06020162 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO1VTRe ,.,,=nR'�IIVFU;l2
ha° 0 " w•'?�+- 'fft --vfSi+A` ,$4
BUILDINGADDRESS: C & D FREITAS CONSTRUCTIO 'PMMMNO-06020162
10110 LOCKWOOD DR
� ER'S NAME: PERMRLSUEDATE
VASUDEO & VAISHALI HADAP 23610 MORREL CUT-OFF RD 03/07/2006
PRONE: SANITARY NO. CONTROL NO.
(408) 353-1228
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
0 0 0 0
20, LICENSED CON7RACTOWSDECLARATION Job Description
O 0 1 hemby afrom Nat I Am liamde
ed unr provisions of Coal.,9(caatimS
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nantlPolssunsde.andmylicevnia REVISION-ATTIC STORAGE (REVISE GARAGE CLG. )
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Dow Convector NO NEW PERMIT ISSUED/ORIG 05090008
p
e 7W ARCHITECT'S DECLARATION
y < 1 understand my plans shall W used as public records
g G S Licensed PmfcssimN
OWNER-BUILDER DECLARATION
i�Y I hereby affirm that I am exempt from de Contractor's License Law for the
02 following reason.(Section 71313.Business and Profesriou Code:Any city or county
S$tn which acquires A permit to construct.Alter,hopmw,demolish,or acpan any s..to.
_I< prior um its issuance,elan requireslM applicant for each permitto file a signed saemem
pp 0 MetWisllansedpursuemtnsheprovisioaloftoContractor'sLicenmlAw(Chapter9 Sq.Ft.Floor Area 'Valuation
Y a (commencing with Section 7W)of Division 3 of the Business and Professiom Cook)or
3— Nal he 1,exempt Ncmfrom And die bub for d¢alleged...,lion.Any vialado.of pN
Section 7031.5 by any applicant for a permit subjecs,the applicant a a civil penalty of 3 4 21 N�I�Iber 0 0 \ gdpancy Type
not mare than five hundred doll...(S5W). 214 5
0 1,as owner of flue property,or my employees with wages As Neirsole compensation.
will do Newark,and deswmute is not Intended.oRend forsalc(Sec.7W,Business Required Inspections
and Profeselans Code:The Contractor's License Law does oat apply a e an owner of q p
property who builds or improves thereon,and wW does such work himselfor through his
own employees,provided Nal such improvements sae not intended oraffere forsalc.If.
however,the building or improvement is mid within on year of completion.the owner.
builder will have da burden of proving that W did not Wild or improve for purpose of
sans.).
0 I,as owner of the property,am exclusively contracting with licensed contractor,to
construct the project(Sec.70",Business and Professi m Code:)The Convac an'.U.
cense law does not apply to an owner olpropeny.who Wilds or improv thereon,and,
who contra for such projeca with a contractor(s)licensed pursuam in the Contractor's
License Law.
❑I oro exempt under See. .B&P C for this moon
Data
WORKER'S COMPENSATION DECLARATION
Or I hereby affirm under penalty of perjury one of the following dalmalimun
0 I hsw ono will mar bCerd37M of C e Lati lo.Ide.fare rte Worker's es,of Me
soon, r provided far by Section 37W of lW labor Cade.for time peRonnaree a!Ile
work for which this permit is issued.
0 1 have And will maintain Worker's Compemadon Inumance.As acquired by Section
37W of to IaWr Code,fa the performanc,of the work for which this permit is issue.
My Worker's Compensation Insunntt Am ier end Poll,number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section natl not W completed if lW permit is forone hundred dollars($1W)
tor lea.)
1 cenffy Not in the part... a of to work far which this permit is issued.l shell not
employ any peramn in any manner as as in become subject in the Werimr3 Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this CWHiielde of Exemption,you should
become abject in the WorkcYs Compensation provisions of the Labor Code,you most
0 Q fonowi th comply with such provisimn M Nis permit shall W deemed mvoked.
.'Z„y CONSTRUCTION LENDING AGENCY
[—i Ihereby affirm that there is a construction lending agency for the performance of
!Yithe work for which this permit Is issued(Sec.3097,Civ.C.)
Vl Q Lender's Name
�z Lender's Address
U0 I eatery that I have mad thia Application and state Nat on,aW.infom.o m is
R. correct.1 agree a comply with all city no county ordinama s and sea laws minin&An
0 building construction,and hereby Authorim representatives of this city in Amer upon de
131 alain-mentioned property for inspection pugmaa
Wed acme to an,indemnify and keep harmless the City of Cuartha against
tr r'/1 liabilities,judgments,toss,and expenses which may in any way accrue against aid City
U Z in consequence of the&=tin&of this permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZA
Signature of ApplicaL Du.
HAZARDODO US MATERIALS DISCLOSURE Type of Roof
WIII theapplicant or futurenooccupantR.eor handle hazardous
u defined by the Cupertino Municipalipal Code.Chapter 9.11,and the NcAlth and Safety '
role.SA y. ON.25s3xaY!
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
trail hamolnus air conamiAmm As defined by the Bay Area Air Quality Management all new materials for inspection.
District?
OYce ON.
I have mo the haurdous materials requimmenu under Chapter 6.95 of the Califon
nia Hculth&SafelyGadA,Secdons 25503,15533 and 25534.1 undersand Nat if the building
does not currently haw a¢nam,thAl it is my responsibility to notify the occupant of the
mgalmmcou;which mostx met poor to issuance of a Ccmrcaa of Occupancy. Signature of Applicant Date
Owner or mthorimd agent Data All roof coverings to be Class"B"or better