimumand!ftessicasCode.And!my it--I- ADD 250SQ BTHRM&WLK-N CLST, STDY RM; NT INCLD
in full to=and Affect.
.nz Llamam 0 RE-RF& NO STRCTRL
ar
C=11.
Dam—4��RCln EECT'S I
I understand my plans shall be used a public
Licensed Prol.saum.1
OWNER-BUILDER DECLARATION
I hereby frarre that I AM attempt from the Contractors Ucaraa Law for ft
rQ0 following nc,ann.(section 70 LS,Butantes,and Professions Code:Any city of county
which msb.a permit 1.manduact.arm,.Mrs... lannalish,or repas,any macm.
Prior to its issuance.also,asquirest the applicant for such Permit to rile a signed junament
that he is Incanted pursuant[a be provisdanut of the Conanclor's U==Law(Chapter 9 Sq.Ft.Floor Area Valuation
(marracreing with Section 7000)of Division 3 of the Business And Profassfinns Code)or $30000
that he is exampt ducrafrom,and the basis for the allqcd compiler.Any violmi,on of
section 7031.5 by say Applicant far A permit subjects the Applicant to A cill!Mostly of
Pat arma data fiw hundred doll.(&SM. 3 2 6 4 6 0 12 )bPj�4 Number Occupancy Type
0 1,astramsecofft parpertyarmycraphaymas with
will do the work.And ftgumenme ismutimended"offered fortale IS..Mal.Bud.
and professions Codta That,Conescom's License Law does hot apply in an owner of Required Inspections
Property who Wilcismintrowi therocam.and wimebassauch omrk hicaulfarthrough his
manteopl.yam,pren,blod dot such Improvements AM not Intended oroffered for Asia.it.
hansom,me building or inaphowment is sold within am your ofcompledca.the owner.
builder will haw the surcen of pmrI.,that W 414 an,Wild or Impose for purpose or
"to.).
0 1.As Wmer of the Property,Am cxclusiniy contracting wids licensed!corwassams to
comuract the projecl.(�7044.Businces And!I'Micssions Cods:)Than Coulaactor's U-
'.Law door net apply to an.of propemy who,buil"a,fimparnes thernam,Anal
he marommi for.uch pramut with a conamuctor(s)licensed purecont in the C.mrsuctack
License Law.
annesenplLunam.SM 8&P C r"is
iir Data—
WORKERS COMPENSA71ON DECLARATION
I hereby Arm under penalty of perjury am of the following declamtkour-
cation.a pmj&d for by Section 3700 of the Labor Coda,far the Performance of the
work for which ibis permit Is issued.
0 1 haw and will maintain Worker's Compensation Insurance.as required by Section
37M of the Labor Com,far ubc,purfammusnoc of the work far which this permit Is issued.
my WmIce C Must.on In... ,And Policy Mark,A.:
Carrier, P" Policy No.:
4CERTRIAAM OF MEWPTION MOM WORKERS'
COMPENSATION INSURANCE
CrIds scatter need Act Accourpload lithe permit Is foram Monaco!dollars(11100)
or Ims.)
I cartify that in the perfourrance of the work for which this permit is issued.I shall not
employ anyperson In any maracrso As M become subject to the Wareas'Compenzation
Law.ofCaliforria.Data
Applicant
NOTICE TO APPLICANT,If.after making this Certificau,of Facampflon,you should
boamarme subjem W the Workmeo Compensation pro,,esions of the LAW Codc.No am
Z f0mwilh..Ply With each imnlismal Or thiS Permit shall W dicamed rawlecd.
CONSTRUCTION LENDING AGENCY
limenthy.M.tantismalsamnstrused..�rdfirg.g.MYf.rd1mparrmAMmuf
the work for which this Permit Is issued(Sm.3W7.Chi.Q
L.A.,
D z Landee:Address
U 0 1 mealy that I haw rosid this Wrestles And! use dust the also.information I.
1,E terms.I&I=to empty widt Ali city And county ordinances and sum laws missing us
0 Wilding construction,And!baroby whorin acinamemadws ofthis city to enter upon use
ahow-mormoned property for impeadim Purposes.
(We)Agree to saw,Indemnify ad kmp hurniess do City of Cupertino against
,,n liabilities,jualgincots,cam and expenses Which MAY in My My KCMA ISAIM Asid City
Z in consequence of the graming,of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS 9 � Date
Sigamum OfAMI!al��- Re-roofs
caMIC... Data
HAZARDOUS MATERIALS DUR&SURE 'Iypte of Roof
Will use Applicant A,far.Wilding occupant sume or handle hatcardous manurial
fined by ft Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 25532(.)7
0y. D No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or Future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harArclums air commairmats a dclowd by the Bay Am Alf Quafifty Management all new materials for inspection.
Distric,7
[3 Ycs. C]NO
I haw Must the hanardws m=fl3i3 requirements underchaptar 6.95 ofthe Califor.
-1.Health&Safety Cod.,Seed.25505.25533 And!25534.1 understand dualrdhe Wilding
does mat currently how A bowl,List it is my numonsibility W Murry the mco,mm of the
requirements which must x Met Our in ismance of.Certificate of occupancy Signature of Applicant Date
r.,:� ..at All roof coverings to be Class'RA'or better
1Owm'or.1:o�Id Dow