07080212 CIT�' OF CUPERTINO ' ' ' ` `
BC1fLDIN�":DIYISION PERMIT ��.1�Tk���C?� ������TIQN ;
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BU1LD NG ADDRESS: PERMIT NO.
�1074 HAZELBROOK DR TBD - T� BE DETERMINED 07080212 •
OWNER'S NAME: PERMTTLSSUEDATE
RAJESH JOHN & SHERRIN FR.ANCO 10 0 2007
NE: SAIYITARY NO. CONTROL NO.
ARCHITECC/ENGINEER: BUILDING PERMR'INFO
BLDG ELECT PLUMB MECH
� � � �
i p p LICENSED CONTRACfOR'S DECLARATION JOb DeSCi1pL1011
� v� I hcrcby aflirm tha� I am liccnsed undcr provisions of Chaptcr 9(comrorncing
; Z� wim Scction 700U) of Division 3 ot ihc Busincss and Profcssions Codc, and my liccnx is D EMO F 0 R S F D
;� y in full Corce and e L (� �'� —,� S
� v� Z Licensc Class Lic. M 71
: F � Datc Conlraclor
� ARCHITECPS DECLARATION
i a Q I undcrstanJ my plans shall bc used as puhlic rcconls
)aU
' u. y Liccnsed PcuCcssional
� y � OWNER-BUILDER DECLARATION
>' 1 hereby alTirm that 1 am exempt Gom thc Contractor's Liccnse Law Cor �hc
j p O following rcason. (Secdon 7031.5, Busincss and Profccsions Ca1c: My eity or county
�,°, � which requiccs a permit ro conswct, altcr, improvc, dcmolish, or repair any suucture
?.Z } prior ui iLS issua�cc. alsu requires thc applicant for such permit to fik a signcd sro���^�
;_ � thai hc is IicenscJ pursuant to ihc proJisions of thc Contractur's Li�rnsc Law (Chaptcr9 Sq. Ft. Floor Area Valuation
u � $ (commencing wi�h Scction 7Q00) of Division 3 of �hc Busincss and Profcssions Cadc) or $ 11 � Q
,, 3.. that he is ezempt Nemtrom and ihe buis Cor the allcgcd exemption. My violuion o[
Section 703I.5 by any applicant for a permit subjec�a U�e app(icant w a civil pwlty of Number Oceupaney Type
noc more i6an five hund�cd dollars (5500). 3 2 6 5 5 � 3 2��
❑ I, as owner of tt�e pcoperty. a my employces with wages u the'v so� eompewtion,
wilt do the work, and the stluctuce is not intended or of(aed for sale (Sec. 7044 s�� Re uired In s CCt10IIS
and Professions Code: The Conuactor's License Law dacs not apply m an owrcr M 9 P
propeny who builds oc improves ihereon, and who does such work himselCor theoagh 6is
own employces, providcd that such improvemw�e are not in�ended or oQued fa sale. It
however, the building or improvement ia sold within one yw of compktion, ihe ownen
builder will have the burden o[ proving that he did not buitd ar improve tor pmpose of
salc.)-
❑ l, u awner of the property, am exclusively conlracting wiih licensed conuac�aw w
construct the projea (Sec. 7044. Business and Rofcssions Code:)'Ihe Coav�t�s Li-
ccnx Law dacs not apply to an owner of propeny who builds or impmvrs iheceoo, and .
who conuac�s for such projecls with a comranar(s) Iicensed pursuant [o the Conuactars
License Law.
❑ I am uempt under Sec. , B� P C fw �his rcason
Owner D�
WORKER'S COMPENSATTON DECLARA170N
I 6eceby �rm under penalty of perjury onc of the folbwing dx�s�
❑ I h:re and will maintain a Cenificatc of Conscnt to xlf-insure far Warkcls Canpc�-
sation, u providcd for by Sec[ian 3700 a[ the Labor Code, for �he pcdarmanoe aC t6e
work for which this pertnit is issucd.
❑ I have and will maintain Worker's Campensation Insurance, az�equired by Section
3700 of the Labor Code. Cw the performance of the work far which �is pe�mit is iswed
My Workers Compensadon Insurance cartier and Policy number are:
Cartier. Policy No.:
CERTIFICA7'E OF EXEMPI'ION FROM WORKERS
COMPENSATION INSURANCE '
(This section need not be completed if the pecmit is for one hundred doDacs (510�
or Icss.) '
1 cenify thxt in the performancc of thc work for which this permit is issucd. t shalt not
employ any person in any manircr so as io bccome wbjcci io �he Workccs' Compensarian
Laws o[Califomia. Datc
APP�icant
NOTICE TO APPLICANT: If, aftcr making ihis Certi�ca�c of Ezcmpuon, you s1�ouW
become subjcct to lhc Workcr': Compcnsation provisions oC ihc Labor Cadc, you must
� O foMwilh comply wiih such provisions or this pccmit shall bc dccmcd revokcd.
z "" CONS7RUC7'ION LENDING AGENCY
[— � I hcrcby aRrm that thcre is a conswction Icnding agcncy [ar �hc perfwmancc oC
p�., � �hc work fur which �his pertnit is issucd (Scc. 3097, Civ. C.)
� Q Lendcr's Namc '
� z Lcndei s Address
V � 1 certiCY ihat 1 havc rcad this application and sta�c U�at �hc abovc in[onnaGun is
�►" corrcct I agree to comply with all ciiy and counry onlinantts and sute laws ¢luing io
�� building conswction, and hcrcby authori�t rcprescnutivcs of this city to cntcr u�n ttic
� above-mcntioned property for inspccuon purposes.
(Wc) agrce to save, indcmni(y and kecp harmlets ihe City o( Cupertino against
�� liabiliau, judgmcn�s, cos�s and expenses which may in any way accruc againu said Gty
U,'�' in consequcnce oC the granting of this permit. Date
"'" APPLICANT UNDERST NDS AND WIL[. C PLY WITH ALL NON-POIM' Issued by:
SOURCE REGU TI S. �
.-� � / Re-roofs
Signamre of dplicanUCo� �tor �
H OUS MATERIALS D[SCLOSURE Type of R oof
Will ihc appli or fuwre building occupant storc or handlc ha marc�iil
u dcfincd by the Cupenino Municipal Codc. Chap�cr 9.12, and the Health and Safery
c«�.s���o� z5s3zca�� All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs O No
wll thc applicant or future building accupant usc cyuipment or dcvias wdtich If a roof i:; ins[alled without first obtaining an inspection, I agree to remove •
uc
emit harardous air con�aminants as ckfincd by thc Bay Arca Air Quality Maoagemcnt all new m aterials or inspecr_ion.
Disvict?
Q Ycs ❑ No
1 havc rcaJ �he hazardcws ma�crials rcquiremcn�s undcr Chap�cr 6.95 of �c Catifor- / �
nia Hcalih & Safcty Codc, Scctioiu 25505, 25533 and 25534.1 undcrstand thaz i(Ihe 6uitding ��� �i ��""�'''
docs not curtenUy vc a tcnan4 �at il is my responsibility w notif � occupartc of �he v
reyuirc n�s w ch must be met prior to issu of a Ccnificaic o 4cupancy. Signature of A licant Date
°`� -- All roof coverings to be Class "B" or better
Owncr or authorircd nt D�� �