06010101 CITY OF CUPERTINO ��
BUILDING DIVISION PERMIT 4�C.ONRRA�C-TORINFfORMATION•.
BUILDING ADDRESS: STATE OF THE ART BUILDERS MffN006010101
10397 AMICTAT) ("T
OWNER'S NAME: PERMrf LRTJE DATE
VIVEK & JYOTSANA JAIN 3657 LOUIS RD 02 /21 /2006
JE:
SANOARY NO. CONTROL NO.
(650) 856-8509
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30a LICENSED CONRACTOWS DECLARATION Job Description
F 1 hucbY affirm on I in hCoond under prOwsons of Chaper 9(mu
mmcing P
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with Satimt T(Orn of Di.luon 3 of de Busite sand Pmfcverts Cods,and my tion Y iton fma.wanea REVISION--REMOVE WALL/ADD NEW HEADERS,
j�z Ixenc Clea Iic.a
Dam conl�n HARDIFRAME REC RM/LIV. RM
ARCHnECT DECLARATION
I undcuadl my plans"l be ucd u NIBC rt<nrds ,
J
sLi:n¢
cd Pmfcaaiatul
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OWNER-BUILDER DECLARATION
1 hcmbr aRru that I sol name from an the Cmora Cod IJcmue ny o for Nc
p O followinghOmassa.(Saito 70713.Bu•Fa.LrrO PmfauOOR Cod,:Any ar or manly
5$� wn ntu tuarcc. Iso m9uu'"J�icI•applicam far�iucE�noWwfk auSrcd mLu,montt
Wna be ullamcdp rn in the pmvl.umu N do Caanctor'a LiCC.La.(C bar r9 Sq. Ft. Floor Area Valuation $0
YI'n (eanmemvtg wlW SMion 7000)a(Div on 3 of We Btdnes and Pm(cdoss COds)m -
}� .. Nat he is uaop tamfmo,and We Wal,fa the alleged amnption.Any vlolatlan of
S<nbo70J1.5byany eppliCaru for It permit subjects the appliaailt W aC]"pcnalry of APN Number Occupancy Type
am mole than nw mmdrtd dollar,(M). 34245010 . 00
01,as owns a ilk Fogmy,m my employ with wgau Heir sale cstopmWm,
will du In, *,and IM1cawcwm I.na imeMcd au Rued for,ale(sec.lou,Buureu Required Inspections
and Pmfefaimn Cade:TIC Cont.twi Ll,nse law dna Wt apply W an owner a q P
,My who bWIdLm impmea theeon,and who dolsaeb wart hmaw for IM^a11%his
wm empltycs,provided Wa such Imprmemenu aie Cast Inesdad moRCW fa ale IL
howe,er.the dtlWing or bnpowment is mW w Win me C..f oompkum-1W owoc
boiM win haw the Madel or pr d.g that M did and bond m Impmte In,pliposc ar as"'
ak.k
1.a sane of the popeny.am u trrirdy contracting vial Iicsaaed ctno.ca,m ✓,
Q tmm the pmkv(S 7014,Business and PmfaJons Code:)Tlx Co 's U-
,aeLatadotsnstapply Inano..nuof nmpen,w botchor impma It Wmerm.and, _
who vrm a for sCIr projects with a euramtor i lianaed NratOor Wttr Cosa '
Liccnaa law.
Q ❑lam ea smile(See .B&P fold,
Owner
/C s Due
IPENSATION DECLARATION
LBM under penalty of perjury One of Ne(dloanng drelsoasm ;
01lu.xandwillIf.by LCW3O of CaveatmCodC.ivefa CdoorraComp,m
viol,n pmHtrA fpa Ot Scum 3'!(10 a(Nc lahm Code.for tte peRarma.m of de
wort fa which this pmnit 4 ianel
D I Wax anA vlll maintain Wor1vS Cmtpctsaum IuurLrcc,as naptirOd by Salim
3700 d the Labor Code.fm the pcformaax of We wort fm whkh Wu pcmil a inued.
My Worker',Cmtpeaauan Inions chic and Polley nmnbcl art:
Gnkr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
jbiaacdon recd dIC.Pkmtl VWe ganga u fmstehtooraA ondars(SPIE
mlea.)
I anif)v Nat In dm pCrfmnaaa of Ina wort for.Eich 06 permit is isaN.l"I rot
.ploy any gesso in any manner so as n beano.sob caU to the Wor",Compoosalm
O 4wa of CLlf m ax
Applkai
Nortcelo ANT:fir,Lfw matin(Wls ComfcLm of Esunpwn,you should
bbccccaaggcc syb We Wohcr'a Campcavum provision of the Mbar Cad,,yta In.
.J foMwlSmmplY vW such pr Won or this permit Pull be Aram arl revoked.
ZO CONSTRUCTION LENDING AGENCY
[-. H. I bereby of it a that Wert is L mnawction lending aFOCY In,the perfarmres of
C' > tW wart Int which this permit is ivied(5¢3097.Civ.C.)
4 Q I<rdcr's Name
0. Z IsMc/s AAdtes
U Q I cxnify that 1 Wax reW this appliuum ad six Wu de Ibo x mromrsdon u
W V const.Istir,mcomply Wild Ill city"COunty mdinlraxs and auxInt misting to
C) building eavovction,aid hemby aulhmirz mpmxnutiaea of Wu city to anter upm tM
W ahove-mentiured core y rm Inpccuan putpoxs
(WC)Lira W saw,indemnify and I,P kukv the
rmCity or Cupertino against
f�j7 IiaNliva,judgmmu,co,u aril caputca which may 1.any w.y acrnc Lia4w said City —
UZ in Ctnxq.of We panting of lhia P n.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
O SO ULATIONS.
Re-roofs
ba m
HAl.SRDOUS MATER At c DISCLOSURE Type of Roof
Win W,applicant m to.WItUng omupant tram m hardlo ha,N .tnwrW
as Aef OCd by the Capmim Municip.1 Cod,.CW pxr 9.11,and the HeJW and Safety
Code.Semlm25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
[3Y. 'Eo�b
menl m or;eca whin If a roof is installed without first obtaining an inspection,I agree to remove
wan the wpli„m"mtmt banding axapaa=cquip
or,basal air anmninams as cofi W by dx Bay Arca Ab Quliry Mwgsmcm all new materials for inspection.
Dlsoict7
DYaa 8+1--6
1 haste mad tW barn jus maxriahmryimmum miler Chapu 6,95 offs Califon
.is Ikalth h safayCodc Sanma 25505.25533 and 25531.1 uMCrvsN Waif do bulWWg
d¢s cot c.mndy Wax a win,ilia it u my rcapwvibilily x natifY do Oaopart of do
msuWhkbmtm melpaiorWiaruanCOf4Ccnlflnxor Signature of Applicant Date
OG
cm All roof coverings to be Class "B" or better
Q Ne