05090212 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,C�INT"CTOR 4NFORMATIO.N n"ry
BUILDING ADDRESS: V MARTINICO AND SONS SHEET PERMRN0.05090212
1655 S DE AN
R'S NAME: PERMIT ISSUE DATE
LORD INDIA CUISINE 1776 SOUTH SEVEN 09/29/2005
NE:
SANITARY NO. CONTROL NO.
(408) 264-5717
ARCHITECT'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR underSDEsionof hap JobDescription�
u C ON
1 krcby afro Ws 1 am licensed u under provision of Chapter 9(commencing AAA
U with Saron'adeffec Division 3of NC Business arW Profrssinns CoEc.and mylicense u [] E®
Lifull cume leanderr«I. REPLACE (E) HOOD TYPE 1 p■�I
c�? License Clear Lim M
F O Dam C-
'J` ARCHITECTSS DECLARATION
3 I undersand my plans shall k used az public reardt /t�olCNT 2005
1a. Yr,sem` L
s n t�, Licensed Prnfessianul
=ms OWNER-BUILDER DECLARATION
I hereby alTrm shat I am exempt from the Convectors License Law for the cti. r5 f n �
H, following mason.(Semon IID I.S.Business and Professions Cole Any city or county t �as p Y `�
m which mquircermm co
s a pit nstruct,alma improve,demolish,nr repair any structure lel( GS 1188,0 0 0
prior it)its issuance.also requires the applicant for such permit to rile a Signed statement -
x
< that he is lice need pennant tothe provisions orpro Contractor's License aw(Chapter 9 Sq.Ft. Floor Area Valuation'
Y~S
(commencing with Senium Ta rad baits;
n 3for of the Business ee and Proression.My
Code)Cabo)or
Q�— that k u exempt therefrom and tk bazs far Ile alleged exemption.My vialatlon of
Section 7031.5 by any applicant for a Permit Writers the applicant o a civil penalty of r Occupancy Type
not mom Oct five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages az their sole compensation,
will do Newark.and the structure is not intended or offered for sale(Sec.1064.Business
and Professions Code:The Convacmrs License law dors not apply in an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself ter through his
awn employ=,provided Nat such improvements are not intended oroRered for ale.If,
however.the building or impmvemens 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
sale.).
❑1.es owner of Ne property,am exclusively contracting with licensed convectors to
conswm she
pmlc'I(Sec.% Business and Professions Code:)The Contrictiaa Li '
cense law does nal apply in an owner of pmpeny who Wilda or improvss thmaor.and
who contncs for such projcm with a conlfYmr(s)licensed pursuant m the Contraaoh
License law.
❑1 oro eaempt 'der Sec. ,B&P C far This
l/SHWAaV/ KR3 v/y'�/r
Data 29 0/�
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aoe of the following declarations:
1 have and will maintain a Cenificete of Consent to self-insure for Worker's Compere
station,u provided for by Section 3100 of the labor Cash.far Ne perfmmana of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,az required by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insunna carrier end Policy numkr a2:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITissuctum reed not kmiercred Utk permit is rmi nehundrtd dollen(SI W)
or less.)
I certify that in the performance of the wor for w(ch this permit is issued,l shall our
employanypersan in any reamnersn as to c reje'amape Workers Compensation
Law
s of Glifomia.Wae 9
Applicant /y.CHO Ien-1 4YJH7'/JYu
NOTICE TO APPLICANT:If,after making Nis Ocnifiam of Exemption,you should
become subject to the Worker's Compensation previsions of the labor Cndc,you must
.�Z forthwith comply with such Pnwiainns or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[- � I kmby affirm that there is a construction lending agency for the performance or
aNe work for which this permit is issued(Sec.3091,Civ.C.)
LQ 0 Le Of a Namc
= z Undies Address
U 0 1 amity that I have mad this application end sue that tk above inrormavun is
D. r- comet.1 agree to comply with all city and county ordinances and sum laws relating to ,
0 U building construction.and hereby autherim representatives or Ous city to enter upon the
C ve
above mentioned properly for inspection pugreca.
f' (We)agree to sa ,indemnify and keep harmless the City of Cupenino against
res liabilities.judgments.cors and apcnuns which may in any way accrue against said City
U in conscqucna of the RSTAgof thi{permi1.
r. APPLI-A N ftSTANDS WILL COMPLY WITH ALL NO POINT Issued by: Date
SOURCE U TIONS.
Re-roofs
Signemre of AppbcantrContncmr Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant Store or handle unernious material
az defined by the Cuperm.Metric Code.Cl apter 9.12,and the Health and Safety
.Section 25532/6)? All roofs shall be inspected prior to an roofing material beim
—I Yea Nv P P Y 8 g installed.
t If a roof is installed without first obtaining an inspection,I agree to remove
Will las applicant or eva building occupant sac equipment ter devices which
mil icll s air canaminans az recd by the Bay Arta Air Quality Management all new ma�r inspect
D vin?
—I Yes
I have mad Ne lose rdrms materials requirements under Chapter 6.95 of the Califor-
aiaHalth& it Cole.5...25505. 533am1M5 .i.n&..dO.if the Wilding
docsrane sly sac.mount.that it' risibility to notify tk$$$ou1se,or to
requimm w mustkmetpdor usoccoraCcrtiricateofOcctyfancy.� Signature of Applicant Date
9// /
Ownerar authorized agent Dap All roof coverings to be Class"B"or better