08030007CITY OF CUPERTINO
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BUILDING DIVISION PERNHT
=RACTOR�IN.EURMAT
BULLRING ADDRESS:
PERMIT NO.
845 ROSE BLOSSOM DR
M—TPAN CONSTRUCTION, INC
08030007
R'S NAME:
PERMIT ISSUE DATE
SRINIVAS NALLAMOTU
348 SURBER DR
04/18/2008
PHONE:
SANITARY NO. CONTROL NO.
(650)996-6099
ARCHITT.0 (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affim Nal l ma licensed under pmvWant of Chapter 9 (ammmWng
with Simtion IBM) of DivWon 3 afthe Rumen and! Profeatiats Codc,aad my Hannon is
COFFERED CEILINGS IN FAM RM STRUCTL CHNGS
i. full forte and eRec.
LlembeClw Uc.g
&STRUCTRL CHNGS TO GARG ROOF & MINR CHGS PER HIGH
Dam Conlcanar
ARCHITECTS DECLARATION
LIGHTS IN A1.1
1 undnNand my plane Nall be used u public worlY
Licensed Pmfcui... I
OWNER -BUILDER DECLARATION
1 Mrcby aRtm that I am exempt fare the Committers Licenw Law for tip
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following reamn. (Section 703 13, Business and Professions Calc: Any city or aunty
which requlma a permit no ansuum, alcor. hnperve. demolish, Or repair any Panum
prior 0 its ictuses , also requisea the applicant for such permit to file a signed Wmmat
oom rsnulaw(Chapmr9
Nybe b, tothe oatheCcmUce
Sq. Ft. Floor Area
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na pmvium
(commerce, with mac Section 7000) of Division 3 or Business and Prateaioa Cude)Or
$1500Valuation
thin as is asemps Mind= W the basis fm the alleged exemption. My Nolatlon of
Number
Occupancy Type
Section 7031.5 by any application for a permit subjects the applicant to a civil Penalty of
net mom nominal A. homd dallart MIMI.
3 5 9 0 3 0 4 5 'V64
I,uownerof Nepmpmty,wmywploycawimw rAudm4alec pemdon,
Required Inspections
Milan Naweck, and NestmcturebmtumndedoroBered tarsals(Sec.7044.8wmeu
and Profitable. Code: The Contractors License Law done at apply m owner an owof
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property wha builds or improves thereon, and who docs auch work himself ser through his
own employees, provided unit Rich improvemau sum not intended moRcmd forsale. If,
however, the building m Imp aremat Is sold within ane year of impletion, the owner -
builder will haw W burden of proving Nat he did net Imid or improve for purpose of
sale.).
❑ 1. u owner or the papery. we erWuurely, anlrMing with OCOnsnd amtracml. in
couwct the papas (Sim. 7044. B uriom and Pmfculdne Cada:) The Cauacprs U.
«are law does Out apply 0 an war or property who builds or improv Merton. ad.
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wbo anuacu ransack projects with •contaarmr(U I-mund purmant to tep Contractor.
License law.
❑ I sm excmptunder Sec ,B l PC fm To, assaim.
Dam 41146
WORKERS MPENSATTON DECLARATION
I hereby affirm under penalty of perjury am of the fallowing decimations:
❑ 1 have and will mW Wn a CeNOum of Camera m selRineurt fmWmkera Compere
wlan, u provided her by Section 3700 or the labor Cade, for the performance of the
work far which this permit is inued.
❑ 1 ban and will mainuln Waftes Compensation Insurance, as mainland by Scum
3700 ofthe labra Cade, for the perromrme often work for which Nit permit i. Issued.
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My worker. CampemWion hsarm amu aud Policy number are:
Caaar,Policy NO.:
CERTIFICATE OF EXEM MON FROM WORKERS
COMPENSATION INSURANCE
IThu section aced net W completed Boom permit Is rmom hundred dogma (SILO)
car IIx)
I COVIN, that in the performance of acre work for which this permit is bound, ) shall not
employ snypermn in any mVeno cob one sex pare m the Workma' Component.4ws
of California Dam
Appllcmt
NOTICE TO APP mating this Geminate or Exemption. you should
become subject to mac Wa a Compensation provisions of use labra Code, yon muss
forthwith amply with Rich rovisiam m Nu permit Ndl be deemed mwked.
_
CONSTRUCTION LENDING AGENCY
1 Kerney alRm that there is a ammuctian lending agency rar use perramaae of
the work for which this permit Is issued (San. 3097, Civ. C.)
Undoes Name
,
Lander. Add.
1 mltty Nn I have mad this appllem. and Rale that the show information is
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coact. I agree an comply wish all city and camlY ordinaaas and sum laws mlaling to
building construction, and hereby mutation rtPmmoutives or this city to color upon the
above -motioned property for inspection purposes
(We) agree to saw. indemnity and kap hamlets the City of Cuperlim against
Iiabilldes, judgments, casts and expense which may In anyway came &&man sesid Cityin
APPLIttees of the graninfing, of this Permit.
CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RFiOU " I 19�-�
Re -roofs
Type of Roof
Signumaor Appftan nnuammr Dale
HAZARDOUS MATERIALS DISCLOSURE
WE the applicant or future building Occupant sera or handle hawdau malorial
at deBmd by the Cupenim Municipal Cade. Chapter 9, 11, and the Health and safety
Section 25532(.17
All roofs shall be inspected to any roofing material being installed.
01 C3 Y. o
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or uevias which
emit buaNnut oar conWninants a dented by not Bay Area Air Quality Management
all new materials for inspection.
Dsukt7
DYau
\mynaaumwfmmomumkrCMpw6.95afdn
I haw mad the huaNaus Wirer.
-is Hoe" S.faYCade,Smim,15503,25533 sell 25534. 1 understand! thnBthe Wilding
dues Ips cumna haw thy Ilia my maponub.1 ly to near, the Occupant of On
mgmrcmcnuw' pidF ia,a,naancutirpua.fCc
Signature of Applicant Date
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All roof coverings to be Class '%W' or better
owner to oun rirml Z.4i a