07080176 CITY OF CUPERTINO `
BUILDING DIVISION PERMIT
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PERMIT NO.
BUILDING ADDRESS:
7679 SQUIREWOOD WAY TBD - TC) BE DETERMINED 07080176 �
pERMIT LSSUE DATE
R'S NAME: .
VIDYASAGAR PREM
SANTTARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECC/ENGiNEER: BLDG ELECT PLUMB MECH
� � � �
� p � LICENSED COMRACI'OR'S DECLARA7'[ON JOIJ DCSCCIptlOTl
} v� I hcreby �rm �hat I am liccnscd uadcr provisions aC Chap�cr 9(rnmmcncing
. Z� with Sccuon 7000) of Division 3 of thc Budncss and Profcssions Codc. and my Iicensc is ADD 5 5 8 - ENLARGE K I THC EN & ADD L I V ING ROOM
>> y in full Corce an d c f fect
� vJ ? [.icensc Class ��• � REMODEL
p Datc Conuactor
:�� ARCHITECTSDECLARATION 100' OPI�N KITHCEN TO DEN.
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a 1 underswnJ my plans shall Ae uud as public records
)yU
• u. � Licensed Prufessionat
: a < OWNER-BUtLDER DECLARA'CION
� �� 1 hcrcby alTirm that 1 am cxcmp� Crom thc Conuactor's Licensc Law for �hc
p o (ollowing zuon. (Scction 7031.5, Busincss and Profcssions Calc: Any city or county
�° � which requires a permit to conswct, allcr, impravc, dcmolich, or repair any suucmre
°" y prior ui i�s issuancc. alsu rcquires the applicant Cor such permit to filc a signcd statcmcnt � y . Ft. Floor Area Valuatio❑
�? a �hat hc is IiccnscJ pursuant lo thc pcov�sions oC �hc ConUactur's liccnsc Law (Chaptcr 9 � 6 6 2 9 3
,�'� t $(commcncing wiih Scction 7000) af Division 3 of ihc Busincss and Profecsions Cadc) or
i�., that he is exempt the�ctrom and the bssis [or �he allcgcd eumpdon. Aoy violauon oC Occupancy Type
Section 7031.5 by arry applicant for a petmit subjecu the applicant w a civil penalty o( 3 6 2 2 7 01 ��'�U Number
no� more than fivc hundred dollars (5500).
❑ I. as owner of tt�e property. or my uoployces witN wages az the'v sa� compensadon,
wiildothcwork.andfhes�ructulcisnoiintendcdoraffercdforsalc(Sec Required Inspections
and Professions Codc: 11u Conuactors License Law does not apply a an ow�r of
property who builds or improves thercon, and who does such work himsel[or tMough his
own employces. provided �hat such improvemenls are not intended or alleced Car sala If.
however, the building or improvemenl is sold wiNin one year o[ comple6an, the ownu-
builder will have the burdu� of proving ihat M did not build ar improvc Cw pu�pose of
salc.).
❑ I. u awner of �he property am ezclusively conuacting wi�h licensed conuxtors w
consuuct the projm (Sec. 7044. Business aad ProCessions Code:) 7Le Con�rxwrs Li-
cense [aw does oot apply to an owncr o( propeny whn builds or improvrs thneon, and .
who contrac�s tar such projecu with a conuactoRs) licenxd pursuant to �he Convactor's
License L.aw.
n i am ezempi u�n S e . B& P C f �his rcuon
:r � V t�� �f Date O 0 _. . -
WORK 'S COMPEI SATION DECLARA170N
I hereby aflirm under penalty of pe�jury onc of the follawing declarations:
❑ I hsve and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation, as provided fa by Sectian 3700 of the Cabor Co�, for the pedormance af the
woric [or which Ihis pertnit is issued.
❑ I havc and will maintain Worker's Compensadon Insurance. as required by Scction ,
3700 of the Labor Code. Cor the performance of the worr for which this permit is issued.
My Worke�s Compensacion Insursnce carricr and Policy number are:
Cartier. Polity No.:
CERTIFiCATE OF EXEMPIION FROM WORKERS' ,
COMPENSATION INSURANCE
(This scction necd noc bc compleicd if tho pertnit is for onc hundred daUars (5100) ,
or IcssJ
I cenify that in thc perfarmance of thc wark Cw which Nis pertnit is issue4l shatt not
oaploy any person in any mannc� psi _� omc subject to ihc Workcrs Compensalion
Laws of Califomia Da�c � �
p N f D Y �hit
NO'I7CE TO APPLICANT: If, aftcr making this CcraGcatc of F�ccmpuon, you should
bccome subjcct to �hc Worker's Compcnsation provisions of thc Lat� Codc, you must
, O forthwith comply with such provisions or this permit shall bc dcemcd revokcd.
Z �'" CONSTRUCTION LENDING AGENCY
(.�-� ►�-� I hereby a[firm �hat thcre is a construeti�n knding agcncy tbr thc perfortnance of �
a, � the xvrk fur which this permit is issucd (Sec. 309'i, Civ. CJ ,
W Q Lendcr's Namc
� z L.cndor's Address
I certify Ihat I have read Ihis applicaiion and s�a�c �hat Ihe above informatiun is
�� cortect. I agrce io wmply with alI city and county oniinances and sta�c laws mladng io
� U building conswction, and hereby autAori�e represenu�ives of Ihis city to enter ��mn lhe
� W above-men�ioned property (or inspecuon purposes.
a (Wc) agrce to save, indcmnify and keep harmlcss ihc Ci�y of Cupertino agai�se
�� liabiliuu, judgments, costs and expenses which may in any way accruc against said City �`�
U z in cansequence o[ 1hc granling o( this permiL DSLC �
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SO E EG LA'CIONS. �f ]��r-
� l��-�. ' ' Re-roofs i � G , �:
Signatwe of Appl dConuact �'� T e of R oof �
HAZARDOUS MATER[ALS DISCLOSURE YP
Will ihc applicant or futurc building occuparu storc or handlc ha•rardous matcrial
'efincd by thc Cupertino Municipal Codc. Chap�cr 9.12. and the Heal�h and Safety
�. Section 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Y � �r,o .
�11 thc applicant or fwurc huilding occupant usc eyuipmen� or Jeviccs which
If a roof i� installed without first obtaining an inspection, I agree to remove
cmi� haiardous air contaminants u Jcfincd by the Bay Arca Air Quality Managcmcnt all new m aterials for inspec*ion.
Disuic�?
Q Ycs �j Nu
I havc rcacl the ha�acdcws ma�crials rcquiremcnts undcr Chaptcr 6.95 of ihc Califor-
nia Hcalih & Safcry Codc, Secuo�u Z5505, 25533 aru125534.1 wdcrstand �hat i( �he huilding
docs no� curten�ly havc a tcnan4 Ihat it is my rcsponsibility to noufy thc axupant nf �hc
rcyu� cn�s�yhir,h must bc met prio�r w �u��« ora c�tir�a� oraNp�r. Signature of Applicant 11 Date
1/=�n,i, 7 � D ����� All roof coverings to be Class "B or better
Owncr or authori� agcnt ���