06020156 CITY OF CUPERTINOTxx �NOW a vp
BUILDING DIVISION PERMIT r:CONTR�ACTUR T1 OimAho, µ
BUILDING ADDRESS: RADHAKRISHNA ADIGA PERMIT NO.0 6 0 2 0 15 6
1089 HUNTERSTON 21,
OWNER'S NAME: PERtAT ISSUE DATE
RADHAKRISHNA ADIGA 01 /08/2006
E; SANITARY NO. CONTROL NO.
vg- P53 -2-01`-0
ARCHITECT/ENGINEER:
B MECH
t� 0
3 W j LICENSED CONTRd under
DECLARATION lob DescriptlollV Alk `►G�ooU
`U 1 learbmr,7 "form that 1 am fth.Du under and
Pordons enCbaper 9(commencingmyIt.. is PSI RR
n; with Section 7IXIU)of Division 3 of Ne Business cab Pro(easlau Coda,and my license is
In RIn fame and.Decl ADD SUN ROOM (3 0 0 ' ) .
j Z License Clua
Dam TSConlD ��� �
.gi p mlor
■s` �AI rJ_/
9W ARCHyIECPSOECLARATION 2/28/06 CUST REFUNDED $4
I unMrwnJ my plane shall he rated u public mmNa
y cep Lmensed professional
p OWNER-BUILDER DECLARATION
9 n f I mea .(firmSu that I ant comp from the Cssimes Co :My c Law for tM
i p o which
mate..(Section 7(13 I.S.raciness and improve,
eeiaro Cade:My city at e caumy
which its ism•permit r eon Wuct.alma hnpmva,demolish of a sig any ummem
_Z tprior hatiouissnsnce,alearquims pft rovisions
for such Permit,aa Law(summem
FF � m,hculice,eJ Punuent to the of Division
of them BramosiVceua4w(Chapmr9 'Sq.FL Floor Area Valuation
y�$ (rot he Is engwim Schon l0nd of basisofr the
theeged exe nd prion.My
Cade)of $16914
that he le eaempl them(tem and de bssLL far tise alleged exemption.My vloudon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number - Occupancy Type
not marc than Rue hundred dollars(5500).
O I,as owner of Jen property,or my employees with wages u Weir into compensation, 36221002 . 00
w(Ilde that work.and the sanctum LL act handled oroRered purism(Sm.70th,BusinessRe aired Inspections
and Professions Code:The Con means Licensees tm
Law dot apply to in owner of 9 P
propeny who Wilds or Importer;thereon.slur who does such work himsel f or through his
awnemplaym,pmided Wmauchimpmme uemtmtinteMedaroRcudfotsem.if.
howew.We building or improvement is told within oro year of erampbetion.the owner.
builder will have the burden of proving slut he did not build or Improve for purpose of
sale.).
❑1,at owner of the property am combatively cenumsing with limsed eanuacmn On
construct me,pmjw(Sec.7044,Business aid Professions Cade:)The Conusctees U.
taus law dm not apply m an awner of Property who builds ar impow marten,and,
who contracts for each pojeete with a eanuulor(i)licensed pursue,or the Cannonades
License law.
O l am
manItra under Sm Bk PC this mAcon
Owner IT' YC �- Dam d,
WORKER'S COMPEN A770N DECLARATION
1 hereby eDirm under penury of perjury ane of the following declinations:
1 haw and will maintain•CedOnm of m selMnwm far Wodmh Compere
sedan,r provided for by
Lab by Section 370D of the Labor Cade.fu de perfannenec of the
work(ser which this pewit is lured.
O I have and will maintain Wmkces Compensation Insurance,as required by Section
3700af the Leber Cade.for me performance of the work for which this permit is luued. ,
My Worker's Compensstian Insurance carrier and Policy number see:
Gnrbw. Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu sectiorn reed not Wcovnumu d if tise Permit afar aro hundmd dellen(5100)
ser bean)
1 certify that In the performance rrofft�qthe WWwork for which this permit B lured,l"I am
employ Bay P.M.1.my mans l 016 hbecame subject m tie Worken'Compensndon
Laws of Califomla.D,AIm
ApPlic or LI -K[
NOTICE TO LICANT,If,after nursing this Ccnircam or Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mute
.J O forthwith comply with each provisions or Wu Permit shall be deacmcJ rooked.
Z tiCONSTRUCTION LENDING AGENCY
[-+ Ihereby e(Ertn that them its contraction bending agency for the performance of
fl+ me work for which this permit 4 issued(Sec.3097,Civ.C.)
WLanders Name
SL,
7 Z Leadeea Address ,
U0 I cadfy that 1 Mw read this application and tum mat de above information u
!" cormctt I agree or comply with W city and county ordinances and sum hat misting W
p SVS building construction,and hereby aumorim representative of this city in enter upon the
W ah were ationed Property far harmed.Purposes.
(We)aSm m save,indemnify and keep hmml.the City of Cupertino against
i—t h Iiabilitiu,Judgmenu.cow
SOURCE�EGand expeun which may in anyway accrue gains,said City
rene
U Z in t osege of the granting or this Permit. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t0—t�
Ui�k NS, r�I g I D
J' K Re-roofs
Signature of ApplearrWanuaaar Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant w future building occupant now or handle harerdom material
u dented by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Coca.Sudan 15531(.)7 ' All roofs shall be inspected prior to any roofing material being installed.
OYca ON.
Will the applicant or future building occupant rue equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
1,haurmus air conn inanu a dented by oat Bay Amo Air Quality Management all new materials for inspection.
DisuicO
O Yu ON.
I havem el the hviNtmsmamrialsrequiromenu under Chapmr695 of tie Califor.
nu Holth&Safcty Cade.Saliau25505,25533am115534.lun&nvs dtuirft Wilding
dm not currently have a tcnma men it u my respectability to badly dm occupant or the
mq m nmw hmuR met mmusnsnce.ra cenilicam or Occupumy. Signature of Applicant Date
Owner or authomedagent da Q— All roof coverings to be Class"B"or better
pint