The URL can be used to link to this page

08070142- PUB I _0 _. 0 P U- - M - m o 501 5 o 9 � € L) s -o ti s o'I m U LP ILd S U U CD cn Z et • rill CD { m Q a to dun I a IVI Ozn CD 0 i f P zn ,..{ , I I P II ( a c � LO i c'), H 0 ul cG oS S S ( CO q S_1 P o [ M� w O 1 x H d -o i [x u i j as O � o a ca S LU U w i Q 0 Z CD 0 CD o O E 0 OZ o 1 ! uai q vCD q i I C o w (CD I a o o � oCL opo �Ijti j E � ❑ z ��.. n x a w I CIL Z �o (D —o w (D ti 0 LD m P cir n c d) � U d p d U 1 I N ` LL. i I } -0 V 1� i_QI _QI f a a. i Li 0 01LU �{ z0 u � iD 1 ri a a n ZII a� 0 0 0 ° � I ! w o °r~° :iii i pw ~ I Q I ri ALJ U IC? C? a i O w o i I a —ii Q w � , > i I Q J m w act U- z �;` OD co m CD CD C?; C? I i •� O to J o ! l i PPPP I co O Ip L!3O 3 Z I N v c.il r� N Z Q Zo! .y 1 e JLC P i ; P.. f f _CO_ p 4C —f2: ` !' a CIL O "iii. ti' .O 0 n •� x0 %c"n .� � x 61 , ` % h a v s to i w �. U j, O c ,� 4Y 4Y N p U S V w ti ii _ , Z .� p E 1 a � L) U E c � i E a o ro L (D ? o ar w a`+ CD CD (L) -Dd c o U I o n 0 a J a- cn d U U U I c O CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTIt�3GTOlLZ INFORITI01�1� .< BUILDING ADDRESS: I PERMITNO. 1.8'/60 TILSON AVE TBD - TO BE DETERMINED 08070142 OWNER'S NAME: PERMIT ISSUE DATE .J .IVAN K.TIOSLA & SAMIR KHOSLA 08/29/2008 PHONE: SANITARY NO. CONTROL NO. ARCHI'I=fENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i o p LICENSED CONTRACTOR'S DECLARATION vI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ? U with Section 7000)of Division3oftheBusinessandProfessionsCoda.andmylicenseis HOUSE DEMO APPRX 1078SQ—ALL TREES SHALL HAVE a e` in full force and effect. z License Class Lic.# PROTECTIVE FENCING DURING THE DEMO PHASE. w Date Contractor ARCHITECTS DECLARATION Z ode< 1 understand my plans shall be used as public records JyU in Licensed Professional rn S OWNER-BUILDER DECLARATION a I hereby affirm that 1 am exempt from the Contractors License Law for the a 0 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 Z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Uccnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation F$ (commencing with Section 7000)of Division 3 or the Business and Professions Code)or $10000 i .. 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 ofNumber Occupancy Type not more than five hundred dollars($500). 3 7 5 17 0 4 0 . U V ❑1,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 and Professions Code:The Contractors 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.). `]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- ccase law dors 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. 0 lam exempt under( B&P C for this reason Owner \V.v'� Date O .WOftK-FR'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers 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 Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMFIION FROM WORKERS' COMPENSATION INSURANCE (Reis section need not be completed i!the permit is formic hundred dollars($100) 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 mann r so as be me subject Loth Workers'Compensation Laws ofCalifornia.Date ' ��o� . Applicant- LVC'4 4 NOTICE TO APPLICANT:If,afro making this Certificate of Exemption,you should become subject to the Workers'Compensition provisions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall be deemed revoked. 'Z CONSTRUCTION LENDING AGENCY H ►� 1 hereby affirm that(here Is x construction lending agency for the performance of .7i > the work for which this permit is issued(Sec.3097,Civ.C.) - (� Q Lenders Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is 1y cored I agree to comply with all city and county ordinances and state laws relating to 0V building construction,and hereby authorim representatives of this city to enter upon the W above-mentioned property for inspection purposes. �y (We)agree to save,indemnify and keep harmless the City of Cupertino against I�y liabilities,judgmcnLs,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit '7 JJ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �' 4 SOURCE REG LAT ONS. -�(�(1p\�\Ifs o`��.171017 Re-roofs Signature o!A caDate HAZARDOUS HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code, Section 25532(a)? Yes M4. 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? ❑Yes I 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 hove 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 Occupancy. Signature of Applicant Date Owner or .aagent 0 ��Date All roof coverings to be Class';.`'or better -_)�-'070 / CITY OF CUPERTINO ` DEMO CUPEKrINO PERMIT APPLICATION FORM APN# Date: Building Address: i cc7 6 o Mailing Address (if different from building address): Owner's Name: Phone: _3 y2, Moi ) Contractor: -�y-?� Phone 11015 --nq Contractor License #: Cupertino Business License #: Contact: M an,Gd Kh o; Phone: 6 fO 6 '15 '+.-—1 Sann9r lC�os\a - ,yo4, `-1�`b6tilC7 Residential Sq Footage ((31 j Commercial ❑ Sq Footage Job Description: ��irna Valuation: $10,000 e Project Size: Express ❑ Standard [5--Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFPOOL-DEM / 1 BSEISMICRE Seismic Residential B Revised 6/16/08 CITY OF CUPERTINO aiDEMO CITY OF CUPEKrINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1DEMOCOM Demo-Commercial B 1COMML-DEM 1DEMOPCOM Pool Demo Commercial B ICPOOL-DEM 1 BSEI SMICOM Seismic Commercial B 1 BUSLIC Business License B Revised 6/16/08 Community Development 10300 Torre Avenue Cupertino CA 95014 ,. Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: 13-76p Tiles PERMIT,# �rV% 6i5o 114 b 0U - � Y� OWNER'S NAME: PHONE # &—,-0 g iy 2 I GENERAL CONTRACTOR: p FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Tile er/Contractor Signature Date