04060143 CITY OF CUPERTINO - -
Bu1Lnl"c olvlsto" PERMIT ACONTRA6TOR INFORMATION
BUILDING ADDRESS: HERITAGE CONSTRUCTION AND PERMIT"04060143
377 M.RNITTRW All
ER'S NAME: PERMIT ISSUE DATE
ML SATYANA
41,IS SANITARY NO. CONTROL N0.
4379-2005
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
2" LICENSED CONTRACTOR'S DECLARATION
d EI bemby affirm mat I am licensed ander provision.Of Chaplor 9(commencing Job Description
Section 7")of Division 3 of Ire Businessland Professions Code.and my license is
ate„ LimnmmaClass
cense rmLie,x erre[` ADD 673 SQ. FT. (BED -& LIV. RMS/BATHRM/REROOF)
j,va v, Li
Dam Cuntrecmr ELECT. PANEL UPGRADE
ARCHITECTS DECLARATION
I understand my plans shall tic used as public records
Jto
''LL Licensed Pnsfc ni...I
OWNER-BUILDER DECLARATION
<S 1 hereby affirm tat 1 am exempt from to Contractor's License Law far the
p o following mamn.(Section TOMS.Business and Professions Code:Any city Or county
K$ which requires a permit m cnmruct,alter,improve,demolixb,or repair any strucms
prior to its issuance.alsumquitntW applicant forsuch pccullso Ric a sigirmstamment _
that he is licensed pursuant te hprovisions of to Contractor's License law lChapter 9 Sq.Ft. Floor Area Valtt$§qni000
C,Fa (commencing wit Section 7000)of Division 3 of the Business And Pmfeuions CudO)or
i that he is exempt therefrom and the Willis for the alleged Caempsion.Any violation of
Section 7031.5 by any applicant fora Permit subjects due applicant oacivil Penalty of ApNNumber Occupancy Type
not mom man five hundred dollars($50).
❑I,uewncrofshc pmpeny,or my cmpleycra wit wagesu sass ante compensation. 36911027 . 00,
will do Or wart,and to atmctum is not immded arafrerW forsale(Sec.TOaa,Box.
and Profession,Coda:no correlates Licemo taw dao not apply to an owner of Required Inspections
property who builds or impmoa themon,and who dmssoch work himself orthrough his
Own employ=.provided Iran such improvements art not intended unframed for We.IL
however to building or improvement is sold within Dec year of completion.on,comer-
builder will have to Widen of proving tat he did not build or improve for purpose of
Aide.).
gh as owner of the prop,.,am exclusively contracting wit licensed mnuacmn to
fOnssmct tate project(Sec.TOaI,Business and Pm(essions Cade:)The Co...,.Li
cense Taw dnu not apply je an owner of property who Wilds or improve.tcman,and � Z�®
who Law ctaforsuchply to a witecontnmmlq who
sedWil poor and mints;Contractor'snd
CCmse Taw,
Arm exempt under Sec. .B&P C for tis¢tion
\1
ea� A ot.-a1'fl-- Dare 9 z o 1pOf
WORKERS
COMPENSATION DECLARATION
I hereby afGnn under penalty of perjury one of she foliawitlg dydarations:
I have and will maintain a CArdrun a ofConsenuo self-imum for WarkerS Compor-
ork, provided for Section 3'!00 of to Labor Code,for the performance of to
wt _
wank forr which this Permit
t is issued.
❑1 have and will maintain Worker's Compensation Insuruce,u required by Section
3700 of tc tabor Code.for to performance of the wvh for which tis permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Lamer: Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Till section need not be completed if the panni,is Toro.hundred d.lars(SICK))
Or Iots.)
I tenuity to in to perfmom met of tM work for which tit pe ni,is issued,1 shall not
employ any person in any munerm a to become subject o the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this CeniReate of Exemption.you should
become subject in to Worker's Compensation previsions of Ire Labor Code,you must
.JO forthwith comply with such previsions or this permit shall bedcemcd revoked.
'Z "' CONSTRUCTION LENDING AGENCY
'a-s� IWroby.M.that tea iso costrucunn lending agency for LW perfurmmuuf
CL to work for which this permit is issued(See.3099.Civ.C.)
W ~n- Lender's Name
!L UO&,'s Address
U C) I certify tat 1 have orad this application and sum that the above infonnoiun is
W f" correct.1 agree to comply wit all city and county ordinances and sure laws meaning m -
O V building Conswction,and hereby autotion repmscmadves of this city m color upon on,
Y' W (chose-m mu ned property for iupmui..purposes
(We)agree Mcost,indemnify and kith may
in an the City of Cupertino against
F"!aA Iiabilltl(We)greeto case.indemnity
and
mayinanyre City Of
CityS4
U Z m cavequcnce of to granting of tis permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date q
SOURCE REGULATIONS. Il y 0(1
Re-roofs
t tare afApplicatVComua r ~ Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or future building occupant store or handle haandous material
Mad by to Cupertino Municipal Code.Chapter 9.12,and IW Heard and Safety
c,Stcuon 25532() All roofs shall be inspected prior to any roofing material being installed.
Ycs T�laa
Will Ire applicant or fuYtuurre building occupant user equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove_
it harardom air contaminants u defined by to Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ycs IG1 No
1 have mad to harardtms materials nquiremenls under Chapter 6.95 of tc Califon
nil HcsWt&Safmy Code,Sectiou25305,25533am 534.1undcroendtoiftt Wilding
does not curtcn0y have a tenant taint is my respm¢ibility m nobly to occupant of to /
qui co tanto ma i he met prior in issuara or a certificate of Occupancy. Signature of Applicant Date
Owner ora ircd.,In( Q All roof coverings to be Class "B" or better