06020048 (2) CITY OF CUPERTINO a ''I "��;
BUILDING DIVISION PERMIT 'z�CON�CRRRRTUR"T�'�RMA'TIIt�N •<
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BUILDING ADDRESS: HANSON CONSTRUCTION CORP PERMITNO.06020048
11254 CATALINA CT
^"INEWS NAME: PERMIT ISSUE DAM
SHDAVIAR, DEEPAK 1539 EL OSO DR - 03/01/2006
NE: SANITARY NO. CONTROL NO.
(408) 517-0300
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MECH
O
�0,, LICENSED CONTRACTOR'S DECLARATION Job Description
r�0Z 1 botchy affirm Nal I ata licensed under Provisions of Chapter 9(commencing
n< with Section 7000)of Division 3 of the Business antd Professions,Code.and my Because,is
in fall force a ad affat. ORIG. PERMIT #05070050
LleanmClua Cun S0+a` 4 � REVISION: FLUSH BEAM/CLARIFICAITON ON MISSING
Dau Conwemr Cr
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ARCHrMCTS DECLARATION DETAILS ON GUEST BEDROOM
y 1 undcnunJ my plans Mall heated u public rccnrW
Licensed Professional
a OWNER-BUILDER DECLARATION
I hereby air,.Nal I am exempt from the Contractors License Law far the
D O fallowing mason.(Seed..7031.5,Business and Pmfcumns Code:Any city or county
which mr,al.a permit to cmuruct.alter,improve,demaluh,ar roput,any munure -
rw prior a is,issuance.also requlms the applicant for such permit to file a signed sunmem
< Nat he is licensed pursuant mBan provisions ofmacorMlatauamaLaw(Chapter 9 Sq.Ft. Floor Area Valuation
xzC$ (commencing with Section 7000)of Division 3 of
thc Busineaamd Promotions
"i"
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3.. that he Ia mempt B ecal m and lie bus,fa me talc{ed ewnption.Any Noladon of
Section 7031,5 by any applicant for a permit subjects the applicant an a civil penally of APN Number Occupancy Type
not mom than nn hundred dollen($SOS).
1,as owner of Bon Impurity,or my employees with wags,as their ole compensation.
will da thewe*..adNesvucmmbnerinmMedar.Bendforsale(Sm.70aa.Buaiaen Required actions
and ProreWaru Code:The Conaactor,License Law does act apply be an Manor of q P
property w ho builds air improves Bunton,and who does such work hi m,e1 f air through his
own employees,provided that such Improvements arc notinu rdea aroRered forsale.if,
however,the building or improvement is sold within ane year of compledon,the owner.
builder will have the burden of proving that he did not build or Improve for purpose of
ick.).
❑1.0owner ofc, property,
ec.704,Business;
d Profession{with:)TheeCestrums -
cauwn Ba:project(Sec.too44,an weer of and nywhoau Cade) proves the on. d
cense Law dounot
uchapply m%withaofproperty)whesedWamimpmves Commences
om mens
whocontractsLace for each projects with a convactor(O licensed pursuant m the ConvsmrS \\
D lana Law.
❑Tem esempt under Sec .BB PCT.thoe rcawn
,or Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury am of the following deelsnflom
❑I haw and will maintain aCeNficale of Conanry to self-insure for WorkersCompen-
.Bon.u provided far by Seedon 3700 of the Labor Code,fm W performance of the
work for which this pewit is issued.
❑1 ban and will maintain Workers Compensation Insurance,as required by Section
3700 of the labor Coda,for the performance of the work fm which this pewit is issued
My Workers arope reNon hnummn ander and Policy number ice:
cmim, S� 'swkf CamQ Policy N.,CoLl600li-A741
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbu vection sued not bucompleted if Ute permit is farom hundred dollars({100)
or leas.) - -
1 certify dust in me Wt...of the work for which this Permit is issued.I,hall not
employ any person in any mamerso as an became subject to me Worken'CompeuaBon
Laws of Califamia.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Cer incate of Exemption,you should
became subject to the Worker's Compensation provision of Bac labor Cade.you most
.,O forthwith comply wiBa such provision air this permit Mall M accrued revoked. '
z CONSTRUCTION LENDING AGENCY
`
[•n I hereby affirm that them is a construction leading agency for the performemc of
�i Bat work for which this pewit u Issued(Sas 3097,Ci,C.)
Vj Q Lenders Name
CL z Lenders Add.
U 1 certify that 1 bun new Thu application wad sus,this Bon show information is
It,;'! cartat I&gra u comply with all city and county ordinances and sou laws retailing m
C)rV' building construction.and hereby authoum representatives of thiscity menta upon the
til whom-mentioned property for Inspection pugnsaa
(We)agree to now,indemnify and kap harmless the City of Cupertino against
cc4 Iiabilides,judgmenu.coon and expenses which may in my way aame against said City
U 7 in consequence of the gaming of this permit.
r•� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date VG
SOURCE REGULATIONS.
O7 of Loa Re-roofs
;Di..ct?
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
fin applicant or fuwm building attvpantuarc or Nndle hmsNous manrisiy the CupeNm Municipal Code,Clexpur 9.17,and the Health and Safetyn 3ss3:(.)? All roofs shall be inspected prior to any roofing material being installed.
4Nc applicant or fthrc buildin{aceupanl um cyuipmenl or dcvicu whichIf a roof is installed without first obtaining an inspection,I agree to remove
us air cemaminants u defined by Ne Bay Ana Air Quality Mmagomcnt all new materials for inspection.
u ErN.
I have mad the hazardous material,requirements under Chapter 6,95 of the Califon -
ni HftlN@SafatyCde,Sedou95505,35533and2S534.1uedcmmd duuition building v
does mt currently hew a arrant.the it is my responsibility to madly Ban oaupmt of the
my ' nn@whic'It mdtxmetpdormiumna rifma to= Signature of Applicant Date
G ^>cwn CSC OZ 01
Owner oramhadvedagent f �Dan All roof coverings to be Class "B°or better