08020061CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BulLgjylc§p%TF NDLELIGHT WAY
K & DEVEL OPMENT INC
PER
0802802 0061 ,
ER'S NAME:
PERbD'1' LSUEDATE
RATHNAGIRI ARUNAGIRI
1060 W HILL CT
03/26/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)253-9787
ARCHITECT/ENGINEER:
BUILDING PERMTTINFO
BLDGIMECH
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LICENSED CONTRACTOR'S DECLARATION
lob Description
1 bcmby affirm that I am licensed under provision, of Chapter 9 (commencing
with Secllon7rai of DlVkian30fthe Busnesdand Professions Codgand mylkenmis
DEMO 1 STORY SFD
in full tome aM effett 4/ �]�,¢
Lkenm CI Lk. N
Dam Connector
a,,upC'
ADECLARATIo
all M used as public rocnnts
I undmsunJ my planas mail
Liccnmd Pmreass(anal
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from that Contractors Leon. Law far the
following mason. (Section 70313, Bminees and Pmfcumas Cade: Any city or county
'
which requires a permit W convect. alter, improve, demolish or repair my suuctue
prior to its issumce, also requires the applicant for Such permit to file a signed sumbeam
that he is licensed o the of dm Conumtor'sUcamm Law 9
Sq. Ft. Floor Area
Valuation
pursuant provisions (Chapter
12000
(commencing with section 7000) of Division 3 of the Business and Professions Cale) or
that he uu
cmpt Ibm eefsoand the bask for the alleged exemption. My violation of
36224054AUtTT'Pe
Occupancy
Section 7031.5 by any applicant for a permit mbjccu the applicant to a civil penalty ofNumber
rot tome mm five hundred doll. (M).
❑ 1. ae O..f the property, or my mployces with wages as done sok mmpensatim,
will da the work, and thesuunum k not rounded ora@red facaale(Sec. 7044. Business
Inspections
and
and Profeasiana CednContractorsContrux's License Lase e to an owe
donot apply r of
e aired
q P
Property who build, mmaime. theman,andwho daasahwmk himmlrorthrough his
awrempinYm, PmAded that meh improvemmu m mt intended oroffemd fmsale. if.
however, me building or improvement Is said within ane yam of compledm, the owar-
builder will have the burden of proving that K did not build or Improve for purpose of
sale.).
❑ 1. as owner of the property, am exclusively contracting with licensed convectors in
coosmet the project (Sec. 7014, Business and Profeadae Code:) The Ommac tens Li-
arae Law demands apply in an ower of property who build, or Improves flu mm, and,
who contracts for such pmjecm with a co mectm(0 licensed pursuant to the Contractor's
License law.
❑ Imaemptunder See ,B&PCfm Wsrmm
u Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following Ileclmtions:
❑ I ham and will mountain a Certificaeaf Consent to self-huum fm Worko's Camper-
sadm, a provided fm by Section 37M of the Labor Cade, for the performance of use,
work for which this Parrott is issued.
❑ 1 have and will maintain Workers Compensation Inmmnce, as Icquired by Section
3700.1' the labor Code, fm the pedoommoc.1' the work for which this psnnit is Issued.
My Worker, Compematian Insurance Carle! and liey number are:
CaOrIar. f Cb^1/. a✓oaAc Pa� o.: 1533 !?�e/
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(This to. sad not lemeopleed If the pe. I. 4 tura. hundred dodsrs(S Ito)
or kis)
1 coolly that in the performance of the work far which this permit is based, l shall not
employ any,coom in any manner an as in become subject to the Worlums Compensation
I. of C.1trunia. Dam
Applicant
NOTICE TO APPLICANT: If. after making this Ont riicate of Exemption, you should
haemo mbjnn m the Worker. Cmpcmtlan provi,iaus of the Lab¢ CSM, you muss
—
forthwith comply with such provisions or Nu permit shall be deemed evoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that then is a contraction lending agency for the performance of
Ne work for which lids permit is Wood (Sec. 3097, Civ. C.)
'
Lender's Names
Lender, Address
1 certify the 1 have mad Ibis application W state the the &hove information is
Manuel. 1 agra to comply with all city and county entireness and 3mm taws totaling to
Wilding convection, and hereby autharim representatives of this city W coast upon the
above-men6.ncd property for inspection purprto.
(We) agree to save. bad .m.if, and keep hemi¢ the City of Curacao. ag.WL
liabilities, judgments, costa and expense, which may in my soy scene against mid City
in consequeae of the tenting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
--tt
Issued by: Date J.
SOURCE REGUL AD s.
Re-roofs `--`---
Type of Roof
SignLLumofAppl(c ,num p ate
ous MATERIALS D1scl.osuRE
Will the a m (Muni beading arnpantzom m handle haantoand aerial
Caperton
RSec by the Cupertino Municipal Colic, Chapmr 9.12. and the Health and Safety
Section 255324)7
❑Yen �Ne
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuWe building occupant me equipment or denim which
Wait hoentoes air cmtsminnts as defined by the Bay Area Air Quality Management
all new materials for inspection.
Disuict7
❑ Yet Co
I have and the hu aNas materials requirements under Chapter 6.95 of the Califor-
meHealth &SalmyCWe,Sections 25505,25533 and 25534.1 undnsmnd itself do Wilding
dMJ al m rattly how 5 Mani, and it Y my espemlbility W Mtify me Moment Of me
requirementsw at be mel prior to issuance of. Ccnifeam ora pua7.
Signature of Applicant Date
_31104d-
All roof coverings to be Class'W' or better
ownerorauth
and Dam'