05110013 CITY OF CUPERTINOr-+ .mtq+w�a
BUILDING DIVISION PERMIT 'CONTRACI'oR TIF'C1 .LMAT.I01v '.;.
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BUILDING ADDRESS: PERMITNO.0 5110 013
7610 HOLLAMERRY 2L
OWNER'S NAME: PERMIT ISSUE DATE
ft RAJEEV PRASAD 02/10/2006
E: SANITARY NO. CONTROL NO.
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hemby affirm Nn 1 am Remand under provisions of Chapter 9(commencing
with Section 7")of Division 3 of the Business and Professions Code,and my license is
in Lice ufares ctax.deRe ADD 563 ' LIVING/FAMILY/BEDROOM
all DatenmCWs Canvalor REMODEL 1075 ' -INTERIOR
ARCHITEACLARATION
I understand my plans NHI be used u public records obb'#
It Liemucd Professional
J OWNER-BUILDER DECLARATION
+� 1 hereby aprome that 1 Are exempt from the Communes Lieenm Law for Oe
i 0 C fallowing mown.(Section 703 0.Business and Pmfessinm Code:Any city or county
5$ which requlr.a Permit w enmtruct,alter,improve,demolish,of repair My auueture
zM prior in I"issuance,also requires the applicant rarsuch Permit in file asigned statement ValoiZie996
�< Out he is licensed pursuant m the previsions of the Cenmcmr's License Law(Chamer9 Sq.Ft. Floor Area
B (commencing with Section 70001 of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis fm the alleged exemption.Any violation of
Section 70313 by any eppllcare for a Permit subjeets the applicant to a civil penalty of APN Number Occupancy Type
Out mom than Ran hundred dollars(SM. - 36229005 . 00
❑L reowner of the progeny.m my employers with wagas a Iha4 solecompensadon,
will do the work.and the wumum It satirumded ereBmrd fm ask(Sec.7044.Business Required Inspections
And Pmrealoes Cede:The ContraemYs Liable Law does me apply W an awaer of tl P
emissary who buildsor impwws dereon,aha who does such work himmlf ar through hts
own employes,provided thatwch improvements sm nal Intended mortared froom If.
hmvever.the built ingar impmvemant is sold within One Year of cmPtetrp.the owner-
Wilda wiB have the burden of proving Out he did rel build or Improve for Impose or
ale.).
❑1,u owns of the property,am exclusively contracting with licensed wnmxcwn in
cansmur the project(Sac.7044.Business and Professions Code:)The Conlramor's Lt.
Oman law does not apply to an owner or propertywho build,or improv thereon.aha,
who contracts for such pmjeeo with a conVsslar(U licensed Pursuant in the Conuaetoe3
License law,
0 1 am exempt under Sec. .B d:P C for this mason
Own. Data
WORKER'S COMPENSATION DECLARATION
1 hereby attune under pptiy,of perjury aro of the following declarations:
❑I have and will msinuin.Cemfiamof Come.m wlr-1.u.far WoecesC.pen. -
ution,as provided for by Salim 3700 of the Lahr Cade.for the Performance of the
work for which this permit is issrd.
❑1 have and will maintain Worker's C^mpemadon Instnmm,As required by Section
3700af are labor Cade.fm the performance of the work for which this permit i,Issued.
My Worker's Cm l ams and Policy num ram:
timer. a W Poliry No.: 1
RTIFlG OF EKQ4PI70N FRO WORKERS'
COMPENSATION INSURANCE
(This motion need not hecomplewd ifihe permit is forone hundred dollen(SIM)
or Mas.)
I certify that In the performance of the work fm which this pmdt Is issued.I shall not
employ any person in any manner leem er m the WorbecO'Compensation
Laws of CW forme.Da
Applies ��— r
NOTICE TO APPLI :If.a er making Nu Cemncaw of Exempuan,you shouW
become subjeet m worker's Compensation pmvisiom of the IaMr Code.you must
0 faMwith comply with such provisions or this permit mail he deemed mwked.
Z CONSTRUCTION LENDING AGENCY
t.^
. 1 hereby afrm Na them Is a Contaned.landing seg may(or de perfurmmax tar
a> the work far which this permit is Wood(Sec.3097,Civ.C.)
{IB QLarder's Name
0.z Lenders Address
U0 1 manly that 1 haw mad this Applicator,and sou that the above information Is
ITT E correct,I a{me m comply with all city and county eNwmostlnm,and most laws misting to
0 SV" building construction.and hereby sudrim repromnmiws of this city to enter upon me
Ila sieve-mentioned property for impection Purposes.LL (We)at"give,indemnify and keep harmless the City of Cupertino against
�•,�rA Ilabllims'ju c .costs and expenses which may In my way acme against said City
U,x In co nee/r)th�non{of that permit n^O l
�'+ APP CANyUNOOBfiSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (/
RC^ GU/ATIONS
—)—/.g —joy loRe-roofs
S u pilo anmmor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Appiiantmfuuue building empml"rc rehandle lumdous material
u dented by Oe Carpathian Municipal Cede,Chapter 9.13.and the Health and Safety
Code.Seem.25532M)7 `/// All roofs shall be inspected prior to any roofing material being installed.
[3y. $Na
Will the applicant r future building aaupnl use equipment or&-vita which If a roof is installed without first obtaining an inspection,I agree to remove
emh haysrdnp air conumipno As defined by the Bay Area Air Quality Mmagemem all new materials for inspection.
District?
❑Ws ),-No
I haw mW the hMandous materials arm under Chapter 6.95ofthe Califor-
niaHoal"SafetyCade,Sations25 3 stet .l undomand that if the building
Jes not currently haw a anent t u y illty m maty IM occupant of the
requirements which musth Poor t amara-enpuey. Signature of Applicant Dale
Owner aramthariana.gem Dam All roof coverings to be Class"B"or better B