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05100049 (2) a CITY OF CUPERTINO . BUILDING DIVISION PERMIT CONTRACTORINFORMATION�� ..d, . BUILDING ADDRESS: SK CONTRACTS INC Pa'kM"NO'05100049 21949 LINDY LN W NER'S NAME: PERMIT ISSUE DATE SEEMA MITTAZ 770 CATALINA DR 10/11/2005 4F. SANITARY NO. CONTROL NO. (925) 455-4201 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDGELECr PLUMB MECH 0 0 0 0 tido LICENSED CONTRACTOR'S DECLARATION ��n{{{�55f r1Y��'rrarraaasr��spB iW❑ IM1esbyoffrte that 1amfthelcdineetprovi8onsnof Chapter9 .y1meass's I v• V ®� with Section]DIIU)of Div 'on3 ofthc Bunn••• P fcuinns Code,andmyliccuc is iii in roti rnree and erreet l 3 ng C TEMP POWER POLE ? Z Lions Claza Lb.N w Dam Contactor NOV 1 CHITEtaJv JCTS DECLARATION 200[ 1 unecssanJ my plans shall W loud u PUM1Iic records JyU m to Licensed Pmfcssional 5 OWNER-BUILDERDECLARATION ; Aa �o q 1 hereby alarm that I am exempt fm N me Contractor's License Law for the U IL 7u CD p 0 following moon.(Section]1D L5,Business and Prornamme,Calc:Any city or county Yu m iii which requires a Permit to construct,alter,improve,demolish,or repair any atmmac 500 prior to Its iauaocc,also requires the applicant for such permit to File a signed statement that he is licensed pursuant to thc P.vi,i...f tom Comractr's License law(Chapter 9 Sq.Ft. Floor Area Valuation XHM (commencing with Section]000)of Division 3 of BU Business and Professions Code)or y $ that he as exempt therefrom and the hub for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of r U U Occupancy Type not mom Nan fr,hundred dollars(SSW). ❑I,uowar of the property,amy employcu with wagesutleir sole compensation. will do the work,and the surmounts is not intended or offered forsale(See.7046,Business and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections progeny who builds or improves themom,and whodas such work himself or through his own employees,provided that such improvements are Out intended oroffcred forsale.If. , however,the building or improvement is sold within nes year of completion.the oway. builder will have the burden of proving Nat he did nes Wild or improve for purpose of sale.). ❑1,u owner of On,property,am exclusively contracting with licensed Contractors to couwct the project Iliac.]Dab,Business and Professions Cade:)The Conuarst is Li. ante law does not apply to an owner of property who builds or improves thereon,and who contracts for such pmjccu with a conuactons)licensed pursuant to the Commactai s License law. ❑I am aaempt under Sec. .B&P C far this maven DauWORKER'S COMPENSATION DECLARATION 1 hereby alarm under penalty of perjury one of the following declarations: jwn,r 1 have and will maintain a Certificate of Consent to self-insom for Worker's Compen- sation,as provided for by Section 37W of the labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,u required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation loss. r and Policy number art: i Came,: Policy No.: CERTIFICATE OF FXEMPnON FROM WORKERS' COMPENSATION INSURANCE mUssecuomaed not be led ifthe permit is for chum oIIads(SIW) or less.) 1 certify that in the performance of the work for whit p it is issued,l shall not employ any Noun in any ton a s b cs I 'orkcrYCompemation ` Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making his Cc iii of cmPtion,you should become subject to du Workcr s Compcmation provi to s r the Usher Code,YOU must .J O forthwllh comply with each provisions or this Permit s at be deemed revoked. z .^�.. CONSTRUCTION LENDING AGENCY F' Ihereby affirm Nat there iso convection lendingageayto,the pe,hOmmmec of the work for which this permit b issued(Sec.309],CO.C.) {t]Q Lender's Namc z Lendee's Address C,)O 1 anify that 1 have mad this application and sate that dm above information b F' correct I agree to Comply with ill city and county ordinances and sues laws mitring to 0 building construction,and hereby authors,mpresenitlis of Nis city to color upon the ahove-mentioned property for uspccti purposes. (~ G (We)agree to ave,Tors. i d keep harmless the City or Cupcnino against h li.biliecs,judgmcnu,costs and which may in any way same against said City U z in,......Ca of the granting mit. APPLICANT UNDERSTA LL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULAR S. (40 (( -5Re-roofs Signmure of ApplicanJCoA to m HAZARDO ERIALS DISCLOSURE Type of Roof Will the applicant or fest building occupant store m handle hsvartim.material .WLu defined Cupertino Municipal Code.Chapter 9.12.and the Health and Safety ale.Scmlbyon 2sNevx')+ All roofs shall be inspected prior to an roofing material beim Installed. ❑vee PfNa P P Y g g Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it ha]ardous air conuminanu u defined by the Bay Arca Air Quality Management all new materials for inspection. trlet, ❑Yeses 1 have a -Nous materials requirements under Chapter 6.95 of the Califon, nia Hcaltb& c ,Sections 25505.15533 and 8534.1 undersand that lithe Wilding docs tenant that it is my responsibility m notify the Occupant of the mqu' me n to atpd.,misssaacOf.Cerure.teo0ccuancy. Signature of Applicant Date its Owne,or m r agent Date All roof coverings to be Class"B"or better .,w,., Community Development ( J 10300 Torre Avenue s Cupertino CA 95014 Telephone(408) 777-3228 -SCITY OF Fax(408)777-3333 UPEI�TINO Building Department JOB ADDRESS: PERMIT # oZ��1 lib1,AJG O5�/00,0 1 j OWNER'S NAME: Rir-j L PHONE # 9 ZS ¢SS Zo GENERAL CONTRACTOR: S ,Iz Ca n!T TS t N FAX # 6 I am not using any subcontractors: 16 jesl S e 'Date Please check applicable subcontractors and coritplet6 the following information: 6a 1 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting ® Linoleum / Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO :t�Cr TEMP POWER IcUPEIZTIN0 PERMIT APPLICATION FORM APN # -� �r Z—Iz; D L(o Date: O l G Building Address: t �- nr (,Awe t,0 Owner's Name: SEekA �� Phos(0 S02- Contractor: OZContractor: f[ C0 tv Phone: 4-435 4-ZbI License #: 74'Z379 Contact: Phone: Cupertino Business License #: r�uc �f r,MC 2-707o Building Permit Info: < D Elect Job Description: Residential IV 1� Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING