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09060145 CITY OF CUPERTINO BUILDING DIVISION PERMIT J�)Rt? '►'� �i€�kY� PERMIT NO. BUILDING ADDRESS: 10081 CARMEN RD TBD — TO BE, DETERMINED 09060145 PERMIT ISSUE DATE OWNER'S NAME: MIR T'rndlPR A�WAMY SX14ftAMe. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description m r- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is TNKLE S S WA7'R HAIR INS TLTN — SUBHA SMITH MAIN LINE i<a in full force and cff, L / / Z �( Z 5_ Z Li — Lk.x PLUMBING PI) FOR BUS LIC t o Date Contractor ARCHrfECTS DECLARATION C< I understand my plans shall be used as public records 6 e U.y Licensed Professional O e OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Mp following reason.(Section 7031.5,Business and Professions Code:Any city or county <$ru which requires a permit to construct abet,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2355 i R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of API q Number not more than five hundred dollars(5500). 35701093 . 00 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 of 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 sak.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct 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 contractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exempt under See. B&P C for this mason Owner Date j WORKER'S COMPENSATION DECLARATION I( I hereby afftnn under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workces Compen- ,ahron,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. 0 I 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: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURAN (This section need not be completed if the permit Wf one hundred dollars($100) or Icss.) I cenifv that in the perform c of the w w this pc is issued,I shall not employ any person in any r so as me jest to orkcrs' m nsati Laws of California.D Applicant NOTICE TO APP ter Certificate of Exempli n,you should become subject to the Wo r s Comtion provisions of the Labor Code,you must Qforthwith comply with such provisio r this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) W Q L.endces Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is (L`­ corcct.I agree to comply with all city and county ordinances and state laws relating to 8 V building construction.and hereby authorise representatives of this city to enter upon the W above-mentioned prop0�y for inspection purpoxa a (We)agree to§fve,indemnify and keep ess the City of Cupertino against nF.t liabilitiesJ oss and rases which m in anyway accrue against said City % V Z in consee grantin f this permit Date 2 /-V/ ►-r APPLICERST DS AND W MPLY W L NON-P Issued by:SOURCTI Re-roofs re o t/Con °ale of Roof HAZA US MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall x inspected prior to any roofing material being installed. 0 Ycs �No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminant;as defined by the Bay Area Air Quality Management all new materiz IS for inspection. '.1rict? 0 Yes No 17 I have mad theardqus m vial requiremctlsuhder Chap 6.95 of thc Califor- nia Health&Safcty C ,$et`i1i 25533 anyl25s34.1 wide d that if the building does not currently , a ten t is my fy the upw of the requirements ' m rte' e,aCcrti of Signature of Applicant Date Date All roof coverings to be Class"A"or better O r thorized agent CITY OF CU PERTINO .. WATER BEATER CUPEI�TINO PERMIT APPLICATION FORM APN # Date: a Building Address: Owner's Name: / Phone #: 6 Contractor: Phone #: �4'3cr� UD�1 h ,�rn a�� �ti �� �i W�. Fax #: Cupertino Business License #: Contractor State License #: �Z- /Z � Contact: Phone #: �71513c Fax #: Building Permit Info: Bldg Elect ©— Plumb Mech �- Residential Commercial ❑ Job Description: Strapped ❑ On Platform ❑ Bonded [ New Location Replacement ❑ Valuation (cost of project)..z 3 Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 01/07/09 CITY OF CUPERTINO x WATER HEATER CUPEkTiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit P f 1 TRAVDOC Travel & B Documentation { 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `;UPEIiTINO Buildin r De artment OB ADDRESS: �� PERMIT # J loa �j C i. io / c� �ov e� �No 076 OWNER'S NAME: r_1 rN S 1q rn PHONE # 416,F : �'- GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signa-:ure Date Please check applicable subcontractors and com lets! the following information: SUBCONTRACTOR BUSINRSS 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