02010006 (2) CI BUILDINGON UDPERTPERMIT CONTRACTOR INFORMATION:
BUII.DI�ADDRESS: PERMIT NO.
10134 MINER PL LINDY ROOFING CO INC 02010006
OWNER'S NAME: APPLICATION SUB DATE
MURALEE BHASKARAN 5554 HARVARD DR 01/02/2002
•I PHONE: SANITARY NO. CONTROL NO.
(408) 269-2025
n e O ARCHITECTIENGINEEIL UILDING PERMIT INFO
E LD ELECT PLUMB MECH
u ri I L--L1
f ¢n
Z F N i LICENSED CONTRACTOR'S DECLARATION Job Description
O z_0 1 hereby affirm 1 am licensed under provisions of Chapter 9(commencing
_u, with Section)000)af Diviivision3of the Business and Pmfesxions Cade and my license REMOVE TILE ROOF, INSALL NEW TILES
y Ism PoII force and affect
adW 6 Liccnu la.
K O u Date -�
.i CDmr
AFa ARCIRTECF' ELICO5
1 understand my plans shall be used as puhire recoNs
�to
wC O O Licensed Professional
Eex OWNER-BUILDER DECLARATION
y1 hereby affirm that 1 am exempt from the Contractor's License Law for the
z a Fallowing mason.(Section 7031.5,nosiness and Professions Code:Any city or county $12340
x O which requires a permit to construct,alter,alter,improve.demolish.or repair any sanction,
a3 'prior to Its issuance,also requires the applicant for such permiuo file a signed statement
that hq is licensed pursuant to the pmasi.nsof the Contractor's License Law(Chapter 9 E[��lpOf easy,• - ssa Valuation
(commencing with.ection'/OtN13 of Division 3 of the Business and Professions Cale)
or that he is exempt thcrcfr.m and the basis for the alleged uemption.Any violation '
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty �D�}Nf1;a�� -
Of net(nate thin rise hundred dollar,(5500). 305 AP_N P'KAOccupancy Type
❑L as owner of the property,ur my employees with wages as their sole compensation,
will do the work:-and'the swnure isnot intended or offered for sale(Sec:WNII ,
Business and Professions Code:The Ciamore T's License Law does not apply t.an 601 - ROOF TEARetpigtgl Inspections
owner of propcny Who builds or improves thereon,and who does such work himself
or through his own employces.provided thatch improvements art not intended or __.. 602 __--, ROOF_.PLYWOOD NAIL ---....._......__ ..- .__.__. .__.. ...
offeredTor-GIe.If.h. Inn ldngoi mprommeninus sold minoneyearor ' 603 — ROOF BATTENS '
o'pl t wbas
the one- (der will have the burden of proving that h did not build or
improve rorpugmm.fxale')' 604 - ROOF IN-PROGRESS
pmpe.7 1 losine dy comrofeisi with licensed contactors to 0.'t CY . I P Pa t
construct the project(See.)Baan Business andpro emy who
Cale)The saes tareon.
License maw dose not apply man owne err propery who builds seimproves thereon.
vemuds for such prolects.with a.conmanor(s)licensd.pursaom moths. -__. _ -_ FIN p-LEO--
Contractors . --.-. -- --- -- -- — - _
License law. r G�'9
❑lam exempt under Sec. B&PCfor this reason a ' 1. . ... .
Owns JAN 0 9 2002
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty ofprarjury,onc of the following declarations:
❑ 1 have and will maintain a eenificate of Consent to.self-insure for Wmker's BUILDING
Compensation, as provided for by Section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
❑1 have and will mai main Worker's Compensation In a ancr,ai requircd by Section -
37W of the Labnf Cale,for the perfomtantt of the work for which this permit is
. -
issued.My Norkefi Compensation Insu ice cirri/er{a�nd Policy number
,,are.
)) _ ,.,,,, „ ,. ....,.....__...._..�..
Cart .. -/ /111.Polly N :aY'''i
CE TIFICATION OF EXEMPTION'FROM WORKERS;,.— �— t r } ,%� .x- \ y i l•A
s s
COMPENSATION INSURANCE `t ..._
(This section aced not be a+mpleteJ if the permit is for one hundred dollars " ` s•• ( ss.. '
s. .
01(1 less.)
1 cell fy that in the traiinamem of the k for which this peimit is issued 1 - t• l .
shall not employ any person in any minter so as to become wbject to the Workers
Comycal laws.&Califomiu.Dam
. Applicant. .. - _. .. .. __ ._. .. . _.. -__.. _.-. , _----
NOTICETO APPLICANT':If,after making this Cenifcam of Exemption,you should '
zO
bccbloto theprovisionspenises Compensation provisions of the labor Code,you must
Qform tit c imply with h p '.Inn..n tE. p limit shall be Accmal revoked.
E'N CONSTRUCTION LENDING AGENCY
I hereby M.That there is a cunswaion lending agency for the performance I'
of the work for which this permit Ilissued(Set.309].Civ.C.)
Q 'al Name a. .... :, ...
LD Lender's AdEresx
U C) '-'
. . . ..
V O .1 certify that 1 have read this application and,tam that the above information is
correct.1 agree tocomply with all city and county ordinances and state laws relming
O V to building coordination.and hereby amhorim representatives of this city to enter upon
the abovemcmioned propcny for Inspection purposes _
� L (We)igree to save,indemnify and keep hararm the City of Cupertino against
l/) liabilities,judgments.costs and expenses which may in any way accrue against said
[,J Z City in conacaseco a or the granting of this parmak. r
APPLICA`'-`UNDE'RST\NDS AND t'ILL :OMPLYs ALLNON-POIYf Issued by:
SOURCE.REG ULATION$ �T
�24
as definMIt the Clupenin Municipal bingJ Chapmrort2 v em Type Re-roofs
S gnamm ul Appl c,nUC moue. eir,
YvI
he
itain or future
ant
HAZARDOU MATERIAL9015C OSURE
or a m nazndaandSol ly ..Type of Roof
and 11 nhh and Safety •l . r j b ,.t'
Cate 0 Yes'255721 1 ` \ 1 t 1
❑Yea"• I`• ❑Nd ;'t * i i All roofs shall be inspected prior to,any.roofing_material.bemg installed,,
. Nillthe appl t t buildn' p t use eq p f r devices which If a roof is installed without first obtaining an'inspection, I agree to remove
emir hazardous t t o tit s air c defier d by Bay Area A Quality Management
Di t all new materials for inspection. Applicant understands and will comply with
❑res ON.' all non-point source regulations.
t•.. 1 have read the bazirdous materials milm amens under Chapter 6.95 of the
California Hmlth&Safety Code Sections 25505,25533 and 15534.l understand that
If the bei king dues not currently have ate t.tb it is my responsibil sty to notify the - -
Occupant of the requirgments which m t benI- rior to issuance of Certificate of
Occupancy. �_ ,� �j� Signature_of A_pplicant Date
o'ner. .r cd agent /oma All roof coverings to be Class "B" or better
.• -. ,... .. OFFICE .. _...._ -. _ .