06030058 CITY OF CUPERTINO ,
BUILDING DIVISION PERMITCUk .l�tACTR I NF',O,rRTI�ON �.
BUILDING ADDRESS: PERMrr 90.0 6 0 3 0 0 5 8
10255 LOCKWOOD DR
OWNER'S NAME: PERMIT ISSUE DATE
RAVI DAVALA 05/23/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 PLUMB
l� t�
Op LICENSED CONTRACTOR'S DECLARATION lob Description I hueby slant I a 14xad under provisoes of Chapter 9(commencing
wM Seonaa TOnO of Divisan 3 of thc Busmmasaed Professions Code.aed my Recent is
s� in mu farce and effect. HOUSE DEMO
int Lmmuccias Lm.0
Dam Comrsmier
DECL
ARCHITECTS DECLARATION
t 1 understand my plans shall be wand an public moria
Y
t W� Licensed Pru asianal
,0 OWNER-BUILDER DECLARATION
ji x I hereby a2rm that 1 am uempt from the Coni utars Lcce.Law for Ne
O o fallowing euon.(Section 703 1.5.Business ad Professore Cade:My city at county
3 g which requires a permit to wnuuct.aim¢Improve.demolish,at repair any stmenre $10000
prior m its issue..,as.mquiru the applicant for such Permit to file a signed atsbement
< thu he isliecesand parasol the Provisoes of the Cornerstone,License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business ad Professions Code)or
r .•
that he m camp,therefrom and the bus r«Use alleged assumption.My violation of
Section 7031.5 by am/applieat for a permit ubjecu the applicant in a civil penalty of r Occupancy Type
nes,mart the five hundred dollars(55(10).
❑I.uowueroftiepropeny,«mymploymawithwageuthemsatecompa Uon,
veld Pr le dons and the he Co.tsar's Li nnow La (ma(o Out apply 70th.Bus«af Required Inspections
also property
be
Cade:The Ces dao ars ndailm Law does Out apply tr rt owner of q p
progenyvelebuilds«improwach Impr,andwhodoessuchworkh rofffedthrough his
howempbymiproWor that such Impmsemenumoat inmsedora@nal tar ale0,
Wilder Nebuildingnalta ovemmntsmid diinoueyear ofcomove forft.the owe•
builder will Nve W burden of proving that K did m,build or improve(fir purpose of
sale..
u oa«r of the property.a aclusvely contracting with licensed amuanan e
ted Law
tieproject(Sec.nanoBuinmwedrty Pro wine
Widaoe:)TheCmuana. d \
«tee Lawdoesno,=it
an can owner ofproperty who buildsorant in'ft Neenseand
whoconnotes;LaM for aucb projeeu with aconummrte)Iivaxd pursuant to tie Convactafs
Liee.4w.
I.aempt undo .BBPCf Nu n
Dm
9 C CLARATIOA N
I hereby same under penalty of perjury one of Ne fallowing declamtionc
(haveand will trumudn a Certificate of Consent a xlf-iuure f«Wonkef,Compmn
sudor,u provided f« S«tiby an 37W of the Lab«Cade,far Ne pe formanx of the
work for which this permit is issued.
❑1 have ad will maintain Workers Compensation Im unite,u required by Scomat
3700 of Nan labor Code.for da perform.close work f«which this Rrmit massed.
My Workers CompeuWon measures Buser and Policy number m:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE r
(This som lan need nes,be eumpletod If tie permit is form hundred daBm(SIM)
or leu.)
1 canify dm,in the pereaanco of than work for which this permit is macd.Phall no,
employ any Perron in ay mm r b" mNeW C on
Laws of Cahlands.Dam
Applicant
NOTICE TO APPLICANT.If,aftor maid
OgMffterdficac of Exemption,9on should
become subject or tie Workers Compensation provision of the labor Code you mac
Q forthwith comply with such provisions or this permit shall be dcu«d necked.
CONSTRUCTION LENDING AGENCY
f, Ihereby M.NU Nem ma construction loading agency far Nc pufummuxeaf
C 9 Ne wort for which this Permit B issued(Sec.3197,Civ.C.)
W^n. Landers Nae
Lender's Address
U 0 1 certify dust 1 haw read this application and Onto our the above Information Is
{L.
c 6M I al x comply with all sty ad county oNiesmv and ren tsas miming n
0 f,) building convection.ad hereby andante,mpresenu,ives of this city to enter upon Oe
W above-mentioned property for inspection purposes.
(Wes)agree to ave,indcmniry,ad keep hamlet the City of Cupertino against
„y TaA ImbillUa,Judgments,costs and expenses which may a my way acme against sd City
V`z, to consequence of Ne{rating of this peal
^ APPLICANT UNDER AND AND OMPLY WTIH A`�` NON-POI NT Issued by: �&aa Date
sou �A S /2?1b-6 Re-roofs
Signature o AppliaulCnnuacer, f DS
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIO the applicant or future building occupmtaom or handle haardon ma anal
as deflned by the Cupertino Municipal Code.Chamber 9.13,and Ne Health and Safety
Cade.Section 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
C)Y.
Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
m huardon sr contain..u defend by the Bay Am Air Quality Mmagemem all new materials for inspection.
DsscT
❑Ya gyne c:
I haw read Ue herardeus materials requirements underChapber 6.95 of the Califon
-is Health h Safety Cade,Sectimts 8505,25533 ad 25534.1 understand that If the Wilding
does not cxmmly Nw ata Net it esihili,Y m ratify No axuleat or oto
mgsre poor ren anCatifkaeofoeco Signature of Applicant Date
«mthadrea age, - Dm All roof coverings to be Class mB"or better