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07030004 CITY OF CUPERTINO ' BUILDING DIVISION PERMIT :4. .3 PERMIT NO. BUILDING ADDRESS: 1018 SEPTEMBER DR PRASAD ADEM 07030004 OWNER'S NAME: PERMIT ISSUE DATE PRASAD ADEM 03/01/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p C LICENSED CONTRACTOR'S DECLARATION Job Description U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPOR kRY POWER POLE t=y in full force and effect License Class Lic.M t- Date Contractor ARCHITECTS DECLARATION 7 C-,Cl 1 understand my plans shall he used as public records )96 U.H Licensed Professional N OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the Z`C O following reason.(Section 703 L5,Business and Professions Code:Any city or county <W which requires a permit to construct.alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area ti t= (commencing with Section 7000)of Division 3 of this Business and Professions Code)or $440 i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36215020 .`RN Number Occupancy Type not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). as owner of the property,am exclusively contracting with licensed contractors to cdkstruct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractor's erase Law. It u�Sec. .B&P C for Wis ieasoa_ Owner Date q�� . WORKER'S COMPENSATION RATIONyI-'�`~'— - I hereby affirm under penalty of perjury one of the following declarations —[]1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manas bee bject to the Workers'Compensation Laws of California—DW AppBc - PmEku NOTICE TO APPLICANT.1,after making this Certificate of Excmptio,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY F~- 1 hereby affirm that there is a construction lending agency for the performance of (x the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Lender's Address U Q I certify that I have read this application and state that the above information is U. correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authome representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against � liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued )y: SOUI#�TIONS. ��ft22yy�t'.. Ado —1—d�— Re-zoo's Signature of Applicant/Contractor r Date HAZARDOUS MATERIALS DISCLOSURE Type o:'Roof Will the applicant or future building occupant stofc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes Will the applicant or future building occupant use equipment or devices which If a roc f is installed without first obtaining an inspection,I agree to remove 4. it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Dt3trict7 �No C Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant•that it is my responsibility to notify the occupant of the require rats wh' must be met prior to issuanc f Ccru to of upancy. r Signati,re of Applicant Date 1. All roof coverings to be Class"B"or better Date Owner or authorized aagentC-.��_ Community Development W 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF rUPEkTINO Build-Ing De artment JOR ADDRESS: PERMIT # OWNER'S NAME: 06AO GENERAL CONTRACTORFAX # I am not using any subcontractors: -, signature Date Please check applicable subcontractors and cont lete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date _ CITY OF CUPERTINO r-71(D 3CUC4 TEWPOWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: Owner's Name: �� Phone #: _ o�3 f Contractor: _ LI Phone: License #: © �� Jo Contact: Phone t Cupertino Busin ss License #: Building Permit Info: Elect ❑ Job Description: }��'Y�2- /vvt-1✓ s Residential i Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group ----9T-EMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING