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F C) F� ►-r U U e CITY OF CUPERTINO DIVISION PERMIT 7-777 ' BUILDING BUIL 1 OG6 1 EsNORTHOAK SQ TBD TO BE DETERMINED PERMIT No. 07060017 OWNER'S NAME: PERMIT ISSUE DATE MURUGAN, RAJMOHAN 06/22/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is REMODEL BATHROOM AND HALF BATH in full force and effect. License Class Lic.tt MINOR STRUCTUAL, INCLUDES LIGHTING Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the Following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to Glc a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $i 0 0 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Number 31641022 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). �i ❑ 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 orofferedforsale(Sec.7044.Business and Professions Code: The Contractor's License'Law does not apply m 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.). 2'r.s; 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 conlractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am ex t under Se , B & P C for this reason Date 2-2 Owner /A OSI"'— ORKER'S COMP NSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 Cade, 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: Carrier. Polity No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (1100) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner o as to, =come subje to rLt�rkers' Compensation Laws of Cal' ria. to -� Applicant NOTICE TO PLI NT: If, after a 'ng this Certificate of Exemption, you should become subject to the'Worker's Compensation provisions of the Labor Code, you must ' forthwith comply with such provisions or this permit shall be decmcd revoked. CONSTRUCTION LENDING AGENCY + I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) - Lender's Name , Lender's Address I certify that I have read this application and state that the above information is + correct. I agree to comply with all city and county ordinances and state laws relating to y building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, ud mcnts, costs and expenses which may in any way accmcagainst saidCity ' in consequence of the granting of this permit. + AP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S CE REG ATI01, Type of Roof 3-2`3i2219_Re-roofs Signature o pplicant/Co 6aclor Dam HAZARDOUS MATERIALS DISCLOSURE 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 roofs shall be inspected prior to any roofing material being installed. ❑ Ycs o If a roof is installed without first obtaining an inspection, I agree to remove - Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? No ❑ Yes 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building docs oat end have a tenant, that it is my responsibility to notify the occupant of the requirem w 2h must be met prior to issuance of a Certificate of Occup-rtanncy. Signature of Applicant Date All roof coverings to be Class -B- or better Owner ur author .cd agent Date CITY OF CUPEkTINO ADDITION/ MODEL ®70600/1 APN # 21/ /_oa1r 441_0.41r1 Date: Building Address: ro g-2 ( N Wa _N tk '%VAtc C'uPC-moi ZtJo, C_r -o301l _ Mailing Address (if different from building address): SSE - Owner's Name: R RTMo HRN Q�1�►n�p��( Phone #: Contractor: Phone: State License #: Fax: Contact: Phone: LP- S,f Y 7 Cupertino Business License#: © L -y'a-Y- Fax: _ Building Permit Info: o. ,, Oda" f? CSh� � gcJ-1nf03 r -L, Fear 1'WOW Bldg 9"' Elect [9`_ Plumb � Mech ❑ � Job Description: -Zhu.-` Acrf rkxt What is being added? kV\ C\LA_r 1,-►,t�4 o�. �� h Qom, PCAV ti0 0►j �Ca Vt, s�6-div t�,¢ t's �V_v hQA 'r0ow, D�- What is being remodeled? �(j,�_ 01 ,, V\ Q _ 0 S kc)W w &I 1\ } � &J �' Y,_ Q -w o` s mk_ CC-) j bS& �A11 . Residential L`S Commercial ❑ Remodel Includes Re -Roof: Yes ❑l/ No N__ ­_Remodel Includes Structural: Yes k�' No ❑ Square Footage: -Z�7— Addition: Remodel: Garage: Porch: Deck: Other: Cost of Project: ct D 0 b u S P Occupancy Group: Type of Construction: Please check this box if the project is a f__ second -story addition: ❑ [Pr ct Size: Standard Y Large ❑ Major ❑ *For office use only* ❑ Over the counter 1 of 3 rt�d� 14- fi t i'` ti ill C1TY OF CUPE�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: tug 21 N�brl�n OaJc S9,t�Grz PERMIT # `7 OWNER'S NAME: V-f}Pv�o i\J PHONE # GENERAL CONTRACTOR: Q FAX # I am not using any subcontractors: N ,24- ignature Date Please check applicable subcontractors and complete the following information Owne C or igna e 0 (+ J-k,tv ,jod -- Date 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 T' Owne C or igna e 0 (+ J-k,tv ,jod -- Date