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07070141- PUB Q7 W p •} OC N y (UL) E aCj U W W � N y S Y y C CL CL 3 0 QY CL Q7 U O fa m U �i 2 U U O va � 3 � a7 O CD 0 Q m o d aw p - rti 06 paCDH 07 O a U m O W W N F W � U d W .7 U W cr ti; a O W p W W H cc d u U v o W W W !]2 O a W N p W N d N Z Wpq LO W O a s A cn z cc p = Qy H P O i N - to _ LO 3 W U MIL LO d Q7 til zCL _ QS _..� L `t N � QI p c tiv -0a 2 U y �O a _ a a a p _ D O O u o to O r- .2 N OD p U J � O UJ 07 co W d r E � LU LL) LL LLj LD O twfi ~ O :2-11 (7 O O [T Qtf? N O O O C H M W LiJ 7 J 1 ti C O J cr O •''- r0 M1 p J W0 a- o N W O r- ~0 0 Cl) til p O - p m d d ny O p v o v v a`) v a y ^ o v v CL y x xv n Ln v, > }' Q7 N p O y a, 3 CL CL �O W _0 ~ x� t1 rti T ip V _ EE xp 3 N V cr} W l] �O Lo S LO in d xy O ca ,� a ZD tai U c v v y n Or 5 CO v M y T' W a`) m o o a a`s .�-u �-D a d to U Z) a O a U U U IL .L 1 CITY OF CUPERTINO BUILDING DIVISION PERMIT =� T41�7>INEQItMATI®1�.: <' PERMIT NO. BUI T6ADDRF bVEMBER DR SHAH, DEEPA 07070141 OWNER'S NAME:1V V PERMIT ISSUE DATE SHAH, DEEPA 1221 CRESCENT TERRACE 09/25/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECf/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description UK I hereby affirm that I am licensed under provisions of Chapter 9(commencing zW with Section 7000)cfDlvision3oftteBusiness and Professions Codc,andmylicenseis ADDITION OF 876 SQUARE FEET FOR FAMILY ROOM AND in full force Z License Class ndcflect Lic n MASTERBEDROOM, PARTIAL GARAGE CONVERSION, NEW BAY iFp part Contractor ARCHITECTS DECLARATION WINDOW, NEW FRONT PORCH AND 2 SKYLIGHTS a� < 1 understand my plans shall he used as public records ,a o y Licensed Professional rn OWNER-BUILDER DECLARATION <� I hereby affirm that 1 am exempt from the Contractors License Law for the 1 00 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 prior to its issuance,also requires the applicant for such permit to rile a signed statement othat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation %I— (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or $95200 r3 '4 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 3 6 216 0 01?��Number Occupancy Type not more than live hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will dothe 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 _ Required Inspections 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.), Z-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 aot 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. ❑ 1 am exempt underSec.Spec, ,B&P C for this mason ., Own6� Date W ER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 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. ❑I 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 Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION IIiSURANCE Crhis section need not he completed i!the permit is for one hundred dollars(EI00) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manncr s 17 ocpmc sJtbjcct to the Workers'Compensation Laws oCCalifyrafa,� '�,� Applicant � NOTICE TO APPLIC :If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z tCONSTRUCTION LENDING AGENCY I hereby affirm that there is a conswctinn lending agency for the performance of p�. > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lcndees Address U Q I certify that I have read this application and state that the above information is V, r-r correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize reprc=1a1ives of this city to enter upon the above-mentioned property for inspection purposes. C4 (We)agree to save,indemnify and keep harmless the City of Cupertino against ►4 C/) liabilities,judgments.costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —Z SOURCE REGULATI S. Re-roofs Signaturcof A licant/Contractor Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupantslorc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? Yes No All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future building occupant use equipment or devices which If a roof 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? r)Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that i!the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Oc upancy- Signature of Applicant Date �1 19All roof coverings to be Class "B't or better Owner or authorized agent Date ti qa CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTfNO ADDITION/PtEMODEL 010-70141 APN# ^ I Date: 0:7 Building Address: Mailing Address (if different from building address): �� Sem em-/ eP Y' l,,40 9- Owner's]Vame: Phone#: �^ 8o 7,3 �'^leeea Contractor: L Phone: State License#: Q to�-� �C["�-1 Fax: ntacPhone: P 9,) ,wo Cupertino Business License#: (�� ,lPFax: Building Permit Info: -f1=0 Bldg Elect Plumb' Mech 2 Job Description: ��,t _ -Am 4 2% 01 ,0 kyj aui u ck m,� What is being added? vxryA \ m �1 �, (� '3 C4 ��.� S S . What is being remodeled`? � I Residential Commercial ❑ Remodel Includes Re-Roof: Yes ❑ No f � Remodel Includes Structural: Yes ❑ No Square Footage: -it. Addition_: , $��p Remodel: Garage: l Porch: Deck: Other: Cost of Project: io Occupanc Gro :` Type of Construction: , F N Please check this box if the project is a second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ *For office use only* ❑ Over the counter 1 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIY OF Fax(408) 777-3333 CUPEkTINO Building Department JOB ADDRESS: 1 C)a QK3 e r&r PERMIT # 0-70,7 ® I I OWNER'S NAME: -e-e fL- PHONE # Cp GENERAL CONTRACTOR: ® FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRAC'T'OR 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 Tile a7 er/Contract Si atur ate