08040084 CITY OF CUPERTINO :+«.: �g, " '
BUILDING DIVISION PERNHT GOAITRACTORINPOR1VIt1T10 ..
., .
PERMR NO.
eu"T"Ne�D�T hNTA LUCIA RD AVALON CONSTRUCTION LLC . 08040084
EWES NAME: S PERMITESUEDATE
VENKATA KALIDINDI 41882 CHADBOURNE DR 04/11/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 252-0980
ARCHrrECDFETIGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION
Job Description
F 1 herby a1Rrm thu 1 am Ilcenrd umkr pmvlions of CMpser 9(commencing
n Z�S xlN Section]IXg))of OiWdon Sof NO BmWut and Profesaions Code.and mylicense is KTCHN&BTHRM RMDL NON—STRCTRL TO INCLD
orN m full forte and effect.
2g? ucmnmaos Ix.w (MEC/ELC, PLMB)
Dade Can
I,ul7a ARCHARCHITECTSDECLDECLARATION
I unducund my plants Send W used as public oa omh
pm
hLLo Licensed Pmfeuiand
e OWNER-BUILDER DECLARATION
�1 I hereby affirm flat 1 em exempt from time Contractors License Law for the
00 following..an.(Section 783 LS,Business and Pmfesaiuns Cook:Any city or cater,
$I'i which¢quires a permit to c mmucL alon,improve,demollm,or repair my Structure
_Z i prior to its issuance.aim mquires an applicant for such permit to rile a signed museum
<
dand be,U licensed pappean,to Me provisions of the Contructor's Liethate Law(Chapter 9 Sq.Ft. Floor Area Valuation
51 (comeacwith Sect1on T00D)of Division 3 of Ne Business and Professions CMc)or $30000
[ mi,dor he is exempt Nord¢¢and the basis fm se Wleged esemp lm.My violation of
Section 700 by any applicant far a permit subjecu the applkam to a civil penalty ofNumber Occupancy Type
Inst mare Nan five hundred dollen(SM 34216098 ,
.V64
❑I,uownerofdepmpeny,mmyemployceswlNw{uuN irmla=penudon,
will do the work and Ne rrom be is maintended oroQemd forak(Sec.7044,Bananas
and Pnefesdam Cade The Contractors License Law does rot apply m an Manor of Required.Inspections
property who builds mimpmves thrmn,andwho doessuch wok him cifor through his
Main employees,Provided der such impruvemons are set I.,, orolfsed fm We.If.
bmwerver,Ne Wilding or Impmwmat is mid within now year of completion,the owner-
Wildar ,MO have IW burden of proving that he did nal build or improve for Purpose of
SUM.).
❑1.as came,of the property am exclusively canuactin{wide licensed censmrMm to
construct dee project(Sec.7041,Business aM Professions Cade:)The Consomme.Li-
«nm law does not apply to an owner of property who Wilds or improves Nemon.and,
who comncu for such projects with aennunctm(a)licensed par ant to the Contractors
License law.
❑I am excmpr under See
/� \, .B l P 4
C far Nreason
IG•V -l,t Q > - V"- It- Dam o4-\t-40— Oa
WORKERS COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury am of the fallowing decluadons:
1 naw end will mainWn o CeNOcata ofConsent m self-inmm for Warkcrs Campcn•
Urban.as provided for by Section 37M of the nor Code.for Ne performance of the
wok for which this permit is isomm,
1 haw and will maintain Workers Compen redon hnorance,as rmlubed by Section
3700 of the Labor Code,for the performance of Ne ark for which this permit is issued.
My Worker's Compnnwian Irtmrvmoo curter and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
India section need sotbecomplem l Hthe permit is foramhman d dollop($100)
or baa)
1 certify that in US porfoma=of tae whk for which this Forms,u issued.I shall am
employ my person in my mmrcr55oo gass m berme mbtt'aal w the Worker'Cmnpentsmon
Iawsof CallfrMlLDam
Applicant %j: 4 Y✓
NOTICE TO APPLICANT:If,after making Nu Cenifiose of Exemption,you Should
becmne Subject In the WorkcM1 Compensation provisions of the Labor Cade you mus
.J O fordwith comply with Such provisions or this permit Nall W doomed revalued.
zm 75 CONSTRUCTION LENDING AGENCY
'(•+ I hereby WErm thou Nem is a aammcden lending agency far the Performance of
!Yi dse wurk for which this Permit IS Wand(Sec 3(07,Civ.C.)
0. Q Lenders Name
Z Landers Addmss
U Q 1 certify that 1 have mad Ws application and sum and the W.irdormadon u
^ torten.I ogre m comply with W city and county ONiAmrc and sum laws retailing to
SV^ Wilding camuunion,and hembymNoim repmaentatiw of Nu city m enter upon the
{g7 aWw-menduned property far inspection purposes.
Ly,,gy (We)as=to Save,indemnify and kap hamtku the City of Capstans against
k.'m Vl Iiablliflujudgmms,costs and expeou which may In my way accme against mid City
in consequence of Ne{renting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i
SOURCE REGULATIONS.
le--\I.L3 . Q o k -Q \L' b4 -3t-08 Re-roofs
Signrum of ApplicandConummr Das
HAZARDOUS MATERIALS DISCLOSURE Type of Roof —
Will She applicant or forme Wilding eccumumstom arluendle baurdoun material
darned by the CupeNno Municipal Curie.Chapter 9.I2,and the Health and Safety
Section 255334>?
❑Yes ❑NM All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant um equipment m devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
emit haxerdnun Sir cen umim ss as defined by the Bay Area Air Quality Management all new materials for inspection. .
District?
Dyes ❑Nu
I have mad the Weallous materials mquimmeml under Chapter 6.95afthe Califon
nia Hnslth&SafciyCade,Sadov75505.25533mdn534.1umkrvmd NrifdM Wilding
thou not curmntly have A MUL thu It 4 my mSpemunility m notify tie occupmt of Ne
requirements which muni M=I pear be Waranm of a Cnrtilkam of Occupancy. Signature of Applicant Date
Ic- v• VJ- Q� L� 04-tl-Dg
owmr or aaboired gent Date All roof coverings to be Class'%Y'or better
l