06040031 CITY OF CUPffIRTIN0 'Ps:�arer�x.� ,F>. .+'«,ettR§.e x- s=xA' +,a,"h9 I':•.
BUILDING DIVISION PERMIT CNRACTOR�INFO ERMA'TIQN.-
BUILDING ADDRESS: STATE OF THE ART BUILDERS ND 06040031
L0397 AMISTAD CT
PERMIT ISSUE DATE
R'S NAME:
VIVEK JAIN 3657 LOUIS RD 04/20/2006
PHONE SANITARY NO. CONTROL NO,
(650) 856-8509
A0.CHRER/ENGINEFA BUILDING PERMIT INFO
BLDG EI-ECT PLUMB MECFI
: Q LICENSED CONrcr5 SDECLARATION Job Description
1 bm,by aril m mm I am Ikcmm oodcr pmviriou of CLp«9(cammerame
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ms=d«rro). Dnn=rurBnmm Pdea m cm.wmrum� REVISE CEILING FRAME IN KITCHEN AREA
z
;.�jN full rniaaw east
,9: Lk,m,Cl.a Lm..
!E ARChI ECIS DECLARATION .
I wdcnunJ mY Plw,hall Ec used a pabB<ra«da
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o Lim acd Pm(c,sunal
OWNER-BUILDER DECLARATION
0 C I bcmby.(Sim Wu I am ansn Tura the k u.oar,LiMy ay o f«Nc
O folWvinP man.(Samm 7011.5,Buircss and Pm&rood Cuda:Any ca m amry
Ss ff wnkh raryw.pmmn W,«WncL aRa.W p^'�mmowb,m mpdr my,uva4,e $0 .
iy pi«a Its iaatu •also mNWmWc.pplkmt fol.1%psmilWrik a,leoN v>rrnlal
2s� Oat b,umnt
liaoao,pu . to lbc povielonaf the Cmlrs,ar'.U..L.v(aaPW9 Sq.FL Floor Area Valuation
3~9 (c«o nit villi Saban 70DD)of Divai Sof Nc Buina Profu,iau Cade)err
d e3 Oat be 4.,t haaaf.m vd We Wfe fn Ne ii uemPdm Any v 31atim of
S,aUml 7031.5byany.ppliamfor a p=it n,bjcw do appllam to a a IPmOr ar r Occupancy Type
,qt mart Wm Rae havdsed IWlhrs(57001
❑I,uo crook_Weft ,a •«my w7blm vkh waSauWevmle .Birma•
"Pr WevmtC mTbw cuei,nesI «aa,amfor ak(See.70./.Bnmaca Required CtlOnS
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cataaruct W=pajea(See.7014.Bust a,m Fafn,{om code:)The Coati 4 \\\J
Lav don mt apply W an oWna M paDatY vta bond,
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-W R 5 cOMPPNSATgN DECLARATION
1 h,ueby aBhm order peeaby of perjury a of We folbWinS
Q 1 h..e W v01 moo,,*a Cuuf WC«our,toxlr-Wu,f«w«hY,comtimi
udm.as paov Im by Sauan 3700 N me Labor Code.for m,prfarrai of the
u for wbkb oris parnit 1.toad.
I bate W wB m o,ain worlds Compmauoe Irlwnrae,u mqulrm by Scram
3700 d We Labrc cmc,f«de ptrformaoa ofde Wort f«White this Penna u ifti .
MY Workda Compo oo lnwrac artier and Pullry numbs arc
Carkr. PNiry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nlis , tt,uzlIDh,pamk la for ars Auntr,d douara(510D)
«ural -
I,vtify Wet b Ur pafinease d We wart r«White da,permit u ivuct I alun oa '
cmpb7•r0'P,rw^ mymmrerw ,a gb�vmemnimWWe�Y!.hc°'Commmtlm
Im of Calirefa..E¢_. (/ 1 J.^r
Appliam Int a. � r
NOTICE TOA U ANT:IC afWr matln5 WI,Ccadn^,"of Eumpfm,rm,I,ouW -
besome ambjm W We Wmtd,C«npcavWon pmvidm.err We talar cmc,you mrvt
O rorWwim comply wiW w vid
pip oau u pmm
or Wil.hall Ix,drncd rtaakm.
zy CONSTRUCTION LENDING AGENCY
[�. I hertby MIM Oat dere u.mr attcd.kmm�5 atercy for We Pcrfonnana a(
IY.> do Workfor WhWh boa pamit isirwd(Sm 3097.CN,C-)
6W. A Istdde Nime
�z LOW,fs Addie. .
nn:fy Nat I base rad oda a 1kiaim and my W,.me above Wontrii b
{ULD 1 emrtct l.tne W mmplr WW all city W many«dinucea"stew l.v,Miming
0() building muouclion,Whcrtby aulhmia rtprneauti.m ofNunly lo,nrcsupnth
Wabove-mendorcd property fm impeedon Nrp.
G (Wo)spree W arc,indcmn,Iy W tap hmm4a We City of Cupadm
C4 .eaina
/1 r.dBlk,JmemenWComo,too upeua which may W any ny a,vuc Madut aid City
U z in cov,9umce of We pmdn'of Wu .it Date � �✓�
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WfIH ALL NON-POINT Issued by:
\ 3 u REGULAT OV
—X--A
�� 7� Re-roofs
S' HAZARDOUS MATERIALS DISCLOSURE Dat, Type of Roof
win me q,pl «fame btfaims P.a«e a bank bnudm,ma.aW
as dented by We Ctryadm MtWclpal Code,maps 9.12,am We IM.Nm W Safay
',.Sealoa 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yn ❑Nu
P 11 We appl-ia,nt«furan baJmae accop,m =wiPmmt m Which If a roof is installed without first obtaining an inspection,I agree to remove
aoit haiaNaa+air,mnami.W u d,Rrcd by do Bay Arn Air Quality Mae,evnmt all new materials for inspection.
D wk0
lhaae mad do hmaNwanw,rWs rtquhaoe,m mderCNpa:r A9f ofine GVif«-
,v.F
lot
to i Oat it AM oeW25bilty WOottrld Wert iftle btulaive
don mI cmaWy Nrt.o-.m Wer k k my r,p,,,tlbillly W Hairy doe aa+gmt of de
which ° IpmWm "�d. m Signature of Applicant Date
All roof coverings to be Class "B"or better