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07050042 CITY OF CUPERTINO BUILDING DIVISION PERMIT C� `k:A '�� kNF� Tk� * »> _.: BUILD�jVLL�P((��PQIESS: PERMIT NO. �� QUEENS OAK CT SNC CONSTRUCTION 07050042 OWNER'S NAME: PERMIT ISSUE DATE RAMACHANDRAN, VIJAY 11923 DE PAUL CIR 05/07/2007 SE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO RE-PIPE HOUSE,GALVANIZED TO BLDG ELECT PLUMB MECH © O D O i o p LICENSED CONTRACTOR'S DECLARATION .lob Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is t=y in full force and effect. ),2z License Class Lic•it -F„m Date Contractor ARCHITECTS DECLARATION 7 C a 1 understand my plans shall be used as public records )yU 'u.ti Licensed Professional H OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the CMO following reason.(Section 7031.5,Business and Professions Code:Any city or county <$ which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior to its issuance.also requires the applicant for such permit to rile a signed statement _< that he is licensed pursuant to the provisions of the Contractor's Licensc Law(Chapter 9 Sq.Ft.Floor Area Valuation e I,$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q p 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.). XI,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 Contractor's License Law. ARY C]I am exempt under Sec. B&P C for this reason NIT SA Owner ��V,­ Dmef I7`T WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑L have and will maintain a Certificate of Consent to self-insure 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. ❑1 have and will maintain Worker's 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: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less.) L certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as Sbcfytltposuhiect to the Workers'Compensation Laws of Califo Date ��ll 77 App n NOTICE TO APPLICANT:[ ter making this Certificate or Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z~ CONSTRUCTION LENDING AGENCY E~-t 1 hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is LL ►r correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorise representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rFr 1) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. C �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued I y: Date SOURCE REGU TION ' �� SJ�l a3 Re-roof; --�` Signature of ApplicantMomrambr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 roots shall be inspected prior to any roofing material being installed. ❑Yes j4 No Will the applicant or future building occupant use equipment or devices which If a roo: is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ®No 1 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 does not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which must be t prior to issuance of a Ccrificatc of Oc upon Signatu*e of Applicant Date ,2_-- All roof coverings to be Class"B"or better OwncreFautho ad agent ate CITY OF CUPERTINO t REPIPE/S E S/MAIN SERVICE 'UPEkTINO PERMIT APP]JICATION FORM Uc D' OD 3 APN # Date: J � 4� -3? - D� �,�7� �- 7 Building Address: ,2—2)-(:�,`l 1 Civ C C t\/S ©A K e-"r l 0 a'C'SZf � C Owner's Name: Phone#: Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: 4 a 2- Building Permit Info: Bldg ❑ Elect ❑ Plumb 99 Job Description: -70z" Pi ocs Residential ® Commercial ❑ Cost of Project: �q000 )-- Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE X Repi e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING