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07120095 CITY OF CUPERTINO - BUILDINGDFi::uION PERMIT o""'Q �tTRA-T QR�INFPi7 ,MA �,ai zr BUILDING ADDRESS: - PERMIT NO. 10820 GASCOIGNE DRIVE TBD — TO BE DETERMINED 07120095 it R'SNAME: PERMIT ISSUE DATE IMPNAVEED & ROMILA ALAM 02/07/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECffENGINEER: BUIIDINO PERMIT INFO BLDGELECT PLUMB - MECH 0 0 0 0 30p LICENSED CONTRACTORS DECLARATION Job Description m F I hewby affl m Net 1 am m licensed under provisions of Chapter 9 wrnmc arcing p with Section TOM)ofDivialon 3 ofdre Business and Profcmlom Code,and my licemse is ADD.LAUNDRY ROOM, REMOD, KITHCHEN,M BEDRM— FARBEX n H in full force and effect. ?�? License Class Lk.0 CONSTRUCTION PAID BUS. LIC 12/13/2007 Date Contractor oiq ARCHrr=S DECLARATION l 1 understand my plans shall be used as public records esu y use Licensed Hafcsdanal OWNER-BUILDER DECLARATION 1 hereby&Iain on I am exempt from Ne CO inats C s :A License Lew for the fallowingot.a (Section 7f17L5,Bualmm and Professions Cuda:Any city or m.. $ which uqulfns&permit re quires the alter.improve,de permit t nr mash any torment _Zy pdorm1llc,n nce,alwmquima thovisio so farsuch comunirmivaftlese,Law statement g€< (that comma cing wit pursuant t00teprovisiom of the ConOwtm'and Prof donC oda)or Sq.Ft.Floor Area $15000 Valuation q (commencing Section t and)the f r infuse B ed assumption. on.An vi Code)of 15 0 0 0 — Net he u e=mpt therefrom and Ne buss for the alleged eumpmn Any violation of Station 7031.5 by any a PWmI for a�it aubjeeu the applicant w•civil penalty of 3 7 5 2 9 0 y PI umber Occupancy Type net mom than Bae.hundred dollen S5 P y 'J p ❑I,as Owner of tiro property,or my employees with wages as their tele wmpewdn, will do the wok and the structure is not intended or offered for age(Sec.70/4,Busimu and Profamiom Cade:The OenrectuA Liamlaw circa rot apply w an owner of Required Inspections property who Wilds or improv theseon,and who does such work himself or through his own employ..provided that such improvements art not intended reoffered forsek.If. however,Ne building orimprowmwt tswld within am year ofcompletion.Ne awncr- builder will have the burden of proving that he did rot build or improve for purpose of can.). tkp(I,a owner of cite property.am emulatively contracting with licensed anhectora w Comimm the project(Sec.7044.Business and Profwions Code:)M Conuacwr'a Li- cense law does not apply to an owner of property who builds or Improv Merton,and, who wnmets for uch projects with a contnewr(s)licensed pursuant to the Con incmr'a License law. ❑lam mem�"unde�rSlM. B&PP C far this won r Dau a�_r�og WORKER'S COMPENSATION DECLARATION 1 hereby at under penalty of perjury one of the following declandom: 0 1 haw and will maintain a Canifiate of Consent to self-insum for Worlwes Compen- shown,an provided for by Section 3700 Of the Labor Code.for Ne Performance of the work for which this permit is immod. ❑1 have and will maintain Workers Compensation Imunnce,u required by Section 3700 of Ne labor Code,for the per(armeme of the wart forwhich this permit is iaamd. - My Workcr'a Campemedue Insurance curies end Policy toorkr an: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need notbecompleud if the Permit is f crane hunthNdollm r$HKB or lea) 1 certify,that in the performance of the work for which this Permit u imued.l shell not employ any person in an manmr mewb the Workcri Campedon Laws of califamia.Date Applicant NOTICE TO APPLICANT.If,a r m mg Nis Certificate of Exemption,you should become subject in the Watrefs Compensation provision of dor labor Code.You mut .J 0 5; forthwith comply with such no,ism.or Nin permit shall Ian deemed rowked. Lz-t CONSTRUCTION LENDING AGENCY [r ti Ihereby afrim NU Nem u a comtmctinn lending agency for Ne performance of C4�; we work for which this permit is mond(Ste.31197.Civ.C.) A Leaer's Name =z Lender's Address U Q 1 certify that 1 have read this applicauun and now Net Ne shave Information is ' Uy F comm I ngrte to comply with all city and county ordinance and state latex relating w - 0Ubuilding conswetian,and hereby&owed=wpnwmatives ofthis city to caterupon ftW above-mwtiuned pmperty for inspcedon purposes. - �"0. (We)agree to saw,indemnify and keep harmlets the City of Cupertino against ' . r),,n mu Imbilities,judgments,coats and expewhich may in any way acemc against said City Z in consequence of we granting of this Permit. ^' APPLICANT UNQERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCR - ONS. 0 Re-roofs Si[neturt of ApplicanUCenaDautadar Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupantswro or handle haurdam material &flmd by we Cupertino Municipal Code.Chapter 9.11,and the Health and Safety gwuo �No zss3z(a)? es ❑YAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove emit haardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? UYes No 1 haw mad the hanNom materials m,.kCu.mU underchma"6.95 of die Califor- nu Hcalw&SafetyCode,Secuon 15505,25533 sad 25534.1 undersand two if Ne Wilding dor not cumntlY how a wngpy Nat it is mY uswf.Ccry w mufy tae occupwl of dor rtquirtmcntsw 'k xmet�prftiti2 menracemrteatenforw,eay. Signature of Applicant Date a—�� use All roof coverings to be Class"B"or better OwncrorauNoriseO agent Date' ' CITY OF CUPERTIN0 77777777777777- ",: - BUILDINGDW:SION PERMIT �C41'('TitA. "CiE)RI1 aC}',NiA t 1r' BUILDING ADDRESS: - PERMIT NO. 10820 GASCOIGNE DRIVE TBD - TO BE DETERMINED 07120095 R'S NAME: PERMIT L95UE DATE AVEED & ROMILA ALAM 02/07/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECffENGINEER: BUILDING PERMIT INFO ELECT UMB - MECH BLDGPL 0 0 0 0 LICENSED CONfRACi'OR5 DECLARATION o lb Description I heroby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section TOM) ofDivialon 3 Ofdvc Business and Proinsaom Code, and my licevc is ADD.LAUNDRY ROOM, REMOD, KITHCHEN,M BEDRM- FARBEX in full Iowa and effect. License Class Lte.0 CONSTRUCTION PAID BUS.LIC 12/13/2007 Date Contractor ARCHn=S DECLARATION 1 understand my plans shall x used as, public records Licensed Professional OWNER -BUILDER DECLARATION 1 herby alum that I am exempt from lac Conuwtor's Lkcnx Law for the following roman. (Section 7031.5, Business and Professions Code: Any city or rounty which not. a permit to musamet, alter. improve, dem.Lah, m repair any auucturo prior to its issuance, asses requires the applicant farsuch permit to rile a signed statement Nal he is licensed to the the Contractor's License Law 9 Sq. Ft. Floor Area Valuation pursuant provisions of (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Coda) or 15 0 0 0 $15000 that ha u exmpt Ihertfmm and the basis for the alleged assumption. Any violation of PI umber Occupancy Type P y 'J p Station 7031.5 by any appliant for a � it aubjeets the applicant w • civil penalty of net more than Ban hundred dollar S5 3 7 5 2 9 0 y ❑ I, as Owner of use property, or my employees with wages as their tele wmpewtioe, Required Inspections will do the wok and the structure Y not intended or offered for ale (Sec. 7044, Bumnew and PwfesdOm Cade: Tha CmurectuA Liam Law does mut apply w an owner of property who Wilds or Improv theeean, and who does such work himself rr through his own employ.. provided that such improvements art not intended reoffered fmssle. IL however, the building orimprowment lswld within am year ofcompletion. me owner - builder will have the burden of proving that he did rot build Or improve for purpose of isle.). tkp( I, as owner of tits property. am meluaively contracting with licensed eonuecwra w Coround the project (Sec. 7044. Business and Pmfwlam Code:) M Conuacter'a Li - crux law dors not apply to an owner of property who builds or Improv thereon, and, who mntneta for uch projecta with a contnewr(s) licensed pursuant to the Con incmr'a Licenm U., ❑ 1 am exem%pt B & PP C for mount rlab /�und/e��rj$�qM,�.�, `& RKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of pedury one of dive following declantiom: 0 1 haw and will maintain a Canifiate of Consent to self-insum for Worker's Compen- shown, an provided for by Section 3700 of the Labor Code. far the Performance of was wok for which this permit is issued. 0 1 have and will maintain Workers Compensation Imunnce, a required by Section 3700 of the Labor Code, for the per(Omauwe of the wart farwhich this permit is iasmd. - My Workees Campemedue Insurance artier end Polley rumba, an: Carrier. Policy No.: CERTIFICATE OF EXEMP11ON FROM WORKERS' COMPENSATION INSURANCE (Thu xctloe need notbecomplemd if lac Permit is f crane hunthW dohan ([100) or lea) 1 certify, that in the performance of the work for which this Permit u issued. l shall not employ any person in any manmrmewb the Workcmi Compewfoe Laws of califamia. Date Applicant NOTICE TO APPLICANT. If, a e m mg Nis Certificate of Exemption, you should become subject in the Workees Compensation provisions of pan Labor Code. You must forthwith comply with such no,ism. or thin permit shall Ito deemed inked. CONSTRUCTION LENDING AGENCY 1 herby affvm Nu them is a comtroctinn lending agency for the performance of we work for which this permit is mond (Sec. 3119'1. Civ. C.) Lender's Nurse Lundeen Address 1 certify that 1 have read this application and saw thst the shave Information is ' carseat 1 agree to comply with all city and county ordinance and state laws rotating w - building conswetian, and hereby authorise mpnsentativ of Nie city to ca terupon dace above-mentioned pmperty for inspection purposes - (We) as= to saw, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expemu which may in any way ¢cmc againsl.aid City in consequence of the granting of this permit. APPLICANT UNQERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO MR - ONS. �f ©a-� Re-roofs Type of Roof Signature of ApplianUCenuDweadae Dow HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building mcupantswro or handle haurdom material defend by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safety , zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed. 0you �No ❑Yoe If a roof is installed without first obtaining an inspection,agree to remove Will the applicant or future building Occupant use equipment or devices which emit haetolo s air cmumine.4 u dcfancd by the Bay Area Air Quality Management .I all new materials for inspection. District? Oyer 'VNo 1 hew road the hvallous materials mgriromcnu underChmm, 6.95 of time Calif., na Health & SafetyCrde, Secuom 15505, 25533 and 25534.1 undenamd tiro if dw Wilding dw nal cuawntlY how a tenggyTthat it is mY wupomiMlity w mtifY the ottupant of time roquirtmentaw'k he41Qp-'itI-f.ccrud"..ic Signature of Applicant Date a - 0� All roof coverings to be Class "B" or better Owncrorauthorirc0 Date' ' agent ua