05010023 CITY OF CUPERTINOp
BUILDING DIVISION PgkCONTA2ACTORNFaR OL�ik,
BUILDING ADDRESS: PERMIT NCO 5010023
10335 FINCH AV V
OWNER'S NAME: PERMIT ISSUE DATE
SREENATH SREEKANTHAM
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LOO LICENSED CONTRACTOR'SDECLARATION Job Description '-
U C I hereby affirm that I am licented under provisions of Chapter 9(Commencing
zp, with Section 7000.)of Division 3 of Nc Business and Prufvduns COde.and my license is
„ NfmLforceand effeet WINDOW REPLACEMENT
p n z License Class Lic.0
Z;:aDau: Convacmr
ARCHITECTS DECLARATION
'y$rc 1 understand my plans shall M used as public records
3LLU
et Liccnud Professional
OWNER-BUILDER DECLARATION
e 3 I hereby affirm o n 1 am exempt from Ne contractor's License Law for the
pr' follwhich requires, (Section]ontr ct. Imssand n.demonsolish.
Code:An,.1,an mcounry
Kie whichitsisssncc.it h+canswcLalcor,imprr such
ticermit u,
me a signed
ignedummnt O
Fze that heiscented c.alsumquims the
ovisio so fnnuchpcnni'mfemac,Law(Cha mem Valuation
Natbe eslicensed pumion7 the of Divisionftheoc Contractor's Businessnd Professions
Code)or Sq.F[.Floor Area
rc��
(commencing is exempt
pt t1amio re and m basis forn 3 of the Business and on,Any
lMq of
i $ that Section
Is exempt Ncmfrom and or basis for the alleged applicant
to Any l pen lty of
not on7hn byany applicant farapmmilsubjecsNcapplicammacivilpenaltyof ¢ Occupancy Type
not more Nan five hundred dalton(ISW).
I,monerofthepmpny,mmycmployceswiNwgnmas irsolceompensation,
will do Nc wotk,and theswnum isnot intended,or offered forsae(Sm.7014,Burnes Required Inspections ..
and Professions Code:The Comsat,.,.License Law.does not apply to an owner of q P
property who builds or improves thereon,and who docs suchwark himself or thurugh his _
Own employees,provided that such improvements arc nolinu:nded or offered tarsale.If. � /
howevar,Nwn
e building or improvement is sold within one year ofcompledon.be oer- IJ3/ / O >
builder will have Ne burden of proving Na he did not Wild or improve for purpose of
sale.).
1,as Owner of the property,am on1mivcly convecting with licensed contractors to —
t a o ben Ne penject(See.7W4,Business and Professions Coil Contractor's Li-
cens,law dors not apply to an owner of property who builds or improves Ncrcan,and
who contracts for such projects with a momcmr(s)licensed pursuant to Nc Coneacmr's
License law.
❑1 oro ex pl uf9�tler Scc. /J/�� B h P far s mss
own / 1. /`rV<.v wf{/a' ) a¢ P S d
WORKER'S COMPENSATION DECIaRA
1 hereby affirm under Penally of per)uty one of the following declantions:
❑I have and will maintain a Certificate of Consent o sel6insumfor Worker's Compen-
sation,as provided for by Section 3700 of the labor Cade,for the performance of Ne
work for which this permit is issued.
I have and will meintsin Worker's Compensation Insurance,as¢quoad by Section
3700 of Ne labor Code,for the performance of the work for which this permit is issued
My Worker's Compensation lnsumnce carrier and Policy number aa:
Carrier: Policy No.:
CERTIFICATE OF EKEMPITON MOM WORKERS'
COMPENSATION INSURANCE
(This section need oat be complemJ if the permit is Bruno hundred dollars(SIM).
or less.)
1 unify that in d¢perfosmamc of the work for which this permit is issued.I shall not
employ any person in any manocrm as to become subject to the Workert Cnmpensnion
Laws of California.Da
Applicant
NOTICE To APPLICANT:IL after making this Ccnifica¢of Exemption,you should
become subject m the Worker's Compensation previsions of the Labor Code, no mull
w
forthwith comply with such provisions or this permit shall be deemed revoked.
O
Z"' domCONSTRUCTION LENDING AGENCY
E-t Ihcurbyah thi thmthcrc iaacrossvec.3W7.dingagcnry l'nr Nc perfmmenceof
U) the work fur which this permit is issued(Sec.309].Civ.C.)
