05070049 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 4C0NTRACT0R INFORMATION z
BUILDING ADDRESS: PERMff NO.0 5 0 7 0 0 4 9
18820 BARNHART AVE
(` NER'S NAME: PERMTISSUE DATE
BALAJI SESHACHALAM 01/18/2006
NE:
SANITARY N0, CONTROL NO.
ARC HITECTIENGINEFR: BUILDING PERMITINPO
BLDG ELECT PLUMB MECII
co, LICENSEDCONfRACfORS DECLARATION - lob Description
x I bcmby, m Wnd
.rflr .t 1 w Ii uer Pro Wcrot of C3.pw 9(rnnttrcrcing P
<i2 vlW Section 7")of Divivov l of the But'T..W PmfcLsiru Cod[.and MYlkone4
fun fotco.odeffem. DEMO (E) HOUSE/GARAGE/POOL
2g= LI .Clay Lk.I
n7 Dm Cuntr.ctar
qg ARC hoE cS DECLARATION
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D S 1 urdemmy P4m ah.1l k uxd u publN
ic reear
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uo LLo� Livxnmd Pntf..w .
OWNER-BUILDER DECLARATION
hereby.farm Wei 1.m c.cmpt tram 0e Contr.nor'.Lkmte L.w rar Me \P�
20 following m on.(Section T0]IS .Ivas.n
,Bod Pmfuads
.ium C :A"cloy or county
e LL which rurydu.pvmit to caaLmc4.11G.impo.e,dcma4ch,m rtpvr.ny uructvm
mblLt ivnrcc..4u mgdrt.the. Rant rat mch rmitm Reaagnetl mtcmrnt
-si Wuhc4litxmcdl�+tolblhcpmvicootafNcCaurebr'.liansl�v(Clryvcr9 Sq. FL Floor Area Valuation
i€$ (rnmtncrmnj wiW SctlaeTODO)dOivb,ian5of do Bucttutvd Prorcalon.Cndc)m $5000
_ tbt be 4 uemrn t Mfinoan vol tk bub,for W[alkjcd v Palm Any violation of
S[ctim701sbyMIpplictntr«.perm4mbicculh[.PPlmub.[i.ilP[mllynf APN Number Occupancy Type
oat nwrc th.n aK hutdmd ddba(55001
37533❑I,u owner of ilk WaaPvtY,a my eroployty rIW wN y Wev colo cvopewtlon.
88
rill do the rerk..rd We twaum 4 not iaton&ti m arfemd fm Wc(S .V44.Boulc Required Inspections
.nd Profealam Cock:The ComnmoY.Luau U.dont cot apply b m owrcr of q P
property rho but nM7.doon,on..nd who Eonmch wart bimredfm throagh Idr
own[mplayeu,IMOlded and m int mvememt K tw inluded arol fm ilk If.
bowetx+,the btdldlng or bopro.emrnt 4 Id wltdn onto Sent of mropinton.ILe ownv-
buiWer will bate do bnden of IvoWn j dw M did cot bo1W or inprme in,ponce or
.k.).
I,u ow+cr d tic pmpeny,w•••ItdveSy eontr dog with lin eonv.etart b
ean.traee the Pmlem(See T0.4.Bu4nm.od Profntbm Code:)Tbc Cooummr.U
[sat LAw dont twt.p Y bN owtn ofWWent wM buJNm Onpnra t ..nd
wpb cantruy rx vxtr pm)eat with.cmu.nm(.)ficorcrtd Purvunt Or th<Cona.naf.
Liccnm L/w.
❑Ivnnemptundc See .Bh PCfm 04
WORKERS COMPENSATION DECLARATION
1'itveby.lntm ander pm.lty d perjury we d We wallowing deeluuionc '
I lu.e.nd ido l f.bn• 37W of he Lt tbCodo.fo, rrc olf— Compeer
.aloof r p thi fa Mi S vont 3700 of Nc I�bor Cade.for the perfarm.rt¢of Ne
work for which W4 permit 4 uvcd.
0 I have.rd w l muwin Wmku4 Cotopem.tlon lno u cc.u leQtdyd by ScNm
3700 of the VDe Code,fa the petf..of We rat rar rtitlt Wirt porMil or inn d
My Wmkeh Cmnpon d®Inwnrce eamiv anG Polky numbc,r
C.vicr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Mh vxdw reed.m be®opkcd If the permk 4 In,one hunA[d ddl.n(SIM)
tw hu)
I certify dot in db p[rform.ac N db wart for which"permit b,is .I. 11 cot
ernploy.try pctma ln.nY.y ub bjcctta WcwmM+t'CorrNmotinn
Law.of Califomid / � -
Applkau on w�
NOTICE TO APP CANT:If,co,r m.klm pr 'rink of Eaaw co,you diallyl
bcc .itmornp b the Wmker't M.Or ttion PmvWom d We IMod Code,you muv
.�O fnNwiW comply with mob puvidom n W4 Pvmit.hall m d[esrd m+aked.
z CONSTRUCTION LENDING AGENCY
; .- Ihcr[by.rfirm tNt dote 4it caruvucthm knding it,o,rar do row moat of
C > the cork rur which Wb,p[rmit 4 b,ttcd(Soo,5091,CO,.C.)
W�Q Lrn4r1 N.
'J Z I<dcr4 o
Add
U O I cwfy Wt 1 have read th4 applindun and mm tNt the.1,o.e inf..ivr,4
IL F., cancell.jroo b comply Mdb WI dry and county aditwtcu.M mk It.mWinj to
0building conluucdon,md bobby authorim rcprccnwi.n of Wit city to onbr upon the
U
r U .have-menllanW property I.inryection P1tp.1.
(We)arl=to ave.indemd ry Nd knp harm a the City of Cupmdno.g.itttt
F'VI Ii.Witim judS.w cmu Nd e.penxa which may in Ny Wy. ithr tt.ud City
U in eco uonoe of the Sporting of W4 permit
^-� APPLICANT UNDERSTANDS AND Will.COMPLY WITH ALL NON-POINT Issued by: Date ` / 7 SGC
SWR TIONS.
�''�� "S'Ie c) Re-roofs
SI jnuurt of ApplimVCon4acbr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the.Ppliam or fuauc building accuP.nt v«c Of h.rdle hauNma rmmria
u dellood by du:Cupertino Municipl Code.Cb.pw 9,12.W the lkalW W Safety
1�u
e.Senior,25552(.)' All roofs shall be inspected prior to any roofing material being installed,
❑ret 50 No
Will the.ppbutnLM,ruuac buudingaccu,nt.cyvipmat a,r .rhkh If a roof is installed without firs[obtaining an inspection,I agree to remove
I h.,udnu air conumimnu u @fired by the B.y Art.Air Ow1i,,Mu omen all new materials for inspection.
Oict?
0Yn �No .
Ih..c mad the hanrdas nubr4l.requucmeou under Cutty 695 of the C.lifor .
HOIW&S�fa cook,Sm 25505.255)5 itntl MN,I urtrmvd thn if We building
.eveeOdy h..e.bn.nt,thin it 4 my mW Fodbifik'b oMifY do a 'nr de
4cmcntt tt,mm[t�immi.m.naof,cmtia[n[ Signa[ureofApplicant Dale
m6 All roof coverings to be Class"B"or better
Ownv or mtbmlaA agent Erb