06070061zC
CITY OF CUPERTINO i�
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BUILDING DIVISION PERMITV�;'1-S�taV�'Y,QIt�ip��lylA�°IDNy�`
BUILDING ADDRESS:
PARTHA BHATTACHARYA
PERMIT NO,06070061
11218 STAUFFER LN
OWNER'S NAME:
PERMIT ISSUE DATE
. PARTHA BHATTACHARYA
07/12/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job DeSCrIpIl00
1 heroby grim that 1 am licensed under provisions of Chapmr 9 (commencing
with Section 7000) of Division 3 ofOre Bush. and Professions Code, and my license is
infull fnreeand efree it yC S
REMODEL MASTER BATH AND MOVE ONE WALL TO
Lkenu Clm, Lk. N I d
Date comrxmt Cane D,..71,0-5
.
ACCOMODATE NEW FLOOR PLAN
DECLARATION
E rS DECLARATION
As
CMS BUILDERS PAID FOR BL 7/12/06 - 01000015024
shall use as public Ns
1 understood my plans shall
Liecmcd Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contmnors Liccnu Law for the
following mason. (Section 7¢3 1.5, Bumess and Professions Cale: Any city or county
which tequitns a permit to eonsuuct, alter. improve, den h. or repair any swetur,
prior 4l its issuance, also re uites the applicant for such permit to file a signed statement
that W is liccvcd pursuant to the provisions of the Contractor's License law(Chapur 9
Sq. Ft. Floor Area
- Valuation
s (commencing with Section 7000) of Division 3 M the Business and Pro toCodc)ar
$21500
Y
. Lou he u exempt di mrmm and 0u basis for Ne alleged eumption. Any violation of
APN Number Occupancy Type
Section 7031.5 by any applicant per a Penni( subjects the, applicant to a civil penalty of
nut mote than five hundred dollars (SSW).
❑ 1. as owner of Ne propmy, Or my employttu with wages u their sole eompenation,
willdO thcw.deliod Neswnum ovatintendedoronered forsale(Scc.7 .Businea
e
Required Inspections
and Professioes Cade: The Comrurols Licence Law doe, WE apply In an owner of
9 P
property who builds or im proves thereon, and who does such work himself or through his
awn employees. provided that such improvements an, not intended araRemd forealc. IL
onwever. the Wilding or improvement is sold within one you of completion, the owner.
builder will have de Wrecn of pmving Nat he did not Wild or improve for purpose of
sale.).
D 1, as awns' of the Property... exdeamly canuacting with licensed mnuxmrs to
constroct the project. (Sec. 70aa. Business and Professions Cade:) The Coouacmis U.
cense Law dmf improves theean, and
suchply b an owner of progeny who Wilds
for
who contracts for such projects with a <onmmogs) liceved pursuant m the CanuumrY
rs
e.Ild Law.
❑lam ucmpr undo See .Bk PCfa Nis mason
rl
ror Date
WORKER'SCOMPENSATION DECLARATION
1 hcmbY affirm under penalty of perjury ane O(de fallowing, dcclamtians:
g� O
❑ Ihave and will mainuina Cenificau of Consent to self -insure fmWortcls Compere-
[)A, �pOss
nation, as provided for by Section 37W of Nc tabor Code, for the performance of the
o
work for which this pnmit is issued.
D 1 have and will maintain Worker's Compensation Ince ance, as regtined by Section
37W orde tabor Code, fm Ne prrfarmanee of the work (Or which this permit is issued
'
My Worker's Competuation Insurance canner and Policy number an:
Carrier. S PoicyNo.: %%3-00IY31>-Octi
EMP ION FROM WORKERS'
COMPENSATION INSURANCE
CITU xnim need WE W compleed time permit u faonc hunted dollars ($1 001
less.)
1 certify that in the pn(ormarec of the work for which this permit is issued, 1 shad! WE
employ any persen In any ma dler,0 as to become subject la the War ect3 Campehol
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If. after making Nu Cenificate of Exemption, you should
become subject no de Worker's Compensation provisions of the Labor Code you most
' foMwith comply with such provisions or this permit shall Ito deemed revoked.
i
j CONSTRUCTION LENDING AGENCY
' lhcmhy Ne Nem iusued(Secti0lending agency for do perfunancc of
chaffirm
' the work for which this permit is issued (Sec. 3097. Civ. C.)
Lendels Name
tendcls Address
'
1 certify that 1 have mad this application and sue Nat tW above information is
' conn. I agree to comply with all city and county ordinances and sum laws relating In
building construction, and hereby authorize representatives of this ci ty to Enter upon the
above-mentioned property for ins,tection.
which
(we) agree to ave, indemnify and keep harmless the City of Cupertino against
j Iiabilitiu,judgmcnu, sono and cxpcnsca which may in any way accrue against said City
.,. ro
On conx�q of Nc gaming of Nis Perron'.
' APPLIyyAAyyIot DERST A D WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUjt[ER LATI�
Re -roofs
Type of Roof
f� DOW ��
sig O Appl'i�r Date
xAZAAD US MATERIALS DISCLOSURE
Will tW applicam or future Wilding occupant store or handle haaudous material
m dented by the Cupertino Municipal Code. Chapthr 9.12, and the Health and Safety
otic. Section 25532(a)7
DYes PPO
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future Wilding Occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air conuminants as dcfatl by the Bay Area Air Quality Management
allnew materials for inspection.
District'
DYes 21,15
Ihav niqNe ardmsmmcrialsmWim=nuundcrCl,N,6.95af Ne Califm.
nia Hcal Safi y ,Sectio x503 33md25534.1.k. nditifNu Wilding
dna n eon 1 ase a mean r i my risibility m retifY the occupant of the
mqm ments rnmavW ria aarvcancerufiesearOcowamY.
Signature of Applicant Dale
o
All roof coverings to be Class "B" or better
Owncroraumaixeda . ✓ Dz