00060006 CITY,OF CUPERTINO .. - '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: `
RUILUING7m I : DONEGAL DR hh PHRMIT1,00060006
owNra'sMRYANARAYANAN- 2 APPLIcA106Sp10472000
BONE: - - - SANITARY NO. CONTROL NO. '
o`• , ALL_ '
OOO ARC]111'ECT/HNGINEEIRBUILDING PERMIT INFO
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O DQ BLDG CLECT MEC IT
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Z O u= LICENSED CONTRACTOR'S DECLARATION Job Description
oz-n ]hcreM1y n]Bnn shot]tun lircnud under pmvisidns of Chapmr 9(camtnencing
pity wFS,Obr70mneroiskfoot3oObnBasinesxamlProrndonxCodwamintylicense 2772 ,LVG SPACE, • 431 GARAGE
is in full force and a • ! ,�� k— D•
�z a Licen<c Cl sat feat Lie, (,7 YH`J C
n° Dommtrecua t
/J .�ARCH P1I'ECtaw CoUGCLAH
I Iden and my pl lan+.hall be uuJ a public recoNx � •
E2 Lire ed pode,jimail
° o OWNFNBUILULR DECLARATION
1 hereby u . S that I m pt train Contractor Licen' Lu
tfor the
1-2�5z/v /C < toll ng n p IS i n7oJl5 Bu.'n a dP Ic C Jc Anycp aunty
y 1 1 t et d pr J 111 r p t any%fr ctua
s 3 m pd n n al reg 'e-thapplicantr suchpermtu rile signed statement .
Ed he is licensed
n m p :on- rm c t a r:l un La lcnpar9 Sq. Ft. Floor Area - Sc'1"At984TLi .
em nnenc ng w'In Section IDW)of O vixinn 3411h,Bu,irv,mad 1'mlexs int+Coded
sir thin he is exempt therefrom and the maxis for life alleged exemption.Any violation '
of Section 701I t by any applicant for a pi rmit subjects the applicant to a civil penalty
ofnntmnrtman Five hanarcd dollars1$500), , - ARMPO,99. 00 Occupancy, 'Type
I.as owner of the part or my employees with wages as their sole compensation,
will Jo the work,and the nature is nm intended or ofercd far sale(Sce.7614,
Business and 11 recisions Cude:the eomnmmr'x L'm'eoo Low does it.,didy 10 on 1.01• — FOUNBAM!ItNnspeetions
caner est preason,Who builds or improves thereon,and who don such work looser .
or flat t his own employees.provided that mcti improvements are not intended or n 102 — PIERS
-
oRercd for sale.If,hnwcver,the building or impmvemem is sold imin one year or
complc.Inn,thcnwnenhailder will lave the hu denof pawing that he did not build or -' 103 _ UFER `
improve har timpase of wle.). _
.171.as gwmernnnd ro crt 1.04 . REBAR
p p 7044.Rsinessycmtocssion,t 1r:)Ihrentrendrsm 105 — ANCHOR BOLTS
ncwd thedue,
project(Sec.4W4.Rosiness and Prnfesions Code:)The Commmor's - ..
License Law Jces not apply ao'an nsvner of property oho Wilds or improves thereon,
and ho contract,rnr such padecns with a contmctors),rcensed pursoam to the 1.06 SEWER & WATER
Comractorslr rerde Sec 202 '. UNDERFLOOR.'PLUMBING'.
❑n."or,tu t ender Sec. .B&P C for thix reason
Owher Dane 203 — UNDERFLOOR MECHANICAL
WORKERS COMPENSATION lircLARArIDN .204 UNDERFLOOR FRAME
Inercny amnn order penalty orperja;ry one nine Ralowmg dep'wail`mx: ,205 = UNDERFLOOR INSULATION '
❑ I have and .1vihmaintain f cby Seed or 3700 oat Its Labor roe for 301 — ROUGH PLUMBING
Com nation, he pmvif r for b Stenon JWX) of Its, LBM1nr Calc, fur the
01 o it base
noill ma.arknnwmchs this
Carmndtl ilian Insurance,
302 — TUB''& OR SHOWER '..
