05070124 (2) CITY OF CUPERTINO 77; 7777M777;777777
BUILDING DIVISION `6N, 777�'
PERMIT :
A
BUILDINGADDRESS: SANJEEV SAHNI 0 5 07 0 124
6733 CLIFFORD DR
OWNER'S NAME: PERMITISSUEDATE
SANJEEV SAHNI 12/06/2005
SANITARY NO. CONTROL NO.
AR ;ITECT/ENGINEER: BUILDING PERMIT INFO
H
CH
C
PL!r !M
LICENSED CONTRAClX)R'S DECLARATION
I wraby.M.Out I A.Imsmailturim,pra,bitimunmCloopue,9(commencing Job Description
""t f d IT
8201 ADD-LIVING RM/KITCHEN/PORCH/BATH
.c
z canif A2A to
Dam Contractor lWA4 10531 REMODEL-FAMILYRM/3 BEDRMS/2 BATHRM
.rq DECLARATION
I tundsocraind my plans&Jmll be usted u public records OFFICE
tw� Licensed Professional
OWNER.BUILDER DECLARATION
I hereby Ali that I am exempt fran the Comment's License Low for the
E02 (allowing ramin.(Section 701 Business and Promousuare,Code;Any city or county
I I which raquores a permit In construct,alter.impurave,demolish,or repair any structure
prior W its William,Alan reqUirm Me APPI]CUL for web permit to file a signed statement Sq. Ft.Floor Area Valuation
that to is limmad pumant to doo provisions of me Comment's Uactum Las(Chapter 9
(commencing with Section 7(00)of Division 3 of the Buriame;and Profications Coal or
that he Is exempt Lhcmfmm and the basis for the alleged exemption.Any violail,on of $281873
Section 7031.5 by any Application for a permit stubjects the applicant ted,a civil partially of APN Number Occupancy T�pe
.at...Mae five hundred doll.(ML
0 I.amnuo(�pmpwy,"mymployomwi��lesuft�micomNnution,
will do the work.and thesicuracturre I.wit intended or offerved fousid.(Sm.7044.Busleseas 3691:1844 . 88
and profession.Code:no Contraeux's Licance,Law it=not apply to A.owner of Required Inspections
Property who mild,orimproves thorcon.andwhoMmosuchwark himseirortmould,his
own employests,Provided that such improvements am Am mutation confirmed foraide.If.
however,Me building or improvement is sold within am yea otcomplietim.Me owner.
buildem will have ft burden of provind,that be did no,build or Improve for purpose of
.10. zsl�ii
0 1.u owner of the property.am exclusively contracting with licensed contrarcuours w
construct the project(Sec.70".Busines,and Proullessions Code:)nic Contramor's U.
ccrac Law it=not apply in an owner of propery,who Wilds at improm thencon.and,
who contacts far such lamijects,with a commuctor(s)licensed pursuant In the Controt
License Law.
[]I ans exempt mider Sec —,B&P C far IN.conswas
Owner DAM
WORKER'S COMPENSTnONGECLARATIOJ�
1 hereby 4111mi under penalty of pedury am of me fallowing declarations:
.and will audmid.A California or Coma,us self-insura for Warromit Coupon.
A.a provided for by Section 3700 of Me Labor Code,for ft performance of the
w for which this PINITAIL I.issued.
0 1 have and will mainum,Warkice,Compensation lessurance.Air raquired by Section
37M of the Labor Cods,far the performance of the wark ferwhich this permit Is Issued.
My Workeez Compensation l�=matter and Policy number AM: 'R
C.Mlm�� Oltx, Policy He.:
CER71FICATE OF EXEMPTION MOM WOI1[K
COMPENSAnON INSURANCE
nissceflon need ant kmmplcwd ifthe permit is foram hundred callaux($11313)
or M.)
I certify that in Me performance of Me work for which this Permit is Wind.I mall nol
employ any Noon In my mother an As At become sabjeet to the Woftro'Companciation
LA..f Ciffif.asm.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate,of Exemption.you should
became subject W the Woulter's Compensation previsions of mc Labor Coal you a"
z forthwiti,comply with soich Partition or this peasnotithall be thermal marked.
0
CONrOtUCTIGN LENDING AGENCY
I thereby al that them is.construction lending agency for th,perfonadow of
the work for which this Manot is issued(Sec.3097.Civ.C.)
LenumetiNscrom
0, Lamien'.Add=
Z)z
U 0 1 caddy that I have read!this application and mate,that the Above information is
U,P counter.I agree in comply with all city mal counly committees and male Is"milling M
C)U building conearrue,tion,and hereby whorism of this city to color upon me
.1mve-arentimml property for inspection purpmc&
(We)agree to All indemnify And keep hannicar,me City of Cupertino ASIMIL
C,) liabilities,jusimmidA,chou and expenses which may In my way amwe against sted City
U 4 In cc unmoorthe grant,ris or this fornit..
n
N .NDS ZAND ILL COMPLY WITH ALL NON INT Issued by.
I '� __Rc
NT
P MRIP El#lu: b e�roofs C7 Date
Sigrillillu".1"A It -Data
Llggg�S MAKE.IALS DISCLOSURE 71�pe of Roof
Will Me Applicant or future building occuparm mom or handle harardaus mmori'l
As defined by Me Cupanina Municipal Code,Chapter 9.12.and the Haim and Safely
Code.Sued..25532m)? All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
Will Me applicant or future building occupard m equipment or devices which
harasadous air comandnarom As defined by the Bay AMA Air Quality management all new materials for inspection.
.1,17
0 Yes awo
I have mad the undeorClospoes6.95ofilue Cables.
a a SAImyQ,*.SecMw;25505,25533 ad 25334,1 undannumil thin Ifthe Wilding
d at Iran a to Oat 116 my ponsibility us"oury,Me,occupant of Me
c
III w a be prior to law of.cmilfic u Signature of Applicant Date
a-
t�f ro
pwa—.fia uMamm"gn. [Dow All roof coverings to be Class"B"or better