05070047 CITY OF CUPERTINO
BUILDING DIVISION PERMITjC®NTRAGTOR INFORMA IIQN it
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BUILDING ADDRESS: PERMIT NO.0 55 0 7 0 0 4 7
OWNERS NAME: PFIU,QT L4UE DATE
AM BAT,AJI SESHACHALAM 01/18/2006
fE; SANITARY NO, CON ROI.NO.
I
ARCHfTECT/ENGINEER:
BUILDING PEIIMrr INFO
BLDG ELECT PLUMB MECH
:00 LICENSED CONTRACTOR'S DECLARATION
4'C Ihcmbyaffirmthatlson licemedUnder piaviim+ofChapter9(commeneing Job Description
tt�fi0thSeclion70(10)of DlHtlon 3 d0.Bunt.and Pro(camnt Code,all my license la
in full omeWcffa ADD 1093 ' -LIV/GARAGE-432 '
Lit.aa:, room. REMODEL (3 BEDROOMS/2 BATH/KITCHEN/LIV. )
ZZ AasolliICTSDECLARATION SANITARY COVERED BY SUNNYVALE-NO .ISSUES
SW IuMunaW my pm^+shall4 Coedupublic m:a0
s aLiccved Pmfcvioal
o
OW NER-BUILDER DECLARATION
1 hemby aMmm Nu 1 am exempt fmm dm Cmuacmrs Licouc I�for ton
�0o follawinT neawm(SatiW]V31_5,Bushnell and Profeseont Code:Any dty no County
$ which ox,tirta a pmmh to®tumet.a t x,knpm Oe.amnnW,a mpir any CmCam,
beamenne,am
prior
bee lncemmd Imili In to do,(nMeiionss iraii 1c a the co�.�.r.',Lwe.La.iCCup.v Sq.Ft.Floor Area Valuation
�$ (commereing with Savor]000)of Division 3 of the Business W RMICteou Code)w $259000
— that Ise m exempt+hcrefmom and One bum for the Jmgcd exemption.My vimmJne or
Seetim]031.5byamy apgiant for apemh subjecu the WIlwu in.cml penalty a AIN Number Occupancy TI pe
na more
than,Ret hoodmd dolma(S!iW).
❑1,u owner of Vie pmpwy,or oY wplvym with x+{u u thew male canperwbn,
and ion,ccodc�Tle Coomalewri I"Com La��,ppy e]0an a � Required Inspections
progeny won mltlsvimproxma Wmeom.W won dousoh wort nimselrm through nm
own em,.the h,provided Wu Soren Impmtemanu art Cot year
deC vdfced fatale.B,
bowet<r.Jmeonet buImpmtemcnsmaalt withinox,year or mprove fn.or pu oze of
budder wi0love the burden of pmHng Was K did not btdld a knprntc for purpose of
sale.), t1 a� r�
❑L.s dbef MWepropmtY•.Bsloem ly conuuong Ctb The Ccono.etars m II 1'�
corneum sac P^mlttt(Sec.]Obs.Buslos and ny Wto la Code:)The Con beleon, a ry] II'p��,r
sore law dao mat"ply m am owter of pr et.10 nvm wilds m'v nn to ea lmmm,sad.
bums U..fm soon pmJem with aceruraner(s)li¢nsedPurwamm WeCmvactofs
oilLaw.
❑Lm sem .Bd 1.diis
tel' ate O/ / Vex
WORKERS COMPENSATION DECLARATION W tdy ,yQ
�I bcrtby aQ urtdcr pemlry of perjury arc of Je folbwing dsi.raslons B�11t�„\VttJtt
1 N.c Wei➢m.inwa a CW Ramc of Contend to self-Insum for Wokcr.Coupon u
tanon,u provid:d for by Section 3]00 of We Ldam Code,rot We pedonx rce of We
wvrk for which this pundit is issued.
❑I bate W will maintain Wota'f CmmpenCodon Imwnrm¢,u m9u�by Sedan
3]W atm Labor Cade.for ton puformana of the wok fm wnleb this em ,is w�.
My Wmtrr's Compensation wwrancc camim and Polity number am:
Carver: PW4y No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ibis minion reed oat tecompleted Witte parch 4 fa tee hulled dd”(SIM)
or less.)
1 atiry Jut in the pvfomuae Cor ton work for which this pmmil a isued.I Coal not
wplq amy pcnm many de wmlYnCmmpeatadon
laws or Calirarmr¢J��/LCL-may
Appilmanc
NOTICE To LICAM:If,after making dits COO=of Etcmptiw,you sh ukl
become auhica to We Wortrr'a Compensation P Woos M tht UW Code,you must
.J2 rorthwith Comply with wen prervwom Or Wil pundit shall w darned mat 1.
zCONSTRUCTION LENDING AGENCY
E"O 1Fumy adin.Wu thenen a..it.Iudimg ascncy for twperfarmanm of
x> Ric wort for which Wig pundit is rolled(Sim.309].Civ.C.)
CLender's Name
,=a Undcr's Addimas
C) 1 aNfy Jut 1 IoI read thin exp Bern.W cute Nat the i mw info.mon m
(L comet.I S.m comply wIN 01 city sad comfy ordinaoes W some Cows rawiag on
C) huiWi,conoutzium.W hemby mi mpresemIMMS ofthu city to aw upne the
C. amve-(We)Is pen",m fm mmiftim!loe,,ea
(We)agmen m Cost,W exp fy es trry humku the City of Cupanat id City
Taj) in Comem,judgmcnu.costa Weapw¢t which may In an)'way aame.rymst Comd City
C)Z APPLICANT
ofdo DUSTANDSJusD iL
WI
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE _ —O¢l' 6r11e0c Re-roofs
Signamm of Appli ontiacmr Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wdl ton Wlcaml or Note bonding oavWt Pom or handle baarde li matuial
u defined by tk Cupenmo Municipal Cade.C n ixer 9.11 and We Ha1W W Sday
ode.s«,ion 2553z(.n All roofs shall be inspected riot to an roofing material beim installed.
ya �a P� P Y g g
Will the appliamt or lumm wilding aanp.at ase wuipment er det;ab wnicn If a roof is installed without first obtaining an inspection,I agree to remove
11 Fit h.rudnut or tonumlnanu to deRmtl by Nt Bay Arca Air Quality Muugtmem all new materials for`in5pection.
Diwim]
Y. "[$Nu
Ibate mad We hvamdol matmials miponeo oswderCMptu 695 ofthe Califo- '
mu Halth&SafnyCode,Sccvou 25505.25533 arJ25534.1 tmJcmvd that If Ne bonding
don Cot cwmndy hove a Imam Wu it u my mpomEilhy m amity the u¢upam of the
rtarymmmc item comet mivma^aof.CuJreattorae Signature of Applicant Date
G �� � All roof coverings to be Class"B"or better O
Owmmm wtho.ired. m Dae 1