❑00f,hcLaborCode.for kerxcoouncr,ofthenance,a+rtyhthispeed by oriia, 303 — ROUGH MECHANICAL
17on nr me Labor code,for he pertornntnen,ar.me work mr which Into Penna is - -
"sued.MyWnrker'xCon;enxam�n msan,e carrier and Policy Boothe`are:
304 — ROUGH ELECTRICRL
Carrier: ,��'gFl NIicyNn.: f .S'4-d-
CH]Tlr—`i EXFMPfION r OM WORKERS' 305 '— FRAME
ICAU0 F
COMPENSATION INSURANCE 306 — HDLDOWNS -
('1his xedon ncid tat he cotnplemd If the pcorit ix infinite hundred dooms — t t
(Sioomelea) 307 .. INSULATION - 1
I anify mat in ate peffmandare of the work for which tax IaernIit is i....ed,l 308 — SHEETROCK
'had ,"Iemploy any porion in any morin,...ax to becomes x.br,,ria the worked' 309 EXTERIOR LATH -
Compcmotom Laos of California.Dam
Applicant' 310 '— INTERIOR LATH
NOTICETOAPPLICANnBuffer,naungmi CenircateofEzemhinn,you.mama 311 SCRATCH COAT
hecomem
bjeel Id the Worker's Compende a provisions or the Labor Code,you mus, '
forthwith comply, air such provisions or this permit shall be,deemed rcroked -
Z 0 „313 — ROOF NAIL
CONS'rRUC'I'ION I.It"NDINGAGENCY a
Iherebyatrrtrrthatthereisaconstructionlendingagencyforthepertamencet 501' - FINAL ELECTRICAL ENERGY-
of the work for which this permit is issued(Sec.3M.7.Civ.C.) .
i E Leader's Name 502 — FINAL PLUMBING ENERGY
z (.ender?;Address
m C ,
I nfyh tlx n J t natp above t
503 — FINAL' MECHANICAL'4
ENERGY
rect. g In comply d city d county a' and 1 ergs 504 — FINAL BUILDING ENERGYO V thbuilding t t dh by authorize representatives of this tyt t upon 505 FINAL ELECTRICAL n ap property rt p t npRwe
"—
Cy. (We)agree 1.case.indemnify adkphit less the ClyfGpct dist
V) liabilities,judgments, t. a expenses hchmyinany -y cs,agnnst. id 506 — GAS TEST
z City APPLICANT
UNDERSTANDS of,thegran A ofmtyym t 507 — FINAL' PLUMBING
OURCE REGU ATIONS. ANq,Wp/ C PLY N ALL NQ�'rPO P� -Issued by' — Date
Signature of Applindarcotnmcmr l/7/•�'X/`/ab� O{/Date IZC-roofs
HAZARDOUS MATERIALS DISCLOs4 tE 509 r' FINAL GRADE
Will Wimfi
ert, smorlaid.huddi «ce
aguperemramliandiena.ado,nanetial Type ofRoof510 FINAL PLANNING
as defined by the Cupertino Municipel Coi Chapter 9.12,and Be T eahh and Safety -
Coal eSection 25512(m7 PEN/ - 4. — F NAL PUBLI WORKS
Cl yes .All roofs Sha aai�ms a ,��.]mI,�por1�.!p aUyp�'QijIL,rj n final being installed.
N'"'theupplicentorfomre building occupant use equipment or devices which ,If a roof is in. ]Cd W7I tJPirst�OlTt�iSp n,i is 1ehion, I agree to remove '
emit huzuNnus Bir comaminanO ur JupnM by the lluy Area Air Quality Manugcmem _.
District?Yes. V•(/ all new mate) orins$ �n.WTI griderstands and will comply with
all non-pointMllAce-re O bis.IN-PROGRESS.
I have trial the haturders materials requirement%under Chapter 6.95 of me.
California Health&Safety Code,Sections 25505,25533 and 25534 l understand that
if he building dues not curremly have a Rom.that it is myrc billy m not ify the t ,
nwup;mt of the r a ircn•nix whhda mus he met prime m' ranee of n Ce ific to of
Germant -3' Signature of Applicant ,Date
owger nr no or, agnn, _ Da,e. All roof coverings Lo be Class "B_' Or better
OFFICE `