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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
BURNHAM CONSTRUCTION
PERMIT"°'06060158
1228 WEYMOUTH DR
OWNER'S NAME:
PERMIT ISSUE DATE
MAHESH GIRKAR & SASHIKALA OBIL1717
GLAD STONE
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SANITARY NO. CONTROL NO.
(408)267-1373
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDO MECHO
Eta PLUMB
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LICENSED CONTRACTOR'S DECLARATION
lb Description
o
1 hereby afflnn that 1 am licensed under provW... of Chapter 9 (cemmm.1.1
with m full �(anoand.rfecDiNelon3ofdleBudnrstand PmfessiomConn. andmylicevnu t.
uc.
Licnnm Glasse "
LM.IfContractor
1 STORY ADDITION 325' - BEDROOM, 1/2 BATH, DINI
ADD 2 SKYLIGHTS, REMODEL 377'
Dam
ARCHITECTS DECLARATION
DAN BURNHAM NEEDS TO RENEW BL
I understand my plans shall be used as public rtenNa
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby eRrm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Profacov Cade: Any city or county
which mqub U a permit on construct. alter, improve, alemolrn, or repair any structure
pdor m its issuance, also requires the Applianl urfuch permit IO lite aligned Smemeni
Liam Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to Me provisions of the Comradiorl
(commencing with Section 7000) of Division 3 of the Business and Profevdom Code) or
$107653
that he is Mu mpt therefrom and ase basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by say applicant for a permit Subjects Ne applicant to a civil penally 01
nut mom dun five hundred d01Wa (5300).
❑ L as awrer of th t Property. ser my esupioyen with "Ices as t e4 talc compenotion,
Required Inspections
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will d0 the work and Ne4Yacmm rnUl intended "Offered Mersin (Sm. 7014, Business
and Prolesduv Code: The Guarantees License Law dao Out apply m an owner of
property who builds or improve deacon. and who does Such wort himselfor Waugh its
Own employees, provided that men improvements K not intended or offered for sale. If.
however. the building or improvement Is seld within one year of completion, the owner -
builder will have dm burden of proving that he did hal build or Improve for purpose of
sale.).
L SU owner of the Property am m clusiwly connecting wide licensed centramora m
troer the project (Sec. 7014, Business and Prof edov Code:) The Camcmrs Li -
ave Law data oro apply It, So owner of property wbo W1143 or improve Nemo., and,
who normae; for such projem with a cemrsemr(i) licensed pursant m the Commences
Liters, law.
❑ l aAt rare un Secy B & P C fo11 Nisrree;/;/tt- n1
owners r S Duel
WORKER'S COMPENSATION DECLARATION
I hereby aQtrm under penally of Perjury one of Ne fallowing da labors:
w and will maintain a Ceadfieam of Covent he self-insum for Wahn's Compton -
n, u provided for by Seaton 3700 of the labor Code, for W performance of the
work for which this permit is issued.
❑ I love and will maintain Waters Compensation Wuruha, as required by Sectio
'
3700 ofthe Tabs Code, for the performance ofW work for which this permit U Unocal.
My Workers Compensation Insurance artier and Policy number Me:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need Out uncompleted ifthe perch h fwanc hundred dollars ($100)
lir leu)
1 amity dol in mo performance of me and for which this "emll Is boned, I Nail not
empl yperaoninanymanner,0asmnaam cc tet WaliYar L'ampas 00
On
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1
N CEITO APP ANT: IL after making this Certificate of Exemption, yod Should
become Subject to Ne Workers Compatadon provisions a( W Labor Code, you mor
forthwith comply with such previdov or Nu Permit Nall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I herby aRirm that mem u • lending agency for Nc perfurmence m
ed (S. 30
' Newark for resines tad, permit ts basad (see. 3097, civ. C.)
jLeaders Name
Lancers Address
1 coolly that 1 haw mad this application and sum that tet above informatrun is
• entrees. l apex to comply with all city rid county ordinances and sum laws mlatng to
building construction, and hereby and odor representatives of Nis city to cmcr upon f
for inspeuian
above ...dead property Purposes.
(We) agree to mw, indemnify and kap haonless the City of Cuper inn against
liabilities. judgments. cors and expenses which may In anyway amus galvlsaid City
in canYqumre Of Ne gMtng of this permit.
APPLICANT UNDERSTANDS AND WILL C MPLY WITH ALL NON -POINT
Issued by:6i Date - — 2'7x1
REgUU pNS.
14
Re -roofs ��1 —�
Type of Roof
MeCE
�./ e I/ A 7, %
' wure of Applian✓0"COMMr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future building occupm ROre whandle naaardona mamrid
as defined by me Cupertino Murtictpal Cad.. Chapter 9.11 and de Health and Safely
Cade. Section 15332(a)7
All roofs shall be inspected prior to any roofing material being installed.
Oyes /XHO
If a roof is installed without first obtaining an inspection, I agree to remove .
Wail me applleatht a foram building acvpam use equlpmenl w rkviao which
hmarmav air commonans u defaal by Ne Bay Arta Air Quality Management
all new materials for inspection.
ME=?
Oyes VN.
1 have read the basalloown Materials m parancnu undcrcuprer6.95 of me Califor.
.is FralNASafctyCode, Sections 25505.13333 and 75534. lunderseand Ndifthe building
dao al arremly have a tenant. Nu its my re povibllity to nodfy the mupml of me
`jmens wh must be met pilar bas sera lam of
Signature of Applicant Date
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,Lrm
All roof coverings to be Class "B" or better
od!nem
Owner w auNad>rA ager Dam '