08070057BUILDING DIVISION PERMIT
Bu1LDP�A RMNEGAL DR NALLURI ASSOCIATES, INC. 08070057
NMR'S NAME: PERMIT ISSUE DATE
SIVA & ROOPA RAMAN 4125 MOHR AVE STE D 1 07/09/2008
KTCHN&RM RMDL,RPLC
n, H in full force aM'Ben
j!Z I.ircna
Cl CHITE l
7Cyp Dim Conmuster
e 7W b `l— _ ARCNr1ECTS 0ECLlicmSON O
Let 1 nMenanJ my plw sIW I W used as public meords � v
sW`o r^ Licensed professional
3 OWNER -BUILDER DECLARATION
ia i I hereby f. that 1 am exempt from tic Co mmuses License Law for tiro
00 following mason. (Section 7031.5. Business and Profession Cale: Any city or coumy
3 $ F which require a permit to cmuwct, elnr. improve, demolish, or .,air any sceuctum
_i ve prior to its issuance. also mquim the applicant for such permit In file asigned sWcmenl
< the, he is liceued pursuant to use Provision of do Con=tm`S License Law (Chapter 9
(commencing with Section 7000)of Division 3efthe Business and Pmfeaion Code) or
Q the Im is exempt therefrom aM the bask for the alleged msmptien. Any violation of
Section 7031.5 by arty applicant fora parmlt subjects the applicant to civil perulty, of
rot more than five huMma dollars ISM
❑ I.ummofdiepmperty,mmyemploynswiNwageut kwlc=peuadon.
aid Pt tcwork Co do he Conek canes Licded m ave does;
to
nmer o•
and Prtywho Cede: The ConvxmYs Liewe Law doe eat apply f rd owner of
propmty who WipromtmprowsthvcomaM who do esu chwmk hiroselrer Waugh his
even <mploym, provided that such improvements art not tended oroneted for sale B,
however, Ne building orw4widencare year orcompletion,side owneo-
samr will have W burden of Moving that haid not build m improve (m purpose of
.).
❑ 1. u owner of the pmperty, am exclusively contracting with licensed concession to
centrum the project (Sec. 7044, Business aM Profession Code:) The Contracts U.
nnsu Law does out apply no an owner of property who builds or improves themon. and
who contracts for such projects with a cnmc,er(s) licensed punnnt to use Cementite's
Lim. Law.
❑ Iarneeemptunder See .B&PCforthi...
41 ner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a lrm under penalty of Perjury one of the following declarations:
Ihsw aM will menWna CeniOnte of CommtwuJf-intim fmWaher's Compem
cation, as; Provided for by Section 3700 of the labor Code, fm the peAarmanco of the
were for which this permit is Wtcd.
W have and will maintain Worker's Compensation Inurana, as mquired by Section
37M of the labor Code, for the puformarioe of the wort for which Nle permit is umhL
My WmkeM1 Compensation Insurance carrier and Policy number am: _ —,_ata
COMPENSATION INSURANCEwM�w' V t
fruit rection need not he cemplcmd if the permit is for on hundred dollen ($IBB
leu)
nrtify that in the perform... of the work for which this permit is eased. I she cat
%ploy any Mount in any manner se as to become subject to W Wortrss' Compmuudon
aws of Califomis. Date
Area
Applicant,
NOTICE TO APPLICANT: If, efmr making this Ccnificade of Exemption, you should
become subject to the Wosters CompeasdUon provision of de, Labor Code you most
., O forthwith comply with such provisions m mll
thin Pcl Nall be domed revoked.
Z y CONSTRUCnON LENDING AGENCY
[—t I hereby Am. dead there k..cruterea n krulm, agency for the "Forms. of
a Ne work for which thus permit k issued (Sce. 3097, Civ. C)
OW. Q Lender's Name
z Lenders Addmss
VQ 1 cortjfy that I it.. read this applicatioanNu
application and,, sus the'Wfmmve inon. is
,,, E correct. l agme a comply with sit cityand county eNin.neae and sale kws mW ng to
C) Wilding commucton. tab Mmby authorise repmscnddve; ofthk city to cow upon the
�+ a abow-mentioned pmpcny for inspection Purposes t/\
(We) C. to taw, iedcmnify and lump harmless the Coy of cepertuct.gain,
(~ hIkbilitiu,jeogmcus. costs and expenses which may in any way ancnm agent mid City
V Z In eonaequerme of the granting of this permit.
'-" APPLlIC NT UtNDERNSA
ANDND WILL COMPLY WITH ALL NON -POINT Issued by:
RnlhR
NAZARDOus MA'fPAlALS OISCIASURE
Will use applicantorfuture Wilding occuPant 1. erh'ndlo hazscms material
defined by Ne Cupertino Mont ipal Cade. Chapter 9.12. and do Nwth are Safety
. Section 25532U1.
❑Yea No
W 11 the applicant or future bedding occupant use equipment er *vim which
emit wMI cu air contemirtants dcuoed by the Bay Area Air Qwlty MansScmcnt
D strict?
❑yea Nu
nmmak mquimmenu undm ChaPW 695 of toe Califm-
.uM5.u533w n5M.ImWcruna Ncifthe Wilding
Nat it k my responsibility m notify fbc Occupant of the
Re -roofs
Type of Roof
Required Inspections
Date 1-�
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class 'A" or better