08010023 I
CITY OF CUPERTINO sub „a n AHR„, r�fc� y ra�y�,�� xa" •I
BUILDING DIVISION PERAU'i' *� ( ;7( AOR
euaTft� `!EstUGGLE PL PERMIT NO.
ALL SEASONS REMODELING 08010023
OWNER'S NAME: PERMIT ISSUE DATE
HARI GOPINATHAN 219 DEMPSEY RD 01/29/2008
JNE:
(408) 946-4744 SANITARY NO. CONTROL NO.
ARCHITECI(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sao LICENSED CONTRACTOR'S DECLARATION Job Description
rd u 1 hereby affirm that I am licemecl under provisions of Chapter 9(commencing p
with Section 70f10)oMivisio.3 of the Business aan7n�dd Profesalm uCode,and my licca.is ADD 13 ' 9"X14 ' SUNROOM 175 ' , ROOF NOT INCLUDED
nzN in fun fare.anda 8620 IJ
a, Lkenac Chu Lk.N
F, Dam Contractor L
e ARCHITECTS DEC L I�TATION
yo
le.,U I summand my plam M$II k used u public reINcords
I
ate Licensed Profcuimed
5 01 OWNER-BUILDER DECLARATION
<S I hereby affirm that I am exempt From the Conmemes License Law for the
E 0 O following mason.(Section 711314 Business and Pmfeuiou Code:My city or county
$ which amulets s panni'm construct,stmt,impmw,dem.11m.or repair any stroetum
zY prior m its issuance.also mquiau me applicant for such permit to file a signed Montreal
k h that licensed pursuant to the provisions of the Convector's Limnu law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7WO)ofDivision3ofthe Business and ProfusionsCoca)or $10000
`<.. mat he is exempt thamfmm and the buts for the alleged mamption.Any viouthan of
Section 70313 by any applicant for a permit ubjecls me applicant to a civil penalty of Number DCGu anC e
asst mum than few hundred dollars($503). 37534065-
P Y TYP
❑1,u Owner of tine property,or my employees with waiex as their ach compewtion,
will do the work,and the suuctum is an[marauder!or offered for sale(Sec.70/4,Business
and Prefaulom Code:The Contrumoh Limue Law clan act apply se m owner of Required Inspections
property who buildsorimprows thereon,and who doessuch work himself or through his
own employ=.I melded that such improwmmts me not mounted 000Qered for sale R. .
however,the building or improvement is mid within am year ofcumpletion,the maner-
builder will haw On buNen of prem,that he did ret build Or impmw fm purple of
samJ.
❑1,a owner of the property,are exeluiwly contracting with licensed c9ntrxton to
cmutmet the project(Sec.7014,Business and Pmfeasiom Cade:)The Contractor's U.
acme law does not apply to an owner of propcny who builds or impmvu lemon,and
who contracts for such projects with acontranor(s)licensed pursuant or the Contractors
Lkeme Law.
❑lomesemptundm Sec ,B&PCrmd ismama
Owner Data
WORKER'S COMPENSATION DECLARATION
I kmby aIDrm under Penalty of perjury rn of the fallowing decl"mrs,
❑1 haw and will maintain a Cmadiieam of 0meam l to self-iuum for W"Ike.Compm-
titian,as provided far by Section 3700 of the Labor Code.for the performance of circ
wool,for which this permit is issued.
❑I have and will maintain Workers Compensation luorsom,u required by Semon
3700 a(the labor Code.for the pcafarms"a orthe work for-which this permit is issued.
My Wmimye.Compeuation ince qac"rim and Policy number amw�s�Q�p [.
Carrier.-j� Pollry Na.;,----, pVOIp
CERTIFICATE O XEM MON FROM WORKERS'
COMPENSATION INSURANCE
(7mhscme.mednot becumpica d lfthe permit is forma hundred dollan($IN)or las)
I acetify dent in the performance of the work for which this Permit is issued.I shall rat
employ any person in ay m pperm as to boom.subject a are Wmkrs'Compensation
Laws of Califamia.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should -
become subject m the Workers Compensation previsions of the Labor Cade,you mum
.J O forthwith comply with such pmvhinm m this permit$hall k deemed newked. r '
ti CONSTRUCTION LENDING AGENCY
[--� 1 kmby allow that them is a cotmreednn lending agency for the performance of
Ri > the work for which this permit is issued(Sm.3097,Civ,C.)
W�Q lender's Namm
Lender's Addrep
t.7 Q 1 certify that I haw need this application and state that the show information is
Iy correct.I agree to comply with all city and county ordinances and stem laws misting to
Q building consmtction,and hereby mmorim repre e,sum of this city m enter upon the
above-anentianm property Fan Inspection purples.
(We)agree to sew,indemnify and keep Mmticu cite City of Cupertino agonal
ti N7 inco sedum gree ts.the Sonadofpemeonnit. may In my way accrue$galneluid City
t.)7 A APPLICANT
of me UNDERSTANDS
"f mu pmmit.
r7 APPLICANT U�{N;gDERSTANDS ANO WILL COMPLY WITH ALL/NON-POINT Issued by: Date
s—� �y(E 1(/Ylfil�r. �/ 2MI f Re-roofs
Sigatum of AppllcanVComismor Dam —/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building mcupant stare orlo ndle Ma Mom material
as defined by the Cupenina Municipal Cade.Chapter 9.11,and the Health and Safety
cm., enzss3z(ar
0 All roofs shall be inspected prior to any roofing material being installed.
Yu 'r�+a i
Will the applicant or future building asupant um equipment or dcviaca which If a roof is installed without first obtaining an inspection,.I agree to remove
.mit ha1atdoes.1,comma i...0 as defined by the Bay Arm Air Quality Management all new materials for inspection.
District? P
❑y.
I haw read the hwmam materials requirements under Chapter 6.95 ofine Califor.
nia Health At Safety Cade.Studom 25505,25533 am125534.1 undemad that if the Wilding
dace amt currently haw a tenant,that It h my responsibility he actify dire a¢upmt of tis
requi mniswhi tkmet arta yin f amficamorG`p SignatureofApplicant Date
Do.D
L vv C 1 o. All roof coverings to be Class"B"or better
Owner or authomcd egcnt " "