05070003 CITY OF CUPERTINO s rw3 .Y"vplm5d*
BUILDING DIVISION PERMIT V CONTRACTOR N URMATIQ,fN
BUILDING ADDRESS: REAL ESTATE REPAIR SERVICE PERMITN�5070003
c;7 qrP.NIC BI AM
'ER'S NAME: PERMIT ISSUE DATE
MEYYAPPAN
ONE: SANITARY NO. CONTROL NO.
406 578-6016
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BIRO EQ PLO O
�oo LICENSED CONTRACTOR'S DECLARATION tttt3��3��....pppp���ay�,,,,iiiiM1M1M1M1'''',,,,AAAA 111l1111 ®®®
+� Iion7 affirmthatIam Ikennd underPrevisionProl Chapter daid. 9(commening .IO�ppq.A,IW��
m wlNSoerceAnd 7M)of Division3of Ute Business and Profcuinn Code.andmylicettm is IB`a'
w nfell roneaneeffttt 2 NEW WINDOWS
lgis- Datc Cleo Continuator /
ARCHITECTS DECLARATION --/ i� 200&
I undenund my plana Beall he=it u public records !!! L
7
o� Licensed Professional BUILDING
■ ■'p ®I p R
OWNER-BUILDER DECLARATION U L N
i M I I musio them that 11. ,Busies faro Uro Commences o License 4w for the
O o follwhich in team n.permit
b 7 construct.
Business and Prowc.de on Code:Any city m aunty
$ which its int n permit re conumcL slur,nt russet demolish,i of .sig any urunurt
prior to its lensed p alio required the Nc applicant russets permit to Ilk. Law ataumcm
< (commencing redpuntion7 the pmviviouo(the or&B sines LicenseLawSq.F[.Floor Area Valuation
$ tham a is exawith Section 70nd the
Division f r of the alleged
exempt and Purccon.An vi Cade)or
'��� than be la sumps Nertfmm and Ne beta for Oars alloged oumption.Any violation of
Section 701.5 by say applicant for a peouh subjects dm applicant to a civil penalty oreT0 0 Occupancy'Type
not mom than five hundred dollars($300).
❑I,uawnroftiapmpany,armyemploymawiNwagesuLimirmucompenudm,
will do the work,and tiro am=.lsnal Intended of offered fm MIC(Sec.7Wa,Bua1MY ns Required Inspections
and Profession Code:The Commemes License taw dead not apply to an owner of 9 P
property who beildsorimprovea theraon,and whodoeuucb work himselfor through his
we emplayw,provided that such ImpmvemeatsaR tmtbacrided maffened forula It.
however,the building or improvement It mid within one year ofcompletion.the owner.
Wilder will have the burden of proving that se did net Wild or improve for purpose of
sauJ.
PS'it
a awnv of the PmpenY.am exclulvelY com bsci ng with licensed conuactan to
tact Ne pmjm(Sec.7044,Business and Professions Code:)The Contractors Lt.
mnu taw docs not apply to an ower of prope ny.wW W(list or Improve Merton.soul,
who cont
Lionan U:!101 pickets with acontrutoNs)licensed punuutm the Convectors .
❑Iam uemp ^ ,B B PC for ream
Dam
WORKERS COMP NSA 01 E LARATION
I bemby,anirm under penalty of perjury au of the following declarations:
�./ Iha.eand will maintain a CeNgntc of Conant to self-inumfor WorkeJtCompcn-
"'e� salon,u provided for by Section 7]00 of the labor Code.(m the per(ormana of the
wart for which this permit Is Issued.
❑I have and will maintain Workers Compensation Insurance,u rtquimd by Section
3100 of the labor Code,for Ne perfamunce of tha work fm which this pereak is utnd.
My Worsera Compensation Insurance carrier and Policy number am:
Cartier. Polity He.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mda rection mend not hecamplemd lithe permit ta foroac hundteddoRars(S100)
or late.)
1 artily that in Na perfor rou'"of the work for which this pertni a issmd.l shall nm
employ any penon in any mucoran u to bayo)g{upj�yp Btea11tB4rY CompenuUon
Lawsca Califprq G` � �rCL/Il(,Btl�(/J
NarICnt II�I
NOTICE TO A e :IL alum making n p Cisions of of Exemption.Labord you ahnhi
become subject m the Wash r'o Compensation provision of the Labor r Cada you mut
.J Q fmNwiN comply wird such provision m this permit Mall W deemed nwoknd.
Zy CONSTRUCOON LENDINO AGENCY
E•r Ihembysifum WtUt.isamruvuctimilandingagencyfertheperfmmanceof
a 7 the work for which this permit is issued(Sec.3091,Civ.C.) '
W 0 Landers Name
z Lender'aAddmaa
U Q 1 mildly that I have read this application and mw Nu the aWve information u ,
11,r^ cotrm I grte to comply with all city and county animations and sum laws miatin5 to .
Q SV" building construction,and hereby mthodue mpromustim of Nu city in enter upon the
W above-mendund PmlronY for IMPPL7Ion pu rmatL
fy (We)agree no save,indemnify and seep parishes the City of Cupertino against
(n
liabilities,judgments,ones and expenses which may in any way acme a gain,said City
(')7 inconsequence of the granting of this permit. y .�
F7 APPLI NDERSTANOS AND WILL COMPLY WITH ALL DN- Issued by: Date
SOUR r 'Uy,T Ns r(�i Re-roofs Q r
Sign4XRof UV
A toI V I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will than,applicant or future building o TUPUL. re or handle hmardous mawrial
dell d by Ea Co m a Municipal Code.Charter 9.11.and the Health and Safety
genian zss3z(a)]
[3y. No All roofs shall be inspected prior to any roofing material being installed.
)PS
Will the applicant or iinntent building uncertain sane equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havardoes air canaminanta u defloccl by Use Bay Arta Air Quality Management all new materials for inspection.
taunt?
❑Yes 'Nu
I have mW due haeardovs mauriaareyuiremems underChapwr6.95 of the Califor.
nla Hot B SalctyDude,Senlnn23.Yd5,25533 aN25534.I undersand thatfdro Wilding
doesnot curmmly how a unan4 Not it ta my mapomibllily w nodly Ute occupant f du
requl ic met Prior m(sau ofaccnincate Signature of Applicant Date
Ownr rauthodredagcnl Da All roof coverings to be Class"B"or better