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CITE'OF CUPERTINO I RMATI�N'
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
VT DAV TE
OWNER'S NAME: 01 04/2007
RAVI DAVALA SANITARY NO. CONTROL NO,
GONE:
BUILDING PERMIT INFO
ARCHITECTJENGiNEER: B� E� PLUMB M�—EC�H
J 0 Z LICENSED CONTRACTOR'S DECLARATION IOU Description
V I hereby affirm that I am licensed under provisions of Chapter 9(commencing REVI S I O]\ PORCH EXTENSION 20 '
=Z with Section 7000)of Division 3 of the Business and Pro(essios Code,and m license is
°oy in full force andeffecL ORIGINAL PERMIT: 06030057
Z License Class Lic•#
t-Z Dam Contractor
ARCHITECTS DECLARATION
a< 1 understand my plans shall be used as public records
DyU
3"U.in Licensed Professional
h O<
OWNER-BUILDER DECLARATION
AH.t
1 hereby affirm that I am exempt from the Contractor's License Law for the
O a following reason.(Section 7031.5•Business and Professions Code:Any city or county
K ( which requires a permit to construct,alter,improve.demolish,or repair any structure Valuation
prior u)its issuance,also requires the applicant for such permit to file a signed statement j(l,Ft.Floor Area
-Z>. that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $848092
YF (commencing with Scction 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of �pf�Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 342140 1 I '(7(J'
not mare than five hundred dollars(5500).
0 1,as owner of the property.or my employees with wages as their sole compensation. Required Inspections
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law. B&P C r this reason
0 1 am,ex Nepr9rlder$SC
Omer ! Dt1C l
RKER'S OMP SATIO CLARATION
I he by affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insurc for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the ork fo which thio thhe Wokrs Compo sation
employ any person in any manse W
Laws of Calif. --
Applicant
NOTICE TO A in g th Cate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
E," I hereby affirm that there is a constructionlending agency for the performance of
p(h✓ the work for which this permit is issued(See.3097,Civ.C.)
W QLender's Name
Gh Lender's Address
V Z 1 certify that I have read this application and state that the above information is
H correct.I agree to comply with all city and county ordinances and state laws relating to
LL
0 H building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments.costs and expenses which may in any way accrue against said City (� v'7
in consequence of the granting of this permit.En
Date
V APPLICANT UNDERSTAND D WILL COMPLY WITH AL NON-POINT Issued by:
SOURCE REGu r, U Re-roof s
Signature o pplicanUCon for am Type of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roo t s shall be inspected prior to any roofing material being installed.
0Yes If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment ordevices whicn all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Arca Air QualityManagement
District?
C Yes `'6 No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that if the building
docs not currently have a at it is m responsibility to notify the occupant of the Date
requirements whictf u m r tui c of a Certificate of Oce ancy. Signatt re of Applicant
r �a
All roof coverings to be Class"B"or better
Own i aur erizcd agent a