08040109 CITY OF CUPERTINO '%="� '""_
BUILDING DIVISION PERMIT d'ONT OTO INFORMA
Bull,glpLc,Lt�OtLESNPERMIT NO.
ORTHCOVE SQ BROTHERS HOME IMPROVEMENT 08040109
OWNER'S NAME: PERMIT ISSUE DATE
VANDONA PADMANABHAM 2510 DOUGLAS BLVD 04/15/2008
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMITINFO
REPLACE WINDOWS LIKE FOR aIDG ELECT PLUMB MECH
l� 0WINBOW
O O
.0 o LICENSED CONTRACTOR'S DECLARATION Job Description
1 thereby afnrm Wt I w demoeed under provision of Chapter 9(commencing ^^^^^
.it S.U.701)(8 of Division 3 oftl a Busureas and PNreYkN Cade.aM my IKCM1ee Y
N4
in full forte and amt ce VIVO
N 3 License Clan LY.0
5 Date_;f/rr/�Comranmr A.ws wv ti�
ARCHIDICI'SDECLARATION Er AM'�e
1 understand my plana shell be used Y public recmdta rro
e6u
h Licensed PmfeuianM
OWNER-BUILDER DECLARATION
aSi 1 hereby.(firm tat I am eempl form the fussierContinues e:nse law for th
O O which maw a.(Satin 71n 13,Budnw and w.d roo Code:Any my m amen
which lea jas s permit re cores dot tlme Improv,demolish,orrepairPair any ruumuro
prior biacensed a.alwrequire prespplic ffar smhpcter'S License
Law saleme9
ss< That he is licensed pursuant to the prevision of the Conlranara I3ccnse law(Chapter 9 Sq.Ft.Floor Area Valuation
Fg (commcndng with Schon 70W)MDivbion Sof Je Burrow end Profwtom Codc)or
— Nn he is exempt therefrom and the bub for the alleged sump ton.Any violation of
Section 7031.5 by Lay applicant for a permit supe"the applicant m a civil penalty of APN Number Occupancy Type
ore mom thsn fiw hundred dollen(&M
❑1,u a+aer of tic property,a my wplaym rlth rage u tletrsekcampenYJn,
wiRdo Newark•andtheg umbrotimmndedwoRet fmsale(Sw.70N,Burimss
and PmreaLOe Code:The Grammes License Law dome not apply 0 an Owner of Required Inspections
property who bui lds cr impress Jvseon,and w ho dues ouch work Mmaelf car Nmugh his
owncreployres,provided that such improvements sr,not intended oroRcmd for We If.
however,the building or Imp r.t Is sold within..year of complete,the owner.
huildsr will have Jr,burden of proving that k did not build Or improve for pUMM of
0 1.u career of the progeny am exclusively contracting with licensed conuacton in
construct dC pmjm(See.70th,Bulne9 and PmfeLON Code:)The ComMors LI-
«ver Law does out apply to an owner of property who builds or improves thenen.and, t
who contracts for such pmkcu with a nnuanor(O lkenxd punuam in the Compsmofs
License Law.
0 lomexcreptundersec ,BRPC1r,lblamuon
Oweer Dan
WORKERS COMPENSATION DECLARATION
1herebyif rte under peulry of perjury aro of the falbwing deelarWora
I hsw and will main am a CmOftale ofOoment to scif-imure fm Workers Compton.cation,u provided for by Section 3700 of the later,Code.for to perfmmaonO of the
work for which this permit is issued.
❑I have and will maintain Workers CompetuNon Insurance,as required by Section
3700 of the labor Code,for to perform.of the work for witch this permit Is issued. '
My Workers Composed.bsmrana carrier and Policy number am:
carrier: Area.,d PoncyNo: Z-0694IOo70j
CERTIFICATE OF EKEM PTION FROM WORKERS'
COMPENSATION INSURANCE
(This=I.need Out he cumpleted if tM pem1R is foranchundred dollars(SIOU)
or less)
1 unify that In the performance of the work for which Nis permit is limed.I&ball not
employ myperam in any mnlerso as m become subject to the Workers'Compnudon
Laws of Calilomia Date
Applicant
NOTICE TO APPLICANT:If,after making this CcNftcam of Exemption,you should
become subject w the Workers Compensation provisions or the Labor Cade,you most
.�Z fo twith comply with such Provisions or this permit Mall M deemed revoked.
„Z.r O CONSTRUCTION LENDING AGENCY
(•" I hereby alarm thuft.is a communion lendingagawy for the Md...of
ai > the work for which this permit is blued(Sec.3077,Civ.C.)
W� Lenders Name
a Z Landers Add=
U Q 1 certify Nat I have mad this applleWn and sate that the above Information is
ty!". Corr.I agree in comply with all city and county aNinaneeg and sate loon relai mg In
.(D building construction.and hereby authorise opiewnativu of this city to enter upon Jr,
{17 shove-mentioned Property for iospecljn purposes.
g1 (We)agree io sew,indemnify and keep hamtlw the City of Cupertino gaunt
Tri Ilabillia,judgmona,cats and eaperrxes which may in coy way meaner against said City
U Z in consequence of ate granting of this permit /
^w APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Cf i 4_L
SOURCE REGULATIONS,
J�rrD
Re-roofs
signuu A Date
HAZARDOUS /
MATFAIALs DISCLOSURE Type of Roof
WIII y t e Cirponl m forum building occupant r 9.1 or Innate huamou material
u deEited by Ik CupeNno Municipal Cade.chapter 9.11,and the Health and Safety
Code.Sectio 25531(0? All roofs shall be inspected prior to any roofing material being installed.
"Yes 0N
Will the applicant or future building occupant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
it hemudous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya ON.
I have reW the haYmwsmaterials requiremena uMcrCMPmr6.95 of the C+lifor-
nbHaW kSafery Cod%Sectiw 25505.25533 mW25534.1 umbwW thuifae building
date col mommy baro a matt that it is my responsibility be relify Ih occupant of to
mgmrement, bmetprior to issuance araCertificate:orOeea
re
owner car anmarima stem Damw Signature of Applicant Date
"" All roof coverings to be Class"n"or better