06010079CITY OF CUPERTINO
" ,�a Y
BUILDING DIVISION PERMIT
GONTRACTOR1I�NFoRMaTION„'=..
BUIIDINGADDRESS:
ELMENGARD INC.
06010079
10455 BYRNE AVE
NAME:
PERMIT LSUE DATE
kNER'S
SESHARAO PATCHIPALA
176 SECOND ST. -
2006
NE:
SANITARY NO. CONTROL N0.
(650)948-3613
ARCHnELTfENGINEER:
BUILDING PERMITINFO
BLDGELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
p
Ka Ch.a 9(Mmmut in{
I bmby.ff Wu 1 w Iketmd uom porlll«u Char
vith Salm 701111) of Division 3 or N, Bu an.f Nofasium Code.nmy Buu
in fullf«awu=L
AOJCi$I
REVISION--TRUSS CAL,
DSLLL
- oR 64M&4'NAy. TNG
NO NEW PERMIT ISSUED/ORIG. #05080202
ARCHITECTS DECLARATION
1 Yndcr M my plana shall be wed u pobtic t„orM
l.k,ucd Pmlcnbn.l
OWNER-BUILDER DECLARATION
I hertby .film Oat 1 .m eacmpt fmm that, Convulah IJcmx lav far Ih,
folhlwin{ rumn. (S dm 70315, Buoncal ud Pmfcall«u Code: My city or oaumy
vhkh r yuiru . Ivnnil to anvrun, AW.. Imfnorc. drmnliN. ac oVa4 any ury
pwohout[� m � P.:�aftc �W'Lax.La 9
Sq. Ft. Floor Area
Valuatio 214
It (chxh.pn
(c«omeudn{ with Schon 70007 of Dir . 3 of Ibc Bulna..M fill oto Co&)«
.
Ibu tr la uwpt I .f..nd Ibe ti.:s for lN, m {W uatfoon- My vl0utkn a(
APN Number
Occupancy Type
Sa0m 7031.3 by any applkam r«. pewit mbjau th, applbnl m. cir0 peaky of
.l more tbn not hod ddolla,(SM
35712037.00
❑ 1.nownu of tie uptaty,«my, apply, wish v{auIE[L mk mmpau.Jon.
Required Inspections
q pe
wiRde Oto wmrk.nd lbe wu wxunatitwlAed«nBexa f«YkfS.s. 7a.,BY.lrca
.nd Pmfesiltw Cede M Contr.uarl I k lav dov not .ppy to .n owner M
property who ildimimpure.thamo,.dwho daaluch waithiauclfor Ouoo{h hll
am cmployaa, prwldcd 0u mch imptaexaul ve roto hucMW aaRaW (or Yle. B,
budbv delalildin{or'vo wkhiooreyar ofiro { m. theowoaf
ofpin,.uao1E
wiB lave Ibe bovdvl of pmvio{ Thu b< silt IPI bdW or impmx f« purpu¢ Of
/
.k.),
❑ 1, u on n of th propm, am eaelua W Y comedo{ With limned alno.cw. to
fw
mnuma d1, pmjea (Sec 71 4. Buena. aad Prorasiom Code:) Tim Comer - L1-
V y.
. Lav dors . apply to In owoa of progeny-who builds or Irn r dorm.. told,
C`
whomnlf.na for mch pvyv. w ih.,.rwm(.) licnmed pmm.ot to t Cteu.no.
�\
funs lay.
v
lannampt.dcsm ,BAPCforthurealm
Due
WORKERS COMPENSATION DOCLalkADON
I kmby.Illm under penally of ptvjmy am of IM folb n{ hcWllanc
❑ I Nrc.W w01 msinuin. Cenlrox o/Cmucnl m v3fin11Ye fa Wortef. C«nprn
udm, n pmvldW f« by Sallnn 37(10 of the labor Code, for tbo pafumn. of the
vat for whkb this .it u wood.
1 bav and vlll mlinum Worlx(. Comic u I.. u rtyoirW by Secdm
3700.f the labor Cod, fa me pafouuneaa( lite work for which Wu palolt 1. IvuetL
My Wortlll Campeuuim Invnua arrfa toot Policy numbs
earth: jTRTE FUND Polity No.:
cunRCArE OF EKEMPnON FROMW ERS'
COMPENSATION INSURANCE
rlbu axd. nasi not W.plo” Bib, parch u forme huadmd do0u. (5100)
or as)
I =ufr situ in We pa0muxe of Ib, w fa which Nu pamlt u ul d, I siu1l not
ewpluy arty perms in any m+acr m u to bccan, mbjW m tb, W«ba.Cnmpamllan
Laws of California. Due
Appfi=
NOTICE TO APPLICANT: If..Rer m.klo{ thla C.61 .0 of Eaemption. you 1bo k!
beeoroe lubfm toTho Warta'. Co Xbauil an j m loo our M Ne Labor Cb&. you toot
foMwiW mmply with such pmisom on Nu pemil.IW I be &=W rtvoYcd.
AGENCY
fm
isa knclING
tku dart uaoonnmn)nnkWl.) ley fm de pufum. ea(
Lh. itun
Ne went for whkh Nil pmmit u inoed (Sec 3097, Cl,r. C.)
hich
'
lalldC/1 N.x
)
tandu'1AWxv
lc en, Nuthe.bo.clnfm•.'.,u
currtn. I .{m, tocomply MN VI Nry mt cowry «din.rcof W wk un rtluia{ m
toclhawrt.dtbu.tm,l cmyordi
udoo r[pRYllalirel of 0111 <uY menta ups the
buibin{cnfi t ro
d .bore (Wtiaed to un foriamify polryo¢.
my(M io
(W,) .{ma to vve, udcmm(Y and teep h.mkv Ne City N Cupaveo .µmo
j IIKc.ede.pvr¢l whirio nuY 1. mY wvy.mm.{.iw vid Clty
IlY1 p.ITR�
A4n{Or
AANDS A ID WILL CO PLY W Al,NON-POINT
Issued by: Date G
S( r,
t�Re-roofs
SlpulDue
of AppksHAZARD to
HAZARDOUS AfSDISCLOSURE
Type of Roof
W l:e acfing hnardaum.kuW
Cuptntafwwkipsi o&.Citrw9.c2. and ftbanik
u deOnW by Oe Cupenlm Munklfol Cook. Cbapur 9.12 and de HUIW and S.fuy
y
. Soli. 2533547
All roofs shall be inspected prior to any roofing material being installed.
❑Ya Na
If a roof is installed without first obtaining an inspection, I agree to remove
wu t1b, Wll for Onyx bwlaln¢aauwnt uxequlpoxna u,& l which
anit ha,vd.l .Ir cmumirow as &11n by Ne Bay A,c. Air QYahty M.n.{cmcnt
all new materials for inspection.
Diluin7
0Ya �No
Ihlc nasi de wa ntb.ntam Cbap,, 493 of de Calif..
otoHoltb 65afn 253113.] 5333and 2533,. I aldctuanE tbu duh, hul,in{
.
dura mtclm .(runt lhto hu my rt4p«ulWky to notify de olxuutle or Nc
xquimta ba met m¢mmmor.Cmtirntar� Y
Signature of Applicant Date
All roof coverings to be Class "B11 or better