00070022 (2) CITY OF CUPERTINO '
uuD,DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUli.DIN +IjR1,+g CRESTLINE DR PERMII N(Witilid. .
OWNER'S ISINGARAJU, SAGAR
PHONE: - SANITARY NO. CONTROL NO.
qq _ -
. O O ARCHITEC/ENGINEER:,, Ar - BUILDING PERM IF INFO
M1 BLDG ELEC11 PLUMB MECII' '
t O IJ CI' 1�
a
i LICENSED a CONnsed under
vision DECLARATION
Z Il, by R thatin3 famed l P £Of Chapter 9(commencing NA DBSCCI l,0g
oy—o isms f- nand, fD'v aan3 urine Bt ' n f•.vsmmsC tie ,n,d myl«rsu REPLACE FURNACES �1DU ON. A/C
�F—� liar I Rest.
C 6 Lccn.ve Cross L c.K • , .
u Dale - Contractor -
3 0 7 ARCHITECT'S DECLARATION
C u O g 1 understand my plans shall he used as public recoilsvO
OO Licensed Pfnfessinmal•
o 'OWNER-BUILDER DLCLARATION _ M
='h • 1 hereby aflimr that 1 am exempt from the Contractor's Licen.ve Law for the -
t Z¢ following reason.(Section 7031.5,Business and Professions Cade:Any city Or county-
I�t O which requires a permit to construct.alter,improve,dcmul ish,or repair any ewnure
ex n
5� pct ., ' ace,u6 1 ,Il, pp'i If hpc IH flsignedtmmen -
than it.11 lillosedea.1a,ma, me p a I da,comontaOi, s Law+cit pm'l SCI. Ft. Floor Area Vat at
(co I n lig ',h Scti 700(4 fId ft n3Of lire Bu.'n and Professions Code),
or that he is exempt therefrom and the basis for the alleged ewroloion.Any violation'
of Section 7031.5 by any upplicanl for a permit subjeti the applicant to a civil perialty
of not mare than five hundred dollars(5500). Af` '� pt�Ig, 00 Occupancy Type
❑L n.ownar of @c pn,penY,or my enq,layces will,wngcs as fair snln eompenswlom, _
will do the work,and the s meanie is not intended Or offered for sale(Sec.7094. -
Business and Professions code:The Contmcmr's License Law dors mmfapply to no 204 — UNDMRQzL1r MpIs994IIAME
Owner of progeny Who builds or innwea,here m.and who does such work himself
or through his own employees.provided that such ineprovem ass are not intended or 301 — ROUGH PLUMBING
Offered for sole.If,howe o.the building fir improvement is sold within ane year Of
immpmdl)a,'he mau.-bmndurismhuromaEmb,nor proving mal hulhd m i hmildp'' 303' — .ROUGH MECHANICAL
prnse tali pu5pase uf,am.). ... 304 — ROUGH ELECTRICAL
❑1,as ownerid the progeny,am exclusively romractin8 with licensed c ado ow,to
con,mc, he arojet(See.roc,Busmen and PmfilWar,Codex The Contmel)r's 505 — FINAL ELECTRICAL•
F License law does not apply to as owner Orpmpeny who builds or mpmvev thmeon, to -
and will)contracts lot such projects with a c,niroetand licensed pur,uant to Ise 507 FINAL PLUMBING
. lraea,rsa uaad,,cI.mv.
Sec Bare for rea,l)n 8. 50 '— FINAL MECHANICAL
01 amexempl ,
Owner Dae 514 — FINAL PUBLIC WORKS
WORKER'S COMPENSATION DECLARATION t
I hereby oflium ander penally III perjury one 01 the I011owlog&chlraibnr,
❑ 1 have end will muirado a Cmifcam of Consent to self-imurc for Worker's
Compensation. us pawidwl for by Section 3901 (if the Labor Code, fO the
arrommure 0 of the work for which thi,rembit is issued
❑1 nouir d will Xt Worker',C � I : e v rqred by S
3]33 f tire Lb Code f thef _
• t • `
tire k for w ,eh th s Penna is
issued.My Workers Ca npInsurancerr ee .]richtion Insurance ca
rr and Policy number are..
Carrier. n:
Policy N (� �
CERI'II(CATION OI Li Policy
No.: (BOM WORKIiRS' "
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
u IBD)or less
.l /
I cenirr that in the performance of the work for which this pit is Isonal,1
shall not erm
employ tiny person int troy mama so as,o hecon,e subject Il)the Workers
Cmneensation Law,it California.Dmc -
,Applicant
NOTICE:TO APPLICAN'D If.after nuking this Cenifcate of Exemption,you should
Z become subject to the Worker's Compensation provisions of the Labor Code.you must t
Q O
both,ill comply wuh such pmvisiom or(his permit shill he deemM revoked.
Z r
ZI - CONSTRUCTION LENDING AGENCY. r -
1 Hereby affirmIlia them is a cnnsu ilmn lending agency for the performance r
of the work fm which this pemnit is issued(Sce.NED,Civ.C.) -
Lenders Name
z Lender's Address_
C.7 I ccnify lam I false read,his opplieaion and xmtu that the static inror tylion is -
Li [. correct.I agree m comply with 511 city and otomy ordinances anJ auic lass relating ,
Q V to building construction,and hereby amhnine representatives noun city to enter upon -
', r� the bove-mcnotancrip perty far m pec t Bmo,
(We)agree'o''o'a,c.inderaoify lot kat,hartraluvifire Cityof C pen against
F•t Cit lindilaws.judgment,,O, ,d .aus whichmay'I any way' fie ago m: td - •' � -* ,
V 4 CiiY thegmfn,ol'Ili reanot, / - ..'.
APPLICANT UNDERSTANDS AND WILL COMPLY wITO ALL NON-POINT Issued b': C '•'e_ Date
SOURCEREGULATIONS y'
Signature of ApplicanUConnunor - Date, Re-roGfsappl `
11A%ARDOUS MATERIALS DISCLOSURE ,
Will the dayCiuml or future building Occupant store OF handle hmanintu material Type of Roof `
u:defined by fupeatino Municipal Code,Chapter 4,12,and the llcahh and Safety - -
Cale Section 25532(a)?
1 7^
ores ON. All roofs shall be inspected prior to any roofing material being installed.
Wiufoapprennmfmurehaddmgmutmentuse equipme,tOrduvlee"whicn If•a roof is installed without fiat obtaining an inspection, I agree to reiiove'
emir allardnns oa,real un.inum,s us defined by the pay Arca Air Condit,Mwelani un, -
Dialrie,9 all new materials for inspection. Applicant understands and will comply:with
❑Yes .. f0bi all non-point source,regu latiort -
I have read the huzurdons mmariuls requirements under Chapter 6.95 of the •-
Culiforniu lleahh&Safc,y Cale.Seclm,s 25585.2.5533 and 2553], mObo m ai ll ut
if the banding does not eurendy have it tented.that it is my msponslMllly m notify dtc
r• -occupant oCwW fhe Oc'mrcmcn s which,Inst he me,prior to Issuance nl'9 CenifcaI of - t ! 1
cu airy. ..
�// /,� Signature of Applicant Date
ornat sed agent- , / All roof coverings,to be,Class `•B;' or better
OFFICE