05070191 CITY OF CUPERTINO ass d �'i "' '^ ' '�' ' � `'•+74 4e
BUILDING DIVISION PERMIT x3CONTI2ACT0RINF0RMATION
BUILDING ADDRESS: PERMrr NO.05070191
20309 SILVERADO AV
R'S NAME: PERM ISSUE DATE
SHARMA SURENDRA P AND DURG PAL 07/28/2005
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
V I hereby affirm that I am licensed under provisions of Chapter 9(Commencing
.� with Section 7000)of Division Sof the Ron.and ProhWau Code.and my Be..I.
2'qz in Lkelllffo esdeffCCL { REPLC EXISTING LIGHT JjqAtEVCH, AND LVNG
9 Date Contractor ROOM/ATTIC FANS
ARCHITECTS DECLARATION
I undersand my plans Nall be card u public records
O
yo� Licensed Professional 2005
^ Oat I am amropt fr DECLARATION
i M I I hereby a01ect on I em exempt from the Cssions o License Law for Nc
p O following remora.(Semon 7(131.4 Business,aand improve.
derw Code:Any city or county
9�a whichitsissretinues•permit re enresuuc4 alter,improve,demolish,ore a sir ed,Welurt
z� prior to iaiensedp pursuant
ntto the theappin o for such pator mfilem Law(Chapter
< (that Commis encing with
Section
the provivi.nso the of the
usinssanditfuaw(C Code)
Sq.Ft. Floor Area aC10t$700
$ (wt he Is engwlNSutiom and of Division.oflhCBcd axe sedon.Anyovi Co,.or
Net he Is,exempt Nortfrom and the bub for Ne We{ed exemption.Any violation of
Session 7031.5 by any'applici at for a permit objects the applicant to a civil Penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(5500). 36939006 . 00
❑1,uowner of the property,or my employees with wages m their sale compcwtion,
will do the wort and Ne ctmcmte is not intended or offered Or We(Sec.706/,Business Required Inspections
and Profession,Code:The Conuacmr'a ucenm Law dw our apply m an Owner of q P
property who builds m impmwa Hereon,and who das such work himself or through his
own amplayrcs,provided than such Impm camnaare not Intended aOff red fmnle.If.
howeveG Ne brei ding a Improvement b mid within ore you of completion.Ne owucn
builder lac burden of proving that he did nal build a Improve fee purpose of
sal,.).
ac awrcr of Ne property.am exclusively contracting wish licensed anweson Or
comwct Nc project(Sec.70a.Business and Professions Cade:)The Concacbr',U.
came law does not apply to an owner of property who builds,or improve thereon,and.
who contracts for such pmjcm with a conuacmr(,)licensed pursuant to the C.numClOeS
Lice.LAw.
❑lam exempt under SM., .B&PC fa Nis con
Das,
R 6 )ECLARATLO
I rtbya under peWly of perjury ore of the following declentions:
❑1 have and will maintain a Certificate of Comentm self-insum fa WorkarsCompen-
ulion,u provided for by Section 3700 of the Labs Code,for the performance of the
work for which this permit is issad.
❑1 have and will maintain Worker.Compensation Insunna,as required by Sada.
3700 of the labor Code.for the performance of tiro work for which this permit is issued.
My WorkeYe Compensation Insurance canner end Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
md;section need notbocampleted ifthe Permit Is fano hundred dollvs(SIM)
or test)
I certify,that in Ne part...of I rq mia Nis,permit isIssued,l ski nuc
cmployanyp nounlnany mummer in fa bjeetio Ne Workers'Com e
Laws c(L'allfamia Das
NOTICEt
N come subject
APO t Women
If. r mak g pr v naaof.f Exemption,abor you should
,J 0become ubjcet W the Woheen Campeaudon trans mal of Um Labs Code,you mon
forthwith comply with ash provisinm or Nie permit.hail On deemed revoked.
ti CONSTRUCTION LENDING AGENCY
(—s Ihereby,Rum that Vert is a Conmm�ion lending agency for the performance of
Oi the work for which Nb pertnh b,ivad(Sec.3097,Civ.C.)
Qlenders,Name
z Lenders Aldmu
U O 1 eamfy that 1 have mad this application caw auto that the.hove infamatia is
{f+ COMM I agree to comply with all city and county ordinances and some laws relating In
O building consummion,and thereby auth.Hm sepmaramiws of this city to coma Olson the
Vd ahave-mentimbed property for impaction purposes.
p4. (We)agree to sew,indemnify and keep harmless the City of Common against
,A liabilitiesJudgmenms,cesuudespenses which may In anyway accts agaimtuid City
U4in conuquenee or the ganMg of this permit.
•^� APPLICANT UNDER AND WILL COMPLY WITH ALL p1ON-PO Issued by: Date
SOURCE REGUL/�'I n A A / r 1,yr 1' a-roofs
Signature ppli n aguT illy
US MATERIALS DISCLOSURE Type of Roof
Will the applicant afuture build"" rat nomahe
amile havardous melerial
dead by tiro Cupertino Municipal alter 9.12.sed the Health Hand Safety
'c,Section 25332()7 All roofs shall be inspected prior to any roofing material being installed.
0 ❑Yes
Will Ne applicant or future buildina room
equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havamnus air cnotaminsna u def y Na Bay Arta Air Quality Management all new materials for inspection.
Diacid?
❑Yes u
1 have mad the hasardw mancriabmquimmena under Chapler6.95 of the Glifor•
nleHealth&SafcryCodc,Secuou255O5.25333and25334.1 askrsaM thatiflM building
dean not currently have a ten 4 it u my mspomihiliiy m notify the occupant of the
rcjumtanuwn ortahmaw.f.CcnifmawofOccupancy. Signature of Applicant Date
Gonna mhmiz gent Dam All roof coverings to be Class°BO or better