06040144CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
ONS REMODELING
PER"ITND' 06040144
ER'S NAME:
PERMIT ISSUE DATE
BANGALORE NATARAJAN
219 DEMPSEY RD
04/24/2006
PHONE:
SANITARY NO. CONTROL NO.
(408)946-4744
ARCNITECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB NECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 omby along that 1 am licnxd under provisions of Chapter 9 (commencing
with Section 7M) of Division Sof the Biomass and Paladins yCCode. teal my lkemcu
and aRCCI-
Ba
PROPOSED 170 SQFT. ICBG PATIO COVER
Licem.
Doul C
RNAL
ARCHITECTS DECLARATIONav
1 understood my Pima mall he wed u public rawds
ED
Licensed Professional
OWNER -BUILDER DECLARATION
I birchy alarm that I am aempt from the Committees Uccne law for the
JUN
following mason. (Section RD 1.5, Business and Professions Code: Any city or county
`006 $6240
which mqulres s permit m ..mesal slur. hnpmve. demolish, or minor my amstum
prior m its issuance, ales requires the applicant for such permit a file aligned aatcmcm
Law 9
�q. Ft, Floor Area Valuation
that he is noticed pursuant a des Provisions of the Cervantes Lata (Chapter
(cwnm n cing with Sccdon 70D1y of Division 3 of tbe Buonas ad ProrrAsia03 Cede) w
Nat he u attempt themfmm and the best& for the alleged exennption. Any violation of
Salim 7031.5 by airy applicant for a paten abjecu the APpOonl a a Civil Penally of
"00—Pricy 'type
nth awe than ism hundred dollar ($500).
_
❑ I, u owner of du property, w my employees with wages a their tele campenssUan,
will do the wwk, ss4 hha swnwe is an handed ororterel for age (Sm. 7a+. Buoteu
- Required Inspections
9 p
and Proletarians Cade: The COnvecuras Liawe Law does not apply to an owner of
-
pr open who bu ilds w impmvea Utmeon. andwho doessuch work himself w through his
ownemplaye s, provided dust such improvements am not immnded aroneredfwasln If.
however, the Wilding or improvement to mid within am you of mmpaion, the owner -
bonder win have tits burden of proving that be did Out build or improve for purpose of
ale.).
❑ 1. a Owner of Wes prepay, am exclusively convecting with licensed rontraman m
aanstroct the proka (Sec. 7044. Business and Professions Coda:) The Contrames U-
ceva law does not apply a an sumer or Property who Wilda or hmprom thneon, and,
who contracts for such projects with a canuarm(s)paned Mmms lm the Cantratoes
Lic ue Law.
❑ I sm aempt under Sea , Bd P C for thio meson
en Data
WORKER'S COMPENSATION DECLARATION
1 but aff rte undo penalty of perjury am of the following decla lutea :
❑ I ham and will maintain fiCauseme of Cansenl a elf-insum for Workees Campen-
sWon, a provided for by Santa 3700 m the IaWr Code. for the perf erg. of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Imurma, a required by Section
.
3700 ofda labor Code, for the eforinan. ofdm work for which this permit is Issued.
My Warkees Compensation hawream, carrier and Policy number am:
Carrier. -r�� Fykd Policy No.:?9e-00/OW
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
v
India section teed tet W cwaplewd Naive Permit t&foronshuntheddallan (Shoo)
or less.)
1 catify then in the perfommes of the wark In, which this Permit ts laced. I Shall riot
employ my person in my mannerm a a became subject a de Worsen' CamPmuWm
Laws of California. Data
Appllam
NOTICE TO APPLICANT: If. afar making this CeNncate of Exemption, yes Shout&
become subject a the WoheeS Compensation provisions of Ula laor Cade, you mug
comply with such providing or this paten shpt W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hemhy alliin that acre Is a construction lending agency for the perfomaao of
the murk for which the permit is issued (Seto 3097, Civ. C.)
Lenders Name
.
.
Lattices Addrang
1 certify that I have mad this spphicWm and sou Wa the some infomNun Is
l agma in comply with all city and county an ironces end suss tows relating to
Wilding construction, and hereby-uthorrre mprommahas of this city to tour upon the
above-mentioned properly for inspection purposes
(Wc) agree to ave, indemnify ad keep homeless du City of CYPenioo against
judgments. ensu ad Capt. which may in anY way game -9-103% said Clry
in eowequence of the grating of this pemlL
APPLIC NT UNDERSTAND ND WILL COMPLY WITH ALL NON -POINT
�7
Issued by: Date
SOUR�jEGULy70NS.
ab�....ao
Re -roofs
Type of Roof
iignetute of AppNcaMCan r Data
HAZAIUDOUS MATERIALS DISCLOSURE
Will the applicant or forum Wilding acupem gore w handle haamous maario
in, defined by de Cupenim hamming Code. Chapter 1, 11, and ties Health and Safety
. Section 25531()7
All roofs shall be inspected prior to any roofing material being installed.
❑Yca WE
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment at dcviaa which
emit haardnus air conusmiO3na as defend by the Bay Ara Air Guilty Management
all new materials for inspection.
Disuia7 —/
❑Yes �fhvu
I hew mad the Nardnusmaadals mquimrnc is undmChapar6.95 of theCalifor.
me Hof" Sarcty Code,SCCU=25705.25533 and 25534.1 undersand thalifde building
rias tet Curstradynew a urian at il'u spongla ly a rally on oceupmt or the
�Mq.,v n nmh_wlbe r aracwlw,tea
Signature of Applicant
'+a ♦�� LjPS�L
All roof coverings to be Class "B" oabetter
Owner w amorizod agent Dow "