Qcos Name Lemi
= z Lcndcr's Addm_v
U C I certify Nat 1 have read this applinmma and sum Nat Nc about inf.mralion is
Lk. (~ carted.I agree to comply with all city and county ordinances and state laws relating to
U U building construction,and hereby author¢reproscntatives of this city to cnar upon the
W ahove-mentioned property far inspection purposes.
H tl (We).,me m same,indemnify and keep loord s the City of Cupertino against _
1,0 liabilities,judgments,toss and expenses which may in any way secure against said City
U in consequence of the granting of this permit. U
— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date /
SOURC(RE CATIONS.
. I ) 0% Re-roofs
lureaf Appli. D,am mVCOmrmmr ---_
.` S2na HAZARDOUS MATERIALS DISCLOSURE Type of Roof
J Will the applicant or future building occupant store or handle hoiardous material
as defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Cade,Section 15532(,)] All roofs shall be inspected prior to any roofing material being installed.
C3 Y. �Nu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
Omit hevatdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District] J -
❑YCs lgklVV
I have mad the ha neouusmaterials requirements underlhapwr 6.95 ofthe Califon
ria Health&Safcly Cmlc,Secume,255115.25533 and 25534.1 underrate thutif the building
does not Cutrcndy have a lenank that 1)3 my responsibility to num.Iy thef thc
rcq�.c�wInk mean be mete9�,y�issuance certificam oracupa/cy. / Signature of Applicant Date
/ c�-crp i l� I/1YC3 I�u
f: 06orOr.mhodxcI.,cut j D,re All roof coverings to be Class"B" or better
First Floor- Kitchen
za "
CEIVED
!AN 0 5 2005
Replacing window with new double pane window
ApPROV 14E
,N PCCDRD NCE J PNCES
CUPERT
pATE
SIGNED „s and UPec+fi—
3hi� ,et of 0b at oll tltriad and R .
on the I chnndd or �ttBiatah`
lawfU1 to make any o drtnis$1dn {�
nn same without wCit•of�jj►kiftitfo,r
tike building Dept., ty
The stamPinB of th+s plana rhlt 6Pet,h bBl
SHALL NOT be held top !f6Yle!!rP
oDPro�al 01 �rdnarateoot ltoto�huw:
04 any -
• First Floor- study room
AM
z
Replacing with new double pane window r
First Floor - Dining And Family Room Windows
Replacing with new double pane windows.
w
u
S
Sg �l
s
® Second floor- Dan
4` u 15-7 OFFICE, CUM
Replacing window with new double pane window
' Second Floor- Master Bed
Replacing window with new double pane window
W New �i l
Second Floor- Second-Bed-Room
Replacing window wide new double pane window
Garage - Back Door
Bara Back Boor
Garage door
Replacing old garage back door with new door
CITY OF-CUPERTINO " - - - # ''<4 *a3 aeras ae
BUILDING DIVISION PERMIT -._ CONTRACTOR&INFORMAIQN
BUILDING ADDRESS: PERMIT Nth 5 0 10 0 2 3
10335 FINCH AV , V
OWNER'S NAME: - PERMIT LSSUE DATE
SREENATH SREEKANTHAM
NE: SANITARY NO. CONTROL NO. -
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
site, LICENSED CONTRACTOR'S DECLARATION _
C I hereby affirm Rn I am IiwvW under previsions of Chapter 9(mmmcncing Job Description - - -
< U wioSection7MI)ofDivision3oftheBusinevandProfessimmCode.andmylicenseis �{
d In mB come and erm9L WINDOW REPLACEMENT q®`Bs (/j{±sp Q
s n i Limme Clan Lic.P p 's�fl/cc_.ts, y
n=� Dam Commcwr H VU !!,u FE ..
ARCHITECTS DECLARATION
ai I undersand my plans shall bused ed u public retards
Sla
0 ty Licensed Pmfeaaional
MAY '3 2005
g OWNER-BUILDER DECLARATION
D o I hereby affirm See Nal 1 1. exempt arum the r Contrsctors Licrn c law Tor the •� ..
O O Following meson.(Section t I am,exempt
f and Professions Code:Any city w county
m(Li which requires a Permit to construct.altar,improve,dcmolLvh.Or mpoir any svuetum . . ^
FIy prior to ite issuance.also mquins lheappliesnt for such permit in rile a signed suamcm rev. �.....�
ss< realW is licensed puremon la LMpmvisimu of the Contractor's License UO,(Ch.pu,9 Sq.Ft.Floor Area . . - -Valuation
sl•O (commencing with Section TRK)of Division 3 of the Business and Professions Code)or
y that he u eamnpt therefrom and tk buss for Inc alleged exemption.Any violation of
Semon?031.5 by airy applicant for a permit subjecu lne applicant in a civil penalty of 6441019tkriberO " Occupancy Type
act mom than five hundred dollars(5500).
