06010106CITY OF CUPERTINO
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' GONTRA-TORWINI�'URMATIQN `�
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMITNO. 06010106
10596 LONNA LN
ER'S NAME:
FERMTI ISSUE DATE
VARADACHEVI RENGARAJAN
02/14/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG EIF.CI PLUMB MECH
1� 0 i
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Wreby .111m,Thal 1 Am licensed under previm..s of Chap e, 9 remannndng
p
wit Section 7070) AID ivialon 3 of to Businusand Profcasinns Codc, and my liccnu t
in full fame and effect.
REVISION --TRUSS CALC'S
License cline
NO NEW PERMIT ISSUED/ORIG. #04120154
nturttr
Dau Calr
ARCHITECTS DECLARATION
1 understand my plans.hall W used As public meets '
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby olTlrm that 1 am exempt from to Contractors License Law far the
fallowing reason. (Section 703 1.5. Best. And Perfesvitts CaM: Any city or county
which requires a permit to contract, alar, improve, demolish, or terror my structure
prior m is issuame. else mquircs the applicant forsuch permit An file a signed statement
wt he is licensed to to Commuoves Littme Law (chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions of the
(commencing with Semon 7") of Division of to Business and Nafcuions Code)or
$ 0
tat he is exempt demfrom and to bub for the alleged aempdon. Any violatlan of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of
not mom tan five hundred dollars ($SOOT
❑ 1, As owner of the propony, or my employers with wages As their sole compensation,
will do to work, and the suuaut boot Mmodelorred sitmoRefor som(Sm. 7044, Bu
e
Required Inspections
and Professions Code: The ConVaaarlaw does Liam ladoes nut apply m an owner of
q -
property who builds At Improves shaman, and who does such work himsel f or through his
awn employees, provided that such improvements are net inursed aroaered forum. if,
however, to building or Improvement is sold within one you of compledan, to owner-
\
builder will ham to burden of proving that he did not Wild or Improve for purpose of
talc.).
Q'L a owner of the property, am exclusively contracting with licensed conoates m
and
consumer to project (Secapply aor i The Canhacmr'a
to an weerBusiof whodns d
and cense law cora not apply loan owner of property who Wilda or improves thereon and
property
whofor uch projects wit aconlraclor(a) licensed pursuant m the Convmh
ac
Licensense Law.
lam exempts do Sec. BkPC or this mawn
Y l� ��� Dau 2���� +l
ORKPRS COMPENSATION DECLARATION
I hereby of on under possibly of perjury one of to following derlasatow:
I haw And will mamutn A Caninest ofComma m self -faun farworkerscompen-
ution, u provided for by Sec ion 3700 of to Iatmr Cade, fur Oe performance of to
work for which tis permit is issued.
❑ I ham and will maintain Workers Compensation Insurance, u required by Section
3100 of to Labor Code, for to performance drive wmt for which Wer permit is Issued.
'
My Workers Compensation Insurance tinier and Policy number an:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITB motion need not Wcanpmmdlite permit is For one hundred dollars($100)
'
or mal.)
I coolly tot In the performance of the work for which tis permit is issued, I shall not
employ any person in any mao!c go xbcome subject to the Workers'Compensulon
Laws of Calif.r au
Applicant
NOTICETOANT:IL after making thisCrnof Eumr you should
Casc,you
become SubjectWt Worker's provisions of to Later mVal
routwih coply wit such provisions or this Permitbe dcemW revoked.
'
CONSTRUCTION LENDING AGENCY
1 hereby affirm that ten is a construction lending agency for Nc rerfurmance of
to work for which this permit is issued (Sec. 3097, Civ. C.)
(.odor's Nam.
,
Landers Addm-.
I certify that I haw read this application and sum tat the salve information Is
correct. I agree be Comply with all city and county ordinance, and tale taws mlting to
Wilding convection, and hereby authorise representatives of this city in enur upon to
above-mentioned property for Inspecdon pulpits.
(We) agree to taw, indemnify and keep harmless the City of Cupertino against
liabili ics, judgments. toss and expenses which may in icy way aecxm against said City
in consequence of the granting of This permit.
APPLICANT VDIRSTANDS AND WILL COMPLY WITH ALIt, NON -POINT
Issued by: Dale
SOURCE @¢ ATIONS.
2 tyf ac
_ V r
Re -roofs
Type of Roof
Signature ofAppNcautContmctor Dale
HAZARDOUS h ATERIALS DISCLOSURE
Will to applicant lir future building aecupanumre or handle huarduus material
'
u dcBned by We Coronion Municipal Code. Chapter 9.11. and the Hcalt and Sa(cry
e. Secret 1553x.)7
❑ Yes O(Nu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will to, applicant or future Wilding occupant use equipment or devices which
It huardnu+air canteminmu u defined by to Bay Ana Air Quality Management
all new materials for inspection.
Disrlet?
❑Yes KN.
I have mad to huardtmimaurials mquimm.nu unhr Chapur6.95 ortc Califon
niaFNaI"SalexyCode, Sections 15505.25533 ud2553a. l understand! dualism Wilding
Does ret currently haw a unant, drat Ir is my movennhaily m notify de actupanl or dro
mya"A nr ateemetpdarlawa,nceofaCertiBexnaraa
Signature of Applicant Date
2 f 0I
All roof coverings to be Class "B" or better
Owner I
or as mixed agent I Dae