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CITY OF CUPEWHNON°z.
INFORMATION t
BUILDING DIVISION PERMITCONTRACTnR
BUILDING ADDRESS:
0596 LQNNA IN
VARADACHARI RENGARAJAN
PERMIT NO, 05090014
OWNER'S NAME:
PERMIT LSSUEDATE
VARADACHARI RENGARAJAN
09/09/2005
SANITARY NO. CONTROL NO.
ARCHDEC i`ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
, 9 (comencing
1 bemby affirm that 1 Am licensed under previsions ins of Chapsm
p
with Seedmo 9000) of Division 3.f de Busi. and Prrfessinm Code, and my license is
In OaB tome and erten.
REVISION --TRUSS CALS
License Class Lie. g
Das Contractor
NO NEW PERMIT ISSUED/ORIG. #04120154
ARCHITECTS DECLARATION
I understand my plans shall be used As public records
Licensed Pmferconal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Conoacmr's License Law for the
following mamn. (Section 7031.5, Business and Prorecdmu Code: Any city or county
which mqui. A permit to cmummt, eI., improve, demolun. rr mpoi, any amonewm
prior to its issuance, also requites the applicant forauch permit to file a signed summent
Ft. Floor Area
Valuation 0
that he if limnwd pursuant to the provisions of me Conuazron Umax Law (Charon 9
Sq.
(commencing with Season ]000) of Division 3 of the Business and Professions Code) u,
Met he is exempt therefrom and the basis for Ne alleged cxempdon. Any violation or
APN Number
Occupancy Type
Section 7031.5 by any applicant for A permit subjects the applicant to a civil penalty of
no, come man RK hundred datura (2500).
35919014.00
I, ss mwner of me Pmpmy, m mY cmplpyca with wage u Meir tele compensation,
Required Inspections
will do the work. and the structure is not sounded or offered for sale (Sec. 7044. Business
and Professions Code: The Connector, License Law doer not apply to an owner or
property who builds or improves themon, and who does such work himself or mmugh his
own employees, pmvidcd mat such improvements Are not intended or offered for sale. If.
however, the building or improvement is cold within one year of eompledon. Ne owner.
builder will haw Abs, burden of proving that he did wt build or improve for purpose of
sale.).
R1, as owner of the property, em exclusively contracting with licensed contractors to
cascud the project (Sec.n and Code:)The Conhercom Lid
�/
A weer of .,whoWi
cerise ttaw docs not apply m as owner of pactorm who Milds or improves thereon. and.
for such proXeu with a conuacnorti) licemed pursuant m me Contractor's
whence
\
Lace
License Law.
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WORKER'S COMPENSATION DECLARATION ) s _
1 heathy affirm under pcnaltY of perjury one of is following declarations:
V
1 haw and will maintain a CerdOcas of Consent to self-insum for Worker's Compcm
scion, As provided for by Section 37W of me Labor Code, for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compessadon Insuranm, As mquimd by Section
371M of the labor Code, for the performmm of the work for which this permit is issued.
My Worker's Compensation Insurance carrier end Policy number am:
Cmricr: Policy N.,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scNm need not becomplesd if the pcman u foronc htmdnb dollars ($10(y)
or lcssJ
1 certify that in me ptrfo mmm of the work for which this permit is issued. I shall not
employ any person in my n s ccome subject to the Workers'Compemation
Laws or California.�s
Applicant
NOTICE TO APPLIC : f. a ter making this Certificate or Extortion. you should
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this Permit shall he deemed mwkcd.
i
CONSTRUCTION LENDING AGENCY
1 heathy Affirm ire them iss construction lending agency for is perfurmarsc of
ed (Sec.
the work for which this permit u issued (Sec. J09T, Civ. CJ
lender's Name
Under Address
,
I Molly Nat I have read this application and sure mat me shout information is
'
moat 1 agsce to comply with all city and county ordinances and sore laws relating in
building construction, and hereby auiorim sp,esema Ives of this city to enter upon me
above-mentioned pmpeny for impection purposes
(We) agree to save, indemnify and keep harmless the City or Cupertino Against
j liabilities, judgments. casts and"remies which may in any way acme against mid City
In consequence or the grand., or this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO CEGULATIONS.
Re -roofs �f
Type of Roof
gig 1 °r
Signazure of Applicacarr Das
HAZARDOUS
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building me stun or handle ha�oAn masriai
luilb
de0ned by the Cupertino Municipal Code. Chapter 9. 12. and the Health anJ Safety
C
Cak.Secdone
All roofs shall be inspected to any roofing material being installed.
❑Ycs �Nu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
wBl me app0can, or future building=upon, user equipment or devices which
p,lic
i, harardnos air contaminants az defined by the Bay Ama Air Quality Management
all new materials for inspection.
isoin?
u y ❑ Ycs XNu
I have ma! the hicubris materials requirements under Chepsr6.95 orthe Califor-
_
ria HealthA, SafmyC0m, Sections25505,25533 and 25534.1 undersand matirthe Wilding
docs not currently have a mann, that it is my responsibility At notify the occurrent Of the
requirements which musticmcl prior m issuance of a Cenlficas of Occupancy.
Signature of Applicant Date
—�, on lbs
All roof coverings to be Class "B" or better
Owner
or Authrrirstl agcm W