08060222 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR II�}EURMATIO'N'
PERMIT NO.
BUIt�I�+Q-g13QA LONG OAK LN TBD - TO BE .DETERMINED 08060222
R' ME:
PERMIT ISSUE DATE
SREE KUMAR PARMESWARAN 06/25/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHIIECrrNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uOp LICENSED CONTRACTORS DECLARATION Job Description
1 hucby turner that I am licensed under provisions of Chapmr 9(commencing P
with section 0)(1)ofDivision]trials,Business and propulsions Code,and mylicense is RMDL EXSTNG BTHRM(NON-STRCTRL) INCLD
N n fan fame andand elf
5ayg Daen 'J>5 Lio.« PLMB&ELECTRCL(605Q)
q Dau ''f�I`S DELL
e W As shall user DECLARATION
! 7 1 understand my plans slWl be usW as public records
JyU
goG Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby artu Nat i am ucmpt tient the Concaves License Law far the
O o following won.(Section]031.5,Business and Profeseans Cale:Any city or county
which acquires a Permit b consumer.almr improve.dcmoluh,or mpoir any amuse.
Z y Prior m its issuance.alta reports;the applicant for such permit to file a signed statement
S< that he is licensed purananl to the provisions of the Contractor's license law(ChaPbr 9 Sq.Ft.Floor Area Valuation
x1- reommemingwith Sce6m7000)af Divuion3efthe BuLnessu fusion Code)or $5000
yo
5? that he is exempt therefrom and the basis for the alleged exception.Any violation of
Section 7071.5 by any applicant far a permit subjcma doe appl¢vn to a civil penalty of Number Occupancy Type
net more than five handled dollar(5500). 34232051 .
❑1,as owner of the property.or my mploYoea with wages as trek sole compenxder.
will do the work and theiwwurc u m,intended or ancrod tarsale(Sec.]Obi.Business
and Pmfesdatu Cade:The Contaxmrs License law does rot apply b an arear of Required Inspections
property who builds wimproves Nemo.,and who doessuch workhimxlforthrough his
owns amplaym.provided that such;mpmvemenu art natim,Mrd aronerad farsale ff.
however,the building or improvement is sold within ars year of completion.the owncr-
builder will leve the buNut of proving that he did rot build w martens for purpose of
sale.). ..
❑1.as owner of the property.am axelusiwly camnxting with licensed anucbn b
construct the project(Sec.7060,Business and Professions Code:)The Cemmenerf V-
ecru law does at apply b an owner of property who Wilda or improves Nemo.,and.
who convects for such injects with a contractor(a)licensed pursuant to the Contractors
Lieenx law.
l urn�cramp,unndo Seer B d P C for this reason
IV WORKER'S COMPENSATION DECLARATION
1 bercby arm under pesWty of peOury one of f following declandone
1 have and will maintain a carade oaf Comerstoself-iaurafarwarkerscompen-
ation,as provided fns by Section 7700 of the labor Code,for the performance of the
work far which this permit is issued -
❑1 have and will maintain Workers CompensNon Insurance,as required by Section
3700 ofte later Code.far the performance ofthe work fw which this pe mit is ivned '
My Work r�sCto�m_pe aeon1 Ina,and Poll,�mark,am:
Camer��Polley ROM No.; J5-
CER IFlCATEOFFJ(EMP INSURANCE WORKERS'
COMPENSATION INSURANCE ,
(ThisseNOn meed ant bocoerpleed if the Permit is foram hunNcddollaa($100)
or less)
1 ceni(y ant in me Perfarmarbe of the work fns which this Permit is Mand.I a1W I trot
employ any person in any mannerx as or become subject to tre Worlaus Compensmare
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
became subject m the Workers Compensasian provisions of the Labor Coda,you mus
.J Q Forthwith comply with such provivasu or Nsh
is Permit all x deemed ravelled.
EM CONMUCr10N LENDING AGENCY
[-m I homily arm Na Nene tea casuesimt lending agency far the perfomanceof
E
7 this work for which this permit k issued(Sac.309-/,Ci,CJ
0 lender's Nam.
z lenders Adder
V Q 1 certify Nat I have mad this mrlicatine sed state that tW awns infatuation is
w H coma I agree b comply with all city and county ordinances and sum laws mining to
0U building construction.and hereby mthmx represenuuvra of this city to tour upon ft
W above-mentioned property for impaction purposes
F„G (We)agree to ave,indemnify and keep hamlass the City of Cupertina agues
liabilities.judgments.toss and exponsa which may in any way acme against aid City
t 1 Z in consequence of the grating of this permit-
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s0 REGULATIONS.
0/10 Re-roofs
arc of AppliaHAZAItamr Data
HAZVrun=b MATERIALS DISCLOSURE Type of Roof
Wilby Cu pent or fmura buildi upanumm or handle havNow mauriu
tleRSed Section
the Cupertino Mumci udc.Chapter 9.12,mW the Health and Safety
.Odor 25512(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes
If a roof is installed without first obtainingan inspection,I agree to remove
coult• Will Ne all cart or fubrt Wdd' aecupam tax equipment or devices which P
Dstrin�.ue air conuerinans u red by the Bay Area Air Quality Management all new materials for inspection.
❑Yes
I have mai tW Wudousmwcriaumquvcnuns under Clop orti.95 of the Califor.
nia Hcslth&SafciyCadc,Scctioa25N)5,25533and25536.lumkrsundthalfda building
dura l ally haw a tenant.tM,it u my respansihility b notify Jc occupant of tW
he whkhmusibcmet or i uan fecc0ifiwbafoccupaney. Signature of Applicant Date
All roof coverings to be Class'%{"or better
caner oranmoruaa agent au g