D1.as owner of Ne limitary,or my employees with wages as tneb mile compcnutim. -
willdothework,and the sanctum is not intended or offered for age(Sm.]041,Business
and Pmfesdons Code:The Conuactor's License Law docs not apply to an owner of .___-- - Required Inspections
property who builds or improves thereon,and who does such work himself or thmugh his
own employees,pmvidcd Nm such improvemmu arc not immndedaf onemd formic,If.
however.Ne building or improvement is sold within one Year ofcompletion.the owner-
builder will have the human of proving that he did not Wild or improve for purpose of
g 1.as owner of the propert,am exclusively convecting with licensed cumoustors to
o erect du Dmjeet(Sec.
7814,Business and Profesvom Code:)The Contractors Li- ,
come law does not epplY Io an owns,of property who Wilds or improves Thereon,and -
who<onlmcu aor mch pmjecu with a convactor(s)licensed pursuant m the Convectors _
Lkense law.
01.uy/�^pt u�Itlor Sec. B&P for s.
Own / )-/�'w•e eIe �.. s d
WORKER'S COMPENSATION DECLARA '
1 hereby aMou under penalty of perjury enc of the following deelantimts:
I hero and will maintain a Certificate of Consent to ul6insum for Worom's Compcn- '-
sation,as provided far by Section 37W of dm labor Code,for Ne performance of the
work for which Nis permit is issued.
01 have and will maintain WoCompensations Compensation Insurance,as mquimd by Section
1700 of she labor Codc.for the penormanm of use work for which this permit is issued. — -
MyWorkers COmDemation Insurance canner and Policy number am: —
Carrier. Policy No.: -
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thu union need not W completed if Ne permit is foronebundred call.(SI M).
nr thss.)
1 certify Out in thh performance of the..,it for which this permit is issued,I shall nm
employ any Parma in any manner m as in become Subject in tM Worlxri Compensation - - .- _ .. •�
Laws of California.Dam -- -" -
Applicant _NOTICE TO APPLICANT:IL after making this Cenifesc of Exemption,you should
Wemme auhjml m the Worker's Compmeamon previsions of the Labor Coda you mus
Q Z forthwith comply with such lumvisinm or Nis permit mail W deemed mvalmd.
z8 CONSTRUCTION LENDING AGENCY
�N+ Ihemhy affirm that there is a conevuclion lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lendch Name
z Lender's Address
L)Q 1 certify Net 1 have mad his application and sum Net Ne eWve information u
0 bunco 1 agree m comply with all city and county Ordinances and sou laws r upon t e /
Q V ahavingcationed mKnd hemhyauthari,emit,cumatives of this city to carer upon the (///
ahovc-(We)a cd pmpcny for emDection puryasea
F gy
(We)agree m cast,indemnify and tech harmless the City of against S id City
h liabilities,judgments.costs and expenses which may in any way accmc against said City \\
V z APPLI consequence UNDERSTANDS
S A permit. \J
^-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E LATIONs. �A ` /01
Re-roofs
\ i naturee(ApylicantiContrxctorata
HAZARDOUS MATERIALS DISCLOSType of Roof
Will the applicant Or future building occupant mre orbandle hnardous mamnal
as defined by the Cupertino Municipal Code.Chapter 9.11.and tM Hcmh and Safny
ads Scerum35532(x)?
0TieNo All roofs shall be inspected prior to any roofing material being installed.
Will Nc a Baanl or r tax e denim,which
a roof is installed without first obtaining an inspection,I agree to remove
pP g Occupant ant D equipment or de
mit haramous air mnuminanm as dc6ncd by the Bay Arca Air Quality Management all new materials for inspection.
Disvict?
Dyes �No
i have read Ne haeardnoos m``amrials nquimmenm under Chapter 6.95 of Ne Califon
nu Hca1N&Safety Cade.Sectium 255U5.15577 am125534.1 undersmM Nuif Na Wilding
does nor currently hoc a unanL Nal my rupomihility no notiry tM rcy�pan of Nc
mentF whiy�r moat Wmetp iaamante ora carUBnm or OemPaggy j S ignature of Applicant Date
//11t //�/�vc Me 1 N( / o
(_ oar O anthmnued oxen( I DA
— All roof coverings to be Class "B"or better