06070162 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT '0
BUILDING ADDRESS: KAMAL KANT PERMITNO.06070162
10670 LA RODA DR
OWNER'S NAME: PERMIT ISSUE DAIS
KAMAL KANT 07/24/2006
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB 0
X00 LICENSED CONTRACTORS DECLARATION - Job Description U I Malay affirm mwe
at I me llCod under Provisions of Chapter 9(Commencing
wM Suction 7000)of Division Sof the Business and Profcaoaw Code.W my[I"=is
in full formandeffeet. 6 Z REPLACING AND ADDING LIGHT FIXTURES THROUGHOUT
;yaz Linenw ClW Lie.•
Date^T 71�th�Contractor DWELLING
r'' ARCHITECTS DECLARATION If
I undersand my plana Nall be tend as public records
!yU
Licensed Professional
t Oat I am exempt
from
DECLARATION
I<$ I naso .(Sem on I em,Business
from site Contraetoo License Law for site
:00 following moon.(SCosian 711314,Bminess and Pmfessiuw Cada:Any oily or county
$
which rat ulm a permit to construct,also,impmve,demolish,or mpoir my structure
Prior u is issuance.else requires Neopplicanl fnrsuch permit to file a signed summon,
i• < Na,heslicensed pursuant mthe provid rusofNeConwctor'IUccnmlaw(Chapter9 Sq.Ft. Floor Area Valuation
I $ (commencing with seethes 70K)of Division 3 of the Bushmen rod Profualaw Code)or $8000
that he is exempt therefrom and site bud for the alleged commission.Any vioutiun of
Section 7031.3 by any applicant for a permit subjects the Applicant to a Civil Penalty of APN Number Occupancy Type
net mem than nue haMwd dollars fISM).
1,as owner of the Property,a my employ.with wages as deal In cernp musa.m,
will do the workwd thestwcam is Out intended or snared for sum(Sec.7o14,Business 3693 Required Inspections
Md Prornec ons Code:The Contrwura Lleme don.1 dowt apply to w owner of q p
property who buhldsmimprom dmaon.and whodanauch walk Moselfor Waugh but
Own employers.prog or Improvement ouchimProwmenusaetrotl can fmaoEved fa ole.IL ��
houcer the aveUse oranlaveld within yeaofCompletim,meowns-
builds will have th burden or proving W t he did Cot build el Improve far puryo¢err
sale.).
❑1,u awns of the property,w ewlusiwlY cmuanin{with hawed mttractars s
commumt the Project(See.7014.Buaum and Prolesdaw Code)The Cmuacwh Ll-
come law dale sot apply w an owns of property who builds or Improe,W won,sad,
who cummcta forsuch inojeela with acenmemrfs)Ilanwd passant wtheCmuaetah A7 y �nry^
E]tarn Law. IfrJn
❑Ion nempt under See .B&PCfa Coes team �MUNI Orem Dau WORKER'S COMPENSATION DECLaRAD
101 hereby aRlm under isometry of perjury anc of the following dalvWonc
have and will mainWn a CeNfiwu of Gwentm self-lnsua for WorluYs Compen-
satim,an provided for by Section 3700 of the label Code,for the performance of man
woh for which this Permit is issued.
❑I have sand will maintain Workers Compensation Iwuana,u required by Section
3700 of the labor Code,for the performance of the wells fa which this permit is Wad.
My Workers Campental a artier ro
CERTIFICATEd Policy number aro:
tinier: �-�C oat Policy No.;
OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fries wctlnn need not becompleted Ifft permit is fame hundred all.(SIM)
nr Icut)
I caoily,that In the performance of W work for which this permil is Intend,1 shall not
employ anypermn in any muncrw u u bee mew et a tM W ry Compema0an
L.of California 0oto 9 b
Appliant �1�—]Y'
N come subject
to to
IL Mr ma n{m inion,at me Exemption,you should
�Obecome marnp y it Wash rS Compensation Pwvisi sua of W labs Code,you moa
forthwith Comply with such provisions or ria penniuhall he damW revoked. '
ZM CONSTRUCTION LENDING AGENCY
[-w I hereby affirm dot mem u a cowtruetion lending agency,far the perfamanceof
(w 7
the work for which the permit is Wised(San.3097.Civ.C.)
14~n• Under's Nam
CL Z Lenders Addrent
U0 I eW fy don I have,sad this applieanim W sate man Ute above itdam ndm IS
U.F cored.I agra to comply with all city rod money o dinanm and sum laws relating to
0 building construction,and hereby mthodre MPC$CmMim of this city to enter upon tM
[f7 ahow-mentioned property for inspection purpo¢a
(We)as.to saw.indemnify and kap harmless the City of Cupertino against
mFy N Iiabilides.judgmenla.coon and eapensu which may N my way accrue against said City
U Z in cowegamc of the grinning of this permit. / _LL 7—
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POIN7 Issued by: Date / _ I (�
SOURCE GU ONS
f� e4,j�k4 -7a�l b Re-roofs -__�
sigwurc A�pplianVCo arecm v Das
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the appll m,orform building weupant store m handle hound..manurial
as defined by the Cupertino Municipal Cade.Chapter 9.13.rod the Health end Safety
Cadc,Section 3333z(a)? All roofs shall be inspected prior to any roofing material being installed.
❑law
Will the applicant at future building occupant use equipment or dcvmM which If a roof is installed without first obtaining an inspection,I agree to remove
II harardsns air conuminanu lined by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have mad the hmandmts materials requirements under Chapter 6.93 ofthe Califar.
nia Health&Safety Code.Sedans 21707,15333 and 25334.1 undcnund Con if the building
docs no,cumnsiy ow a Cnsm that It es my rwpomlMlhy to notify W o empent of the
requlra�mc�e be PH a laaaana a fa canina.an faav�� Signature of Applicant Date
%,�2l a 61 All roof coverings to be Class"B"or better
Owner err autharived agcm Dam"