05070050 (2) CITY OF CUPERTINO *' *✓ TM -ice'' 11 < 1 1r '""""' ,^'
BUILDING DIVISION PERMIT YC,ONT,RAC�yrTOU�INFORMATIION
It
UI'DING ADDRESS: HANSON CONSTRUCTION CORP PERMITNO.05070050
9C;4 rATAT.TNA CT
_ER'S NAME: PERMIT ISSUE DATE
DEEPAK & SUMEDHA SHERLEKAR 1539 EL
NE: SANITARY NO. CONTROL NO.
(408) 517-0300
ARCHITEC'UENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB - MECH
0 0 0 0
u0o LICENSED CONTRACTORS DECLARATION JobDescri [ion
u C I artery grim that 1 am Hustroed under Provisions of Chapter 9(commencing p
xU with SccGon]OfN))of DivisionJof Nc Businrs asb ProfcsximLS Codc.and mylittnso is
^!�D in full farce and ea 1
q: LieenroClaar _L .« �, _ ADD 1515 (MS /BATH)
F,p Dale Cunmw ^'
"J ARCHITECTS DEC TION GJ✓f a'.N�1�
¢� I understand my plans shall he used as public rtcnNs / ti a"
}� (s!t
g p G Licensed Pntfessional _It 13 ?I II!5
x 3 OWNER-BUILDER DECLARATION ray/"
EE I hereby.('firm onthat I70 1. exempt from he Corm.;Co e:Any C Law for Nc
Sp o following mason. pant t ]1131.5, ,alts ss and P dc.,,s Code:Any city or county
m which mquims a permit re prim,m k alcor.Improve,e applicant por h Permit t nr repair any manure $324770
prior art its issumec,also
m
that
commencingwJpurstion7 )ofDivionsnf the oftheBmnessanctors ianaclsw(Chapter ode)9 Sq. F[. Flo Valuation
xFo (cat So IS(commencingwithSection]000)of Divisioor of the Business pt Professions Code)or
at W is acme((Mrtfmm and she buts for the Jkgee eumpuon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r U U Occupancy Type
no(mom Nan five hundred dollars($500).
1,u ownu of the Properly.ar mY emPloytca with wages u Heir salt compensation,
will des the work and the suuctum is not intended or offered Image(Sec.70Na,Business
and Profeuimts Cook:
Tho Com outors License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided thm such improvements art nolinmrWed or offered for Sale.If.
however.Ne building or improvement is sold within one year of completion.the owner- -
builder will have be burden of proving that he did not Wild or improve for purpose of
sate.).
❑1.as owner of Ne property,am exclusively concocting with licensed commissions to
construct Ne project(Sec.704th,Rusiness and Professions Code:)The Common's Li-
cense Law does not apply to an owner of properly who Wilds or improves thereon,and
who concocts for men projects with a contrimor(s)licensed pursuant an the Conmctori
Lleense law.
❑1 am exempt under Sec. .B h P C for his reason _
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby&Rom under penalty of perjury One of the following decleations:
1 have and will maintain a Certificate of Content to self-insure for Worker's Compen-
sation,u provided faf by Section 3700 of the Latin,Coda.far the performance of be
work for which this permit is ounce.
Fl have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Cods,for the pcRarmanee of she work for which this pemi(is issued.
My Workers C mpememo inmrsome carat,and Policy numb,art:
i Carrier. /1s'llt YBeIiq No.:�J L-- ' s
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not W completed if(W permit is for one hundred dollars($Ind)
or less.)
1 CWKY Nal.in the parformanee of to work for which his permit is issued,l maR nu(
employ any person in anymanrlgsn hecgmaSLbjca mtW Workers'Compensuion
Laws of Cahl9r Dam VV ((JJ I
Appikam�LMja :u` vt Ijr. fAvn n
NOTICE TO APPLICANT:If,after making this Conificale,of Exemption,you should
become subject m the Worker's Compensation previsions of the Labor Coda.you mus(
Z, forthwith comply with such provision$Or this permit shall W deemed revoker.
ZO CONSTRUC`DON LENDING AGENCY
�-. 1 hereby affirm that Nem is a convection lending agency for be performance of
(y'v1 Ne work fur which this permit is issued(Sec.3097,Civ.C.)
V4 Lender's Name ,
z fenders Address
U Q I certify,Na(1 have read this application and sure Na(the above information is
U. r correct 1 agree m comply with ail city and county ordinances and sum laws relating to
O U Wilding construction,and hereby auNmrire representatives of this city to emir upon tM
r f1.1 aWve-mentioned property for iupection purpose&
(~ a (We)agree to Save,indemnify and keep barmier the City of Cupertino against
N
liabilities judgments.costs and expenses which may in any way seem,against Sold City
U,Z in consequence of the granting of Nu permit.
^ APPLICANr UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 40 3---
PCC��REG'�}A NS.
1�I:tdlJ�t Cr`( 1a�. 10—�1 is Re-roofs r y
Signature of ApplicanVConracmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore building Occupant ser¢or handle haamous material
L-defined by(W Cupertino Municipal Code.Chapter 9,12.and be Health and Safety
c,Schon 15531(.)? All roofs shall be inspected prior to any roofing material being installed.
So �No
Will toapprantor future Wilding occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
I
t hazardous air conuminants is dcfine!by the Bay Area Air Quality Management all new materials for inspection.
Disric17
Yca
I have mad the hmaNOus co mru srequirements under Chapter 6,95 of tM Cali Or
ria HcalN&Balmy Codc,Sccdom15N15,8533 and 25534.1 understand NmifNc Willing
does not currently have a mnam.that 1113 my responsibility to notify the meupan(Of the
rer <mc wnich. rts( met , ssranmeacrni0atcmrOctrpan�ry. Signature of Applicant Date
Oww u cent -'(�o
Owner or armorirnd,gen( D,m All roof coverings to be Class "B" or better