05020148 CITY OF CUPERTINO + e•=a ' *'� `,�"°'
BUILDING DIVISION PERMIT ,CONTRACTOR NFOR^M ATION mi
DING ADDRESS: STEVE NAN CONSTRUCTION PERMTrN`05020148
20883 ELENDA DR
nW NER'S NAME: PERMIT ISSUE DATE
GOVINDARAJ PADMANASAN 10599 N S
ONE.: SANITARY NO. CONTROL NO.
(408) 203-3933
ARCHITECUENGINEER: BUIIDING PERMIT INFO
BLDG ELECT . PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION O O O O
x C 1 homby affirm Nal I am licensed under proisioru of Chaplet 9(commencing Job Description
t! with Section 70M)of Division 3 ofthe Business and Professions Code,and my license is
n in full force and effect,
5'gzLic...Cmss nLic.x SFDWL-1 STORY (3685r -LIVING)
Canrmmr
HfTGARAGE 625 ' FIN EC'1-50ECG 0
1 undersand my plans dull the nand as public records
�yU
G Licensed Profcssinnel
3 OWNER-BUILDER DECLARATION
Comm ON www
0 0 1 hereby.(firm Nal 1 i. exempt from the Costas o License C taw for the MAR /006
O O which
re reason.(Section To s5.Business and Pmfee o li Codas:Any city s county n
m which requires a permit na Construct,attic.improve,demolish,of repair any atrucwre
prior to its issuance,
ensedpalsontnations On applicant ranchpermitw Oles L1w(itammem
F?G that me cingwith
iit Pursuant tom)of Division
the eBusinessatJanscssions oprer9 S FI. Floor Area
¢H$ Out he is exam t tSslify0 TIXnd go,basis f r of the aged axe and exemption.
vi Code)of q R1 S I
.. that he is exempt Ncrtfrom and the Eesti far the alleged exemption.Any violation of RR��// N
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number. OccupancyType
not msec than five hundred dollars(SSM). YP
0 1.ss owner of the property.or my employees with wages ss their sole compensation. 32630025 , 00
will do the work,and the structure is not intended or offered for sale(Sec.7014.Business
and Professions Code:The
Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improve.thereon.end whodoes such.,it h reself.fthrough his
own employees,provided that such improvements arc not iammund oroffered forsale.If,
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden.f proving that he did not build or improve for purpose of
sale.).
0 1,as owner of dre property,am exclusively contracting with licensed contra0mn in
contract the project(Sec.7044,Business and Pnefecsions Code:)The Conuaewrs Li- .
cense taw docs not apply in an owner of pmpeny who Wilds or improves thereon,and.
who contracts for such projects with a conuacmr(s)licensed pursuant to the Contacto`3
License law.
0 1 am exempt under Sec. .B k P C for this reason
act Date
WORKER'S COMPENSATION DECLARATION
1 hereby Nsa under penalty of perjury one of the following dedanuoes:
1 have and will maintain a Certificate of Consent to self insum for Worker's Compere
.tion,ns provided for by Section 3)00 of the labor Code,for the performance of the
work for which this permit is hound.
0 1 have and will maintain Worker's Compensation'murance,ss required by Section
3'100 of the labor Code,far the performance Of the work for which this permit is issued.
My Workers Compensation Insurance c cr and Policy number em:
tinier. /y�,,{,� r Polity No.: _
CE Fl ATEOF EMPSIONFROMWORKERS'
COMPENSATION INSURANCE
(This section need not W complcity if the permit is forouc hundred dollar(51M
or less.)
1 Unify that In the perfiarmN[e of On work for which this permit is issued.I Nall not
employ anyper.n in any mannose az In become subject to the Workeri Compensation
Laws of Califomia.Dole
Applicant
NOTICE TO APPLICANT:If.after making this Cenificaw of Exemption,you Nould
become subject us the Worker's Compensation provisions of the labor Cycle,you most
.JO foMwith comply with such provisions or this permit shall he deemed revoked.
z Vy CONSTRUCTION LENDING AGENCY
[-+ 1 hereby One that then is a construction lending agency,for the performance of
the work for which this permit is issued(Sec.3099.Civ.C.)
AUnder's Name
a z tender's Add^..
U O 1 certify that 1 have mad this application and sun that the above information u
Is. P e.ne0.1 agree to comply with All city and county ordinance and sau laws minting to
0U building construction,and hereby eutbon>e mpre.mativas of this city to enter upon the
Ikl abovcmentioned property forimpaction purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
fag liabilities.judgimma.casu.dc.,.which may in any wayaccmn against said City
U in consequence of the granting of this permit.
'—' APPLICANT UNDERSTANDS AND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATNS. Re-roofs
SI re of Appbc.UCOnuxmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haorkb.us material
az defined by Oe Cupertino Municipal Codc,Chaptcr 9.13,and the Health and Safety
.ansa sccu.n 1531(11)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya �Nu
If a roof is installed without first obtaining an inspection,I agree to remove
Will the app'icnl or future building occupant use equipment or devices which ,Pi
mit ha>ard air ena in.ts u defined by du Bay Area Air Quality Management all new materials for inspection.
Distric,
OYcs cp�u
1 have mad the havardnus materials requirements under Chapter 6.95 of the Califor-
iaHculN6SarcyCode.Souem 25505.25533 25534.'understand thtifthe Wilding
dos eves)urrtndy have a umm,Nm it i y unity w ratify the occupant of Oct
mquimmc-ts which Must met n.rwiou )ofxccrdficauor Ocapmtry. Signature of Applicant Date
�� ��.�a9
All roof coverings to be Class"B"or better
a ser amhomcd escm � Dau g