04120066 CITY OF CUPERTINO . ... - -
BUILDING DIVISION PERMIT �"CONTRA.CTOR INFORMATION
'ZK ,
BUILDING ADDRESS: NU-DESIGN MANUFACTURED PE`U`""904120066--_ - `-
10270 S
'IER'S NAME: PERMIT ISSUE DATE - - - -
RANSAN KESHAVAMURTHY
ONE: - SANITARY NO. CONTROL NO.
(408) 374-4362
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRACTOR'S DECLARATION Job Description - =
,-C G I he b firm Nu I am limed under pmKvonl of Clupxr 9(commencing - -
U wiNSecia` xhasOof Div'ion 3 ofthe Busineaand fe ions Code.and myliccuc is
mmnm a eRee LieG' SUNROOM (345: SQ.. FT. ),
Con r -
AR HTTECTS RA r
'. I ndc Idns shall he
us
Oa
u Licensed Pmfcssmnal
+03 Dt I am cUIIDER DECLARATION _
7 I hereby affirm Net 11. exempt from me le Contractors Co License law for to " - - - - - - - - -
_O 0 following rosson.(Sccum 7117 L5,Business and Rofessiem Code:Any city or county
m� which rul a peri,us construct,alar,improve,domolixh,m.,.it any swnure -
prior.ita issuance.Also requires the applicant for such Permit m rile a signed ataxment
5n mat het.licensed p.mount mthe Pmvisiimscfthe Contractor.LhronxLaw(Chapter9 'Sq.Ft. Floor Area Valuation
st-0 (commencing with Section 0000)of Division 3 of the Business and Profusions Cale)of
i $ this he u evempt memfom,aM the bass for the alleged exemption.Any violation of
Section 7031.5 by ury,applicant for a permit subjects me applicant •civil pcndty of �et0 0 - -- . Occupancy Type -. _ ....
not mole than five hundred dollars(5500).
• ❑I,u owner ofthe property.m my employ.with wages u their sole compensation,
will do me walk and the swmam u not immmdcd w.head forsale(Sec.711M.Business _
and Proressiosts Code:The Counselor's Limme,Law does not appy m an owrtu of . - Required Inspections
propvtywo builds or improves thermn,and whodousuchwork himse)for through his
own emplonea,provided Nat such improvements are not intended oroRered forate.If.
however,the building or improvement is sold within one yeu of complcuou.me owner- - -
builder will have me burden of proving mat he did not Wild or improve for purpose of -
sale.).
❑1,as owner of dm pfopeny.am uduaively convecting with lid mmracbrs m
...met the pmjen(Sec.7044,Business and Protetiou Code)The Conuxbts Li-
cmue Law docs not apply m an owner of property who Wilds or improves.anon.and
who contracts for such projects with a contracui licensed pursuant the Convertor's
License Law, -
❑IamexemptunderSee ,B&P C for this reason _
Dam
WORKERS COMPENSATION DECLARATION -
Iherebyafrumunderpenallyofperjuryoneofthe following declarations: -
-
IhsveandwillmaintainaCerofies¢of Consent to self-insum for Worker's Compen-
orio t.as provided for by Section 37W of One labor Code,for the peff..sxc Of the -
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
17M of tabor Cade.for mcpcsfarman 9rthewnrk lowhich this permit is issued.
My, eft Asa o ea er and Policy number am:
Cartier. Policy No.:
CERTIFIC OFEKE PnoN FROM R ERS' _
COMPENSATION INSURANCE
em(This secton Aeedat W c.ordowd ift - - -
Notroddollm($100)
of los.)
I cenifv mat in the perfosmanee of the work for which oris Permit is issued.I shall not
employ any person in any mannerso as to become subject mme Workers-Compensation
Laws of C.1if..is Dmc
Applicant
NOTICE TO APPLICANT:If,afkr making this CeniRcam of Exemption,you should
become subject or the Worker's Compensation provisions Of the labor Code,you must
.Jz feMwith comply wit such previsions or this Permit hall he deemed mveked.
z O CONSTRUCTION LENDING AGENCY
P:4 1 Mushy alarm mm them is a conswctinn lending agency for me Pcrformarcc of
:9 > to work for which this permit is issued(Sec.3097.Civ.C.)
W
in Lsndcr's Namc
= z Iandefs Address
V Q 1 certify mat 1 have mad this application and sox that the above information is
t" correct.1 agree to comply with all city and county ordinaneu and state laws misting m
�('J building construction,and herby authprim representatives of this city to enr upon thc
D.1 move-mentioned Property for inspersion Purposes
G (We)agree to save,indemnify and keep harmless the City of Cupertino agaiw
fq liabilitiujudgmcnts,costs and expenses which may in any way recrue against saidCity
V z Aconsequence
PLIC ucnccof the granting STANDS of thisAND OMPLY WITH ALL NON-POINT Issued by: Date
SOU GULATION . _
zpflol"D f Re-roofs
Sig u of ApplicatuCroracmr ��__���1��/� Than,
HAZARDOUS MATERIALS DIS{.mmet Type of Roof -
Will the applicant to
future building uccupro ststem or handle heommus maxtlal
as defined by dx Cupertino Muni I Code.Chapter 9.12,and the Health and Safety
7�q,
c,Sccuon 25532(a)? � All roofs shall be inspected nor to an roofing material being Installed.
0Yes 1� P P Y g g
Will the applicant or future building occupant taw cycipr orm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t haurdous air conmminanu a fined by d.Bay Area Air Quality Management all new materials for inspection.
1hdvc mxl the hanNnus materials requimments under Cltapxr 691 of me Califor-
Hcalth&SafetyCade,Sauom25X15,255JJand2553d.lundcrsundNetifthe Wildings not eta dy hmc a renan4mmit s m spouihility to notify the occupant of the
ite hich must tPu to co a.ofOceopa Signature of Applicant Date
rte oreuthorirtdagcmDat All roof coverings to be Class"B"or better v