06030063 CITY OF CUPERTINOt 88k�a7r�ka.�ry:�a n�q�+�',�• ' *pla �T'�+�'�*�fy�k�
BUILDING DIVISION PENT ys of\ ;k&j8TQl �'yI -s�O�¢,�.�
BUILDING ADDRESS: I PERMIT NOO 6030063
110640 JOHANSEN DRIVE
OWNER'S NAME: PERMIT ISSUE DATE
SUBRO KOLLA 06/23/2006
)NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG
l� 0 PLUMB
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Sop LICENSED CONTRACTOR'S DECLARATION
0 I berery affirm Nu i sm licensed under plevivmu of Chapter 9(commencing Job Description
with Section 7000)of Diviaion 7 afthe Business and Professions Cod^,and my license is
in bill force am elreu. NEW FRONT PORCH ADDITION 1431
License Clan Lle.0
3 W Dass Contractor
DE
ARCHITECTS DECLARATION
1 undemund my plans shall he used as public ecnNs
)6
;Q Licensod Pmfevianel
^ OWNER-BUILDER DECLARATION
4 0 9 I borchy aOirm that 1 1. exempt from the Crntrsemra License taw for tbo
3 p O following won.(Section]osomm Buainess am Ma.stil Cade:MY city car county
z I< which its issu a permit re tires do ,per,improve,h Permit t or epsig any stmuum $30654 0
_Z t, prior aitsissatedpalso nyuite theisionsnlfor such Permit Lfilesse Law
a (Chapter
< NUWLLceucdpumuntecheprovisions 3NeConvecmil IJcettselaw(Chmser9 Sq.Ft. Floor Area Valuation
i�g ththeisa(commencing with Section 7000 the lustu for^(the egad mmd P My vi Code)or
Nal he LL eumpt therefrom sod the besLL for the ulgm exmptian.My Notation of
Section 7071.5 by any applicant for a permit subjects the applicant in e civil penally of W-F#-4qQ0erU U Occupancy Type
not mom than live hundred dollars($5007.
❑1,as owner of the property,or my employes with wages as their sale compenudan.
will do Newark,and let ent LLnot intended createdfarul0/a,Business
and PnOftesious CodTheCentral Liam Law4.Out apply e an owner
Requireduired Inspectionsections
Property who bislls mimpmwsthermal who
himmets arasrchwohbmsehis
Own employees,provided that suchimprovements are an,intendedorortered(Waal If.
however.the Wilding or improvement LL Withinmss year ofa Ne owu
Wilder Mhaw the burden of proving that he did et Wild or improvfor i
purpose of
1, , l
I, a awns of the Property,.B eulusively ewua9rg With Ii The Crnnmctuu U. ' 1
tinct d project(Sec.7044.amarr of sod Imperil
Who u Code:)The Crcumuh U- �7
cense LA.arcs act apply b an owner of wbo wilds or improves Hexon.and,
who contracts for such projects with a eanuxtorGl licensed putwant u Ne Conuanuls O�
Lleeue Law.
❑tom see un r5 ,Bk PCf rNLL on
Owner Dass 7'
CO SA DECLARATION
1 hereby aRime under penalty of perjury me of the following declatWans:
I have and will maintain a Certifical C^ment an self-hues,fu Workers Compel
urian,u provided for by Section 7700 of the Labor Code.fu the performance of the
woes for which this permit LL Wood.
❑1 have and will maintain Workers Compensation resonance,u required by Semon
7700 of the tabu Code,for the performanh of the wart for which dds permit u luued. '
My Worker,Compen al I^suxee curia and Policy number am:
Cartier, Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ihissecdan need notbe completed If the permit LL forme hunthnddallms(3100)
Or ml
1 certify that In the performance of the work for which Nim permit is issued.I shail ant
employ any person to Alm sou eco embl a Ox Workers'Compensation
Laws r(Caiifo
NOTICE
��•
NOTICE TO AP akin{ h ni emption,you smug
become subjectieNe Workers Compenud^ provieioro of the laborCode,you must
O forill comply what such provisions or this pundit Nailod e
be doemwked_
CONSTRUCTION LENDING AGENCY
(-n I hereby artirm Nat Nem is a construction lending agency for the performance of
the.,it for which this permit LL issued(Sec.5097,Civ,C.)
0.Q Lei l Name
Z Lenders Add.
U0 I certify that 1 haw mad this application and rote that the above informalun LL
Uy F cortmcL i.gee u comply with all city and county ordinances and rote laws elating be
OU Wilding conswction,and hereby mthmx mpnvemnivesof Nis city uenserapnn the
W above-mcmiuncd proper for inspection purpaxn
(We)ogee to taw,indemnify and kxp hemless the City of Cupertino 396MI
In liabilities,judgments.case am expenses which may in my way accrue against mud City
U z A ernxgrcR Of the granting of Nis IL -7 ins -r/
^-' APPLI UNDERSTAND AN WILL COMPLY WfI11 ALL NON-POINT Issued by: Date C. fj--riG_..
SOU RE UL NS.
Re-roofs �L
SignImsfirld'ApplitsfuslCommuclory Date
HAZARD US MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant mom or handle hahtdou raised]
u de0ed by Ne Cupel Municipal Code.Chapter 9.12.W ate Health and Safety
Code,Sa0on 21532407 All roofs shall be inspected nor to any roofing material being installed.❑Yu kNa
W0l tho applicant or fume Wilding occupant use equipment or decks which If a roof is installed without first obtaining an inspection,I agree to remove
mit hmardous air centaminants u defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes �No
[how mm the huandsusmaserielsm luiementt underChap¢ra.95 urine C,Bfol
M.NhW&Safmy Cade,Scctms25575,25533 and 21534.1 understand NulfNm Wilding
duan menily hex a coa at It LL my expo l lhlllty tabour me ouupant of the
say m w tau met eissuancmOfaCcltifua yyt�t . Signature of Applicant Date
S x. All roof coverings to be Class"B"or better