07110078 CTTY OF CUPERTINO
BUILDING DIVISION PERMIT C01�1T12AG' QR, `I,NI'UT.tMATi '
e:
BUILoINo,(.00RM ESs;ICHWOOD DR TBD TO BE DETERMINED P07110078
OWKElR''SS NAME:: PERMIT ISSUE DATE
GANESAN & PRABHA SRIRAM 01/29/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITECI'IENOINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
t� It t�
30e LICENSED CONTRACTORS DECLARATION lob Description
rd iy I hereby+frim that 1 am licensed under provisions of Chapter 9(commencing
with Section 70(10)ofDlvision S of the Businev and Proletaians Cade.and my license i. ADDITION & REMDL KITCHN
n full face and effect. 1 r�
Z License Cl. Lk.N ` '^/
DI- Dau Comracar 36
ee ARCHITECTS DECLARATION
Y 1 understand my platy Mall W used u public rerordi
�t
g cad Licensed Prefcssi...I
S OWNER-BUILDER DECLARATION
v� E 1 kmhy afirm that lm exempt from the Conaecmrs License law for the ,
COC following moon.(Section 7031.5,Business and Professions Code:My city or county
13 E! which req.t.a Permit to ca.4 Alar.W prow,demmlN,or repair any structure
Zvo prior a its issuance.also requires the applicant forsuch permit to rile a signed statement
�< That he is licensed pursuant to the provisions of the Conauar's Lieme Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commAcingwith Section 7000)of Division 3 ofae Business and Prorulama Code)or $100000
au W h exempt therefrom and the bash alleged the eged exemption Any violation of
Section 7031.5 by aro'applicant for.permit subjects the millmee t W.civil Penalty of Occupancy
rot mom than ftw hundred dollan(SS L 36908046 ! NumberTrpe
1,u mw of Bk plopeny,m my mplaycu with wage a aeh sok campenssdon,
will do thoworll.and am aacuen Is mI intended coffered retain(See.7044,Business
and Prefualaru Cade The Communes License Law dace Out apply a an awner Of Required Inspections
property who builds orimpmvea thereon,andwho duessuch workhmaelfer through his
avvo employes,provided that such improvements ase not intended arofrerad fault U.
hmeveq the Wilding or improvement U mid within aro year of complamo.the owner. '
builder will have the burden of proving Wt he did mat Wild or Improve for purpose of
vale.).
❑1,a owner of ere Property,m exclusively contracting with licensed com ants to
consumer the project(See.7014.Business and Profession Cade)The Communes U.
cense law data oat apply in an awmar of property who builds at improve Nanton.and.
who contracts for such projects with a contractor(a)licensed pursuant in the Com actor's
Lke•.-Law.
❑Iamesemptunder Set ,B&PCforthhraum
err Date
WORKER'S COMPENSATION DECLARATION
I hereby of an under penalty of perjury aro of ere following declanllaN:
❑I have and will maintain a Ceniricau of Covent in self-Insum for Waimea Campion. '
smon,u provided for by Section 3700 of the Labor Code.for the performance of ere
wart for which this Parrott is iuucd
have and will maintain Wafkees Compensation lRNranco,as mainland by SecI1M
] of the Latta Cadc,for the performuee of the work for which this permit is Issued.
My Warkers Compensation Insurance terrier and Policy number am:
Carrier, !f tlC ins�'C.(�.,. Policy No,:AI�Il-W-00
CFATIFICAIE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis smann need nal W comPlemd If tes permit h formic hundred dollars(5100)
K kat)
1 certify dal In ere perfmmuce of the work for which this permit u issued.l Nell not
employ any person in my manrcNo as a become subject a ere WOrkcrs'Com;w"., on
Laws of Califomis.Data
Applicant
NOTICE TO APPLICANT.If,after making this CeniMut of Excmplion,you Nauta
become subject to the Workers CompONuian provisions of the labor Cede,you mutt
O forthwith comply with such provisions or this permit Nell ke dacmed revoked.
z'^ CONS RUCTION LENDING AGENCY
[r Ilumh,wTim Nat North.construction lcndingagency far the perfamance of
the work for which this Permit is issued(Sec.3097,Civ.C) '
G Leader's Nunn
= z Lenders Address
U O I mtify oat I haw and this application W sum that rho shove idam atiun is
.D. E contact.I agree a comply with All City and county aNinuaNa
s end u laws misting
C) rVWilding construction,and hereby euthorire mimsenudws of this city to Omar upon the
W aW--mentioned Property for inspection pugwset
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments.costs and columns which may in any way somas,agalnsLssid City
V 7 m cones les sofa {Totems Of this pcmlt.
•7 APPLICANT UND MANS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE MotA 0
ll' �9 C Re-roofs
Signnum of Appli actuatoIS MATERIALS DISCLOSr Data '
A2A=LURE Type of Roof
Will de app0cant or future Wilding occupammore At handle havrdaus maarial
as defend by the Cupertico Municipal Code,Chapter 9.12,and ere Hcailh and Safety
Cade,Section ss53z(a)] ���((( All roofs shall be inspected prior to any roofing material being installed.
❑yta yJ Iva
Will site applicant orfutureWilding Occupant use equipment a Ikvima which If a roof is installed without first obtaining an inspection,I agree to remove
emit huamnu air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District]
El Y. gnu
1 have mal the Wz..it it.materials requiremcnu order Chmser6.95 of the Califar-
Ail FaalNhSueLyCakr 'on,23505.25533 sal 255M urakrstsnd astlfde Wilding
docs nal cumn" Wafirl—o
ithmympotaibilityanotiy ere aceupanrofdemqulmmcnts.1mrilieauanm err Ceniruau Dc 1 Signature of Applicant Date
ownererraahaarII Dass All roof coverings to be Class"B"or better