08090151 CITY OF CUPERTINO a ., fs ' •"% �"` �'"
BUILDING DIVISION PERMIT KONTRACTOlti `E0RMATI0N !,
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BUILDING ADDRESS: PERMIT NO.
1217 WEYMOUTH DR TBD - TO BE DETERMINED 08090151
-R'S NAME: PERMIT ISSUE DATE
SRIDHAR SODEM 09/23/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
GO ELECT MECH
Btu O PLO O
UMB
ua, LICENSED CONRACTORS DECLARATION
rdV hermthan 1 eby affirm I am licensed umlat pmvisians of chapter 9 fenamamng Job Description
awits Section7")ofDivision 3ofthe Business Audi ProfassfouCode.and mylicenseis RMDL BTHRMS (2-127SQ)KTCHN(1-30SQ) NON-STRCTRL,
in full tarts am effect
5'q_ ucenxclass LIC.g ELEC/MECH/PLMBNG
=� Dow Contractor
eARCHITECTS DECLARATION
e U 1 uMersmM my plans shall W used As public soothe
6
yG Licensed Professional -
3 OWNER-BUILDER DE Ce ConusConuaON
I batehY affim
Nat 1 am exempt cmpt from nah License law for 1W
y o O following moxa..(Section 1031.5,Business and Profcasiuu Code:Any city or county
$ which rtquhas a permit x e asuoet.aIle+.W prom.demulLsh,tar mpmr any structure
.t< prior to its issuance. lan mgaim3 NeapplieNl for such Permit b file a Signed ammmenl
that he t$licansal pursuant to the provisions of dx Contracx/s LJcenscLaw(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7010)of Division 3o the Business and Professions Code)or $13000
Nat he is exempt therefrom and the but$for Be alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects dm applicant to a civil penalty ofNumber Occupancy Type
not mom Nan five hundred dollars($5M. 3 6210031 :V l7' Pane Y YP
1,u owner of 1W poperty,o my ervPlvym with cages u Ne'vxlecompewtion,
Will do IW work and thowtumm is net intended or aRered forsale(Sec.7014.Business
and Psofessict.Code The Contranols License Law dors an,apply to an owner of Required Inspections
property who Wilds orimpmve Nemon,and whodoessuch work himselfor through his
awn employees,provided that such improvements tie not intended aromtesi foraale If.
boweve.lie Wilding or improvement Is sold within one year of completion,the owner.
builder will have the human of proving that W did not Wild Or improve for purpose of
sale.).
1.u owner of are property are exclusively contracting with licensed contractors x
nsaam 1W project(See.7044.Business and Professions Code:)The Contractor.Li- .
ccue Law does not apply At an owner of property wW Wilda or improve Merton,And.
wW mntrscn for much projects with acmauacuar(s)licensed pursuant As Ne Conuanols
License Law.
Iftaereaemptundar See .B&PCIMthumaxn
W, i /%.-��--� Dora Mini
ORKER-S COMPENSATION DECLARATION
I hereby ammo under penalty of perjury,arc aides fallowing dodma u:
I ham and will maintain a CeNftux of Catsent to selftiuum for Workers Compton.
nation.As provided for by Section]RIO of the labor Code,far and pcRom.of de
wort far which Nis permit is issued.
❑I have and will mainui.Workefs Comperaation I..u required by Sued.
1100 of Ne Labor Cada,for the performance of Ne were:for which this permit U issued. '
My Workefs Compensation Luueamce carrier AM Poliry,number am:
Carrier. Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mdaxNm aced net he completed ifft Permit is feature hunNcddollan(5100)
car ken)
1 certify that in Ne perfamancc or the woh ror which this pedal,is issued.I shJ1 not
employ any person to anymanner t bcc m sub'en Ice IW Wmlwa,Compensation
Us
w
Applis of Califomig, te
cant l j- N II.
NOTICE TO APPLICANT:It.after making Nu Ccnifieaate of Fsempdon,you should
become subjm m the Wo Ions Campeotadon previsions of the Lather Code,you must
.,O forthwith comply wit such provisions a Nu pemm
it shall be demand ated.
Z U; CONSTRUCTION LENDING AGENCY
I hereby affirm thou fm era cmearwainm ldndingagnnry red de pe,f...f
FC r�r thn wart for which this Permit 4 issued(See 3091,Civ,C.)
A Lenders Name
Z) z LeM e.AM.
U O 1 certify Nat 1 base mad this application aM sax Nu the shove iofomudun t$
W Pconceit-I grce in comply with Al city and county oNinencce and ante laws mIndng to
OU building construction.and hereby authorize reprammadves of Nis city to caxr.'r,f
W above-mentioned property for inspection purposes
W (Wei)agree to save,indemnify and lest hamlass the City of Cupmeno against
it r/J Iiabilitics.JMgme^u.cuts and expense,which may in any way accrue agaiul said City
U Z in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
_ /1-�� D9I2ata3 J� Re-roofs _�-
Sgnamrt of ApphcaHAZA r HAZARDOUS
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
AkkIf
Ne applicant tar(mum Wilding ottupul store tar handle Health and Wcty
fined DY the Cupertino Municipal CMe,Chapter 9.13.and the Health and Safety
.seoion us3zU>7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or fumed Wilding Occupant sax equipment If a roof is installed without first obtainingan inspection,I agree to remove
sap B P apaant of device,whim P
cD CL?aunns air canounitants u defined by de Bay Area Air Quality Mansgemcnt all new materials for inspection.
❑Ye,
1 have.&10,hvamnes mamrials mquirtmanu under Chapter 6.95 of Ne Califor-
nia Health h SafmyCade Smios 25505,25533 aW 25534.1uMersuM thaifft Wilding
does not currcm0y have a unlit-Wt it is my mapaaibility x notify de occup r,of Ne
requirements which must W met M.,re issuance ofa Certificate mfaapaneY. Signature of Applicant Date
Owner or auNamad agent DO.092 OX All roof coverings to be Class'�W'or better
Da '