00110030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Ilmt.uwG/fffgrV8 METEOR DR WOODS ROOFING PERMIT N000 I
OWNER'S NgNMES H. HARIHARAN 1020 HICKORY CT I
APPLICATIT '/ICY/`000
(831)637-5576
PNONI SANHARY NO. CONTROL NO.
°MooO�, ARCI HI'LCIYF:NGINEHIR BUMPING PGRM1IR INFO
s w_ .D' ELECT PLUMB MEGA
°' LICENSED CONrRACI'OR'S DECLARATION
8'i< .. Job Descrip on
z. v, 1 nerrny aasm,mm I i i lien,xed under prompt..,....r Chapm,9¢Imnmendag
°_t_° ;wish SoOion 70O0)nf Division 3 of the Rome,,and Prune ma,Cale.andnty licarce SHAKE TO CELOTE'X 40—YR. PRESIDENTIAL
Y�,,� 'Ix ll,VIII fnrvv'anti ell 'I
m ge< License Class_ ',�� Lic.«�151 _
f
a'°wu Date Culnac aaAltClI IC'I"SDIiane .ta r plaml Mytgcs
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i�o Lmcnhea rrotesslanm
OWNHW BUILDER to OECe RXIContrION
IKli In a hereby al llnm elm tan cxcnhp,fnnn Oro n,uon,C's .Any a Law for,he
following noun.(Section]011.5.Rhinos and Profccsion>Door Any city otmm�e
dFFG which I 'aP )t li t altimprov.demolish p Y-wnurc c
C m prior I I x I: y ,1 ppl' r l h pc I I b I:tatcmm�t
Wit— than hocoodpersonal, the sthe c , um,].i.e.Law(Chapter9 Sq. Ft. Floor Area
(counneaci ngwl It Scoioo 711110)of Dvoi 1n or lhv 111: ,,,imd P 1 -.- side)
or that he is exempt therefrom and the basis rot the alleged exanplum.Any violation V
of Seddon 711.11.5 by cony npplicanl fora permit suhicete,he mpplic,d at a civil penalty
in cut mere man file lumdred cheers(s500) AP..rL Nt rr berry .� Occupancy Type
do lc. l0 Ste _
❑I,d owner mise and
be s,ru nye is o t in wile wages a ed f hale le(Se.7(W.
will do the work,vsi the structure I e is not intended it w Law for salt(Sec. to an ��e
Maness andrWho bCale. i c'omdhrmo Liren.c Law does not
...k Wa,an 305 — FRAMtquired Inspections
(�Wmtr ughisOproperty harm bund,or nvidedt moan:.and who encs inch wink ndned or v
eougn his own emv,c,, provided that wen improvements m el are not intended or
inched to,endo.u;Dina .n,a naaniahg o Drone en i..uld winhM iae sea lir 307 — INSULATION
iimpletion.me m.ner-milder will base the lharden of proving that he did not build or 601 — ROOF TEAR OFF
mrroio fir pat of hale.),
OLa.owner anhe propeny.alit esalisiiey contracting with licensed enmmemr.,n 60'-2' — ROOF PLYWOOD NAIL .
Lm,uno ire ,j,,,(see.7044.liasioays and rradaaal..Code)Tne Canra0lorh 603 — ROOF BATTENS
Pn
icense Law does no,apply to an owner of Pottery who build,or in:prnves Ihemon.
:and who common%for such projects with a amtmeutnh)licensed pursuant to the 604 — ROOF IN—PROGRESS
Co.,...on,iJam's Law.
01 am exempt under sec. .a k P c fir mix reusan ,
wncr Date
WOHKIiR'S C'OMI'1:NSATION DIiCt.AR6nON
I hereby affirm under penalty of Perjury one of the following declarations:
❑ 1 have and will maintain a Cenificam if Cinsem to wIl-inwre for Workers
Cilnpclnaliun. as pravideal for by Section 1700 of the Labor Code. for the
Naftnimance ol'lhe work for whim this waiiiil i.issued,
0 1 hove and will maintain W,tker's Conlpunwlian Inwmmce,a.required by Stenion
3700 or the Labor Cale,fur the Psafnmunce a the and,far x1,ich his panni,is
sued My W'orker',Conlpcnv:nion do m ee aarrienmd Policy number arc:
sro PnreyNo:oo�y/G
CCFj IICA'I ION OF EXIiMI'1'ION FROM WORKERS'
COMPENSATION INSURANCE. '
('fhis section need nut w completed o We rennin is Ibr one hundred dollars
(511X)or le".)
I certify that in the srlourance of me work lin which this permit is issued,1
µnull nor onploy airy person in any Inunnar so its to become subject,o the Workers'
Compmnallon taws n1Calil'ontia,Dem
Applicant
NO ICH 10 APPLICAN1.u',aflar making In,Cer)ieala lir r,.enapdnn.you stolid
become subject m the worker'.Compensation prat isions of the Labor node.you must
O ronhwim comely with such provisions or this evemit shall be decided resulted.
CONSTRUCTION LENDING AGENCY
I wuaby unix„that mere b II corrlrm,im,Ieadi ng agency err me parrinnance
of the work for which this Permit is issued(Sec.1097,Civ.C.)
Ql.aadats Nome
7 Z Lender.Addrexh
U O 1evoirylhaI note read 11hoappliaanianand smct the,dannme imbormam,is
Lt. E~' correct.I agree to comply with all city and cotamy oNinances and state Tawe aiming
O t.7 to building con..Imainn.and heabylnmhorize repmt ofmix city owner upon
the ads, ,learnionerl ungsd,Jor' ,,al ip D. .
'V ps (We) g m,am.indemnify and keep h..Iv,,the City of Cupertino ag s,
�L h haul, judgineans.s i 1 I a.. hi,li nay it,any way name age .laid
U 7 CIycome
4 ra of th a
N911CANTU DERSTANUS NI}W�}{COMPI 'ITH ALL NON P(MNT Isstledb 'tet' /n�7. .C.�C-.�C Date
S(lU ArIONSf yi'
6 •n—ammo Am,Ecm.Vcm...... YY"'Ve / 1Y,h6te Re-roofs
HAZARDOUS h1AT1iRIAIS DISCLOSURE
Will the:mphairm tit Rona wilding tweavant same of Dandle hazardous material Type of Roof
as defined by me Curytino hmniaip:a node.Chapter 9.12,trod the Health and Salcly
Cede.Section 2551200"
0 cis 0,t�_ All root's shall be inspected prior to any roofing material being installed.
Will lhcippllcun or fumed wilding acaupant ate cydptnem ordedcawman If a roof is installed without first obtaining an inspection, 1 agree to remove
emit h r,mrais air comuminum,as defined by the EaY Arca A,Vuanly Monegamenl
Dismm7 r�� all new materials for inspection. Applicant understands and will comply with
O Yes all non-point source regulations.
I nave read the hanminamn.lx namiramemrs under Chapter 6.95 of the
it the role ianOtHealth, Safcur ntdc, veISection,25.505.25533 titis and 25514.1 ty to ncmd Isle
it
buildingdue.not cunendybluentenant,e, itis my rt........fac' ifi'medy the
tcupvm lir llm rcyllir�munu abicb maul be Ines prior m Issuance o(u Cenilicnm lir
kaups ce, Signature of Applicant Date
—
as namhorizeJ Ll All roof coverings to be Class"B"or better
waggro Date
OFFICE