06090036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT .C, 0NTRAC.T()R IN „RMATIgN�„
BUILDING ADDRESS: CENTER-LINE CONSTRUCTION jTrrNO 06090036
22314 CU
ERS NAME: PERMIT ISSUE DATE
SANJAY & GEETHA RAO _ 918 WASHINQjQN ST 12 /OR /2006
P NE: SANITARY NO. CONTROL NO.
(650) 632-1501
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION Job Description
mF I thereby affirm Nei 1 am licensed!umler provisions of Chapter 9(commencing p
:Ztywith Section 70MI arthritics 3 ofthe ss O Busineand Professions Code.and my license is
a« iomnfret..d.feel. SFDWL-1ST STORY 2244 1 , 2ND STORY 1206 1 ,
,pz 4censoClass
Das Con C.Mr BASEMENT (LIVING SPACE) 1124 - , GARAGE 4371
!-p DEC
ARshall kTs DECLARATION
w 1 understand my pens shall bo used as Public records -
o Licensed Pmfessionel
OWNER-BUILDER DECLARATION
C 1 W retry.(Sct Nm I am exempt from Nc Canvacmrs License law for the
p O fallowing reason.(Section IID I.S.Business and Improve,
dtoons Code:Any city structure 1.9 which rtquiros a permit n concs oL ppic impmun,h pC o0sh,tare.sir any slramare
M priorsits lIssuance.
ensedpalso requites lhavisiosofarl to,ths,sucCohment's License
sutemcnt
Natal islittmeJ pursuam to Nc provisions oflW Conuacsr's l�carse law(Chapter9 Sq.Ft.Floor Area Valuation
`sp•Q (commencing with Section 7(100)of Division 3 of Ne Business and Professions Code)or $1005167
—
that he is eumpo thartfrom and the basis far Ne alleged aempdmt Any violation of
Section 70313 by any applicant for a Permit subjccu use applicant to a civil penalty of APN Number Occupancy Type
eat more Nan five hundred dollars($50(r.
1,u owner of Jz property,m my employcex with wage az Ne'v mk compewtion,
will do lW work.sell the a.,,..ismt Nsnded moBerca rarsale(See.7044.Business Required Inspections
and Profes9ens Cdc:The Characters Lircme Law does rot apply N m ma.or q p
Property who builds m i mpmves therm.,and who does such work himself e,through his
"a employees,provided Not such improvements art not intended aroResd for al.1f,
however.Ne building ar improvement Is sold within orc year of completion,IW owner.
Wilder will have Ne burden of proving that he did not Wild or improve far purpose of
sale.).
O I.as he,of the property.am exclusively contracting with licensed cenmctors m
construct the project(Sec.7044.Besin.s and Professions Code:)TW Contractors U.
cense law does not apply N an owner of property who Wilds or improves Ounces.and
who contracts for such projects wish a conuactor(s)licensed paraumt m Ne Connecters
License law.
r-1 Is.r — WORKERexempt der Se. .B&PCfmth 2a Raz0n
�t ,,a pate 1'1g�J'S COMPENSATION DECLARATION --
1 bemby alrmre under pcmhy of p dr orc of site folkwing dmlarations:
0 1 ham and will maintain aCc tificos of Cowunuo self-insure for Wmkcrs Cmnpem
ration,as provided far by Section 3700 of Ute Labor Cade.for the performance of the
work for which Nis permit is issued.
O 1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of Ne labor Code,far the performance of Ne work for which this pemil is issued.
My Workers Compensation Inm ance artier and Pulley number are:
Carrier. policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Nis section need not W completed if the permit is fmons hundred dollus(SIM)
or less)
I coni Net in Ne pe,rameneo of the work far which this permit is issued.I audit nut
emPloanypermn is my mamuome subt la thWorp r
Compensation
Laws ofCalifama.Dae 16
Applicant mo?
NOTICE TO APPLICANT:If,after malting this Confines of Eacmption,you should
become aobject m the Workcri Compensation provisions of the Labor Case,you most
.,2 Forthwith comply with such provisions or this permit shall he recmW revoked.
LZ..'O CONSTRUCTION LENDING AGENCY
(-+ 1 theaffirm that there isa construction ending agency far the performance of
C the were for which th s Permit is issued(Sec.3077,Civ.C.)
Wh Q Lender's Name
=;Z Landers Address
U Q I CCnify Nei 1 have Rad this application and Shue that Nc above inrOtraauml Is
Is.I--' Cosa 1 agree to comply with all city and county oNissames and state laws relating to
OO building conewaion,and hereby authorive Rpresenutives or this city to enter upon the
a how-mentioned property fm impecuou purposes.
F1 (We)agree to save,indemnify and kap harmless the City of Cupertino against
pI liabilities.judgments,costs and experomi which may in any way accrue againsl said City
of this Permit.
U z IAPPLCANIT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONSyt
-lam— m tu11 Data Re-roofs
Signature of Applicanl/Canttor " pas
HAZARDOUSMATERIALS
cupo DISCLOSURE Type of Roof
Will Ne applicant malum Wilding occupant sort or handle hazallous material
u defined by 25 Cupertino Municipal Code.Chapter 9.11.and IW Health and Safety
.section 25531(a)7
erns ON. All roofs shall be inspected prior to any roofing material being installed.
Will the appliCom or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havatdous air contommoom as defined by the Bay Area Air Quality Management all new materials for inspection.
DiWlf4
❑Yon ONo
I hove red do,hvvdeve materiais requiremcnu under Chapter 6.95 ofthe Califor-
his Hesidl&Safmy Cods,Sectimu 15505,25533 and 25534.1 understood dist if the Wilding
does ml ctooral holt a mane Nat itis my responsibility he ratify the occupmt of Ik
rtlmoon yawl+en mutekmet poor w issuance of a certificate of Ce paney Signature of Applicant Date
.�,
17 MIDIS
M. All roof coverings to be Class "B"or better
OwnJuthonsa ascus