04060231 CITY OF CUPERTINO
BUILDING DIVISION PER �MIT C-0NR T"CTOINFORMATIONx a,
BUILDING ADDRESS: VISHI. NATARAN PERMIT N`04060231
10280 FARALLONE DR
OWNER'S NAME: PERMIT ISSUE DATE
Adbk VISHI NATARAN 10/19/2004
[: SANITARY NO. CONTROL NO,
ARCHIT13CflENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB M[CH
al" LICENSED CONTRACTOR'S DECLARATION
51 hcmby arum bar I am licensed ander po,vWmo or Chapter 9(Commencing lob Description
zees with Section 7004))of Division 3 ofdu:Business and Pmfcssinm Cade.and my license is
C3� inruurn eanaerr«I. ADD 340 SQ. FT. (FAMILY RM/OFFICE/CLOSET)
p�3Z License Class Lic.N
L F O Dae Contractor
ce ARCHITECT'S DECLARATION
i=¢ I understand my plans shall he used as public records
it U
o Licensed Prom,xiunal
` a OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 9031.5.Business and Professions Code:Any city or County
m which mgoims a Form, construct,aler,improve,demolish,or repair any structure
prior In its issuance.also mgoims the applicant for such permit,file a signed statement
that he is license)pursuant o the pmvneions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
"n (commenci ng with Section 70C(Baf Division 3nfthc Business and Procesinns Cndc)ur
i that he isxempt therefrom and the basis for the alleged exemption.Any violation of $36441
Section 1031 .5 by any applicant for a Permit subicula the applicant to a Civil pcnahy Of - APN Number Occupancy Type
not mme than Bvc hundred dollars(5500).
1,u owner of the property.Cir my employees with wages u their sole compensation,
will do the walk,and the seucture is not intended or offered for sale(Sec.1044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who docs such work himself or through his
ownempinyudenpfmcm nedor eemd for mic.Ir.
however,the buildingorimprmvemetissold
within one yarofcompletion,Ne ene-
builder
-/�
will have the burden or proving that he did not build Or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contouring with licensed conuacmrs to
construct the project(Sec.1044,Business and Professions Code:)The Contractor's Li.
cense law docs not apply to an owner of property who builds or improves Ihemon,and. O,C\
who contracts for such projects with a contraam(x)licensed pursuant to the Con mmor'x V
License Law.
[�I am exempt under Sec. ,B&PC for this reason
Dat O -
\ ER'S OMPENSATION DECLARATION
G Ihucby affirm under penalty of perjury one of lhe`IZZog declarations:
1 ha¢and will maintain a Cenifcac of Consent to self-insure for Worker's Cumpem
smmn,as provided for by Section 37W of the labor Code,for the porformance of the
work rte which this Ixamil is issued.
❑1 have and will maintain Worker'x Compensation Insurance,as moluined by Section
37M of the Labor Code,for the performance of the work for which Nis permit is issued.
My Worker's Compcnxation Insurance canner and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need noUte completed if the permit is for one hundred dollarsduos))
nr Icss.)
I eenifv that in the qe fommnee of the work for which this Permit is issued.I shall not
employ anypermniga nermulgheC �bj/cn to NC Workers'COmpensalion
Laws of California.131�c ice`_----
Apo lca t
NOTI NSPPVACANT:If.alter making this CenflEcac of Exemption.you should
beco j c the Worker a Compensation provisions or the labor Code you must
.J z roabwilh comply with such provisions or this Permit shall M deemed revoked.
zCON STRUCr10N LENDING AGENCY
j-. I hereby affirm that there is a construction lending agency[or the performance or
CL the work for which this pemtir is issued(Sec.300,Civ.C)
D] Lender's Name
0. Lcndcr's Address
nz
V O 1 candy Nat I have read this application and sone that the above information is
Fcorrect.I agree to comply with all city and county ordinances and sus laws relating to
pU building construction,and hereby auromire represemaivea of this city to enter upon the
r Lt1 ahoyment(We) cd pmpcny for inspection
mnify an keep ha
(We)agree to Cavi,indemnify and which
harmless the City or Cupertino against
UZ incoitics,jnce of thecostsand of this Permit. may in any way accrvc against said City
U z A APPLICANT
of DERSTAN of this permit.
�-^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
IZ1 — i;��9-D e/" Re-roofs
9 narere or An h�aomr 0.1.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stem or handle b raduus material
az dcfncd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
code S«rias z5532
(O' All roofs shall be inspected prior to an roofing material being C]Yes No P P Y g g installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ha..amous air canurminamx as defined by the Bay Area Air Quality Management all new materials for inspection.
tiC1,
❑Yes
I hove mud the harmterials mquircmcnts under Chapter 695 of the Califor.
Nie Health&Safely Code.Sectio,255115.25533 and 25534.1 undcmand Nat if the boiling
does not Carmody have a tenan4 that it IS my mxponsihillty les moi fy the rstcupant of the
regnir�ncnla which must nT� pnmmm
ismcenn cemrcam lxancy
arennSignature of Applicant Date
J All roof coverings to be Class "B" or better
Owner Or ambuirtrir agent Dam