06010007 CITY OF CUPERTINO '9=.'^'sx%re» 'tom' '+"' �• `" '�"' ¢^
BUILDING DIVISION PERMIT CbN'. 'RiCTOR TNFIMA.T�,TOI�t,,
BUILDING ADDRESS: ,g� PERM"NO. 06010007
220 LEBANON DR
i'S �4ZWZJ�
NAME: PERM"ISSUE DATE
ANAND GANGADHARAN 01/31/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFD
BLDG ELECT PLUMB MECH
IM O O 0
3096 LICENSED CONTRACTOR'S DECLARATION
09 Job Description
IN
1 Wmby affrm that 1 am licensed under provisions of Chapter 9(commencing
Section 70110)of Division 3 of the Burncu and Profceslow Cndo,and my license h
^� a full fora mdeffwt. ADD 4661 -KITCHEN/COVERED PATIO/2 BATHS,
Dm� `Glm` Contractor
aELECT SERVICE UPGRADE/WATER HEATER/HEATER,
ARCHITECTS DECLARATION REMOVE (E) FIREPLACE
1 understand my plans shell be used u public mcords
G Licensed Professional
g
OWNER-BUILDER DECLARATION
4 $ 1 hereby affirm that 1 em exempt from the Contractor's License Law for the
p O following mason.(Section Nn",Business nd professions Code:Any city or county
a$ which redoes Permit to ter
construct,al ,hormone.demolish,or minor my stmttum
'��ny^ prior in its issuma,also requires the applicmt for such permit to rile signed moment
that he is licensed pursuant to the provisions of the Comracmr'a U..Law(ChaPer 9 Sq.Ft.Floor Area Valuation
zC$ (commencing with Section 700(])of Division 3 nt the Business and Profusions Code)or $250000
3— that he Is ammpl therefore and the basis for the alleged assumption,Any violation of
Section
ects n 7Nen fobs nwetpwpl�i:for a permit
e b subjects the appliant m a civil penalty of APN Number Occupancy Type
not❑1,Is,owner of the penpcnY•or my employees with wages as their sole compensation,
will do the work and theshurure boot intended or offered for ask(Sm.704A,Buslrcm Required Inspections
and Poremimu Code:The ConhmYor's License law does not apply m m comer of q P
property who builds or Im pow Nemon,and who does such annals himself or though his
own employees,provided thatmch Improvements ase not Intended proffered for ale.It.
ho+ewr,the building or improvement is sold within an year of completion.the ma ar
builder will bow the burden of proving that he did event build or improve for purpose of
sale.).
❑1,as odor of the popery,am exclusively contracting with licensed combacrors in
cease La the project(Sac.in an ower
or and property
wouas Cade:)The Cmhmmh U• "NAL
�
cede law does not apply e m ower of properYwho s d P or improve mucea.cod,
who contracts for such pojeets wlmeemuactna(a)lia�dpunwmothe Contractors ��
License Law. D
m Laempt under Sa. B&PCfor this moon
CM\ Date 3 /wt T
WORKERSC,MPNS'ATION DECLARATION 7 �V/ 12 ?QOQ
1 hemby&ill=under penalty of perjury ow of the relieving declarmow. �I U
t]I ha.and will for by eCmnriam ofC Labor Code,
fa WmYeM1Ce or the I
melon,m provided for by Section 3700 ar Je Labor Code,for Ne performance of the
wog for which this permit is issued.
❑1 haw and will maintain Wnaten's Compensation Inatome,m required by Sectlan
3700 of the labra Code,for me performance of the work for which this penno(b ismed.
My Workers Compensation Who e n artier and Policy number am: '
Cmrier, Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thisswil n wed notWconplcwd if the permit is forme hundred dollen($100)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in my mmwrso m m bwome abject to the WorSni Compensation
Laws of California.Dam — a 1
Applicant 'j A O
NOTICE TO APPLICANT:If,After'making;this Cerinlae of Paempdon,you ahwlJ
become subject to me Wotefs Compensation p mnislow of the labor Code,yeas soul
OQnalh
fwith comply with such Provisions or this permit mall W deemed mooted.
„zo CONSTRUCTION LENDING AGENCY
[ti l ttemby aRnm than Jere ha constructhm leaning agency far the Performance of
C> the wort for which this permit is issued(Sec.3W1,Civ.C.)
W Q Lenders Name
2 Lender's Address
f J Q 1 cert that I Mw need this application and sum that the also.information b
W^ cored 1 agree to comply with all city W county ordiwwes and sem laws missing m
Wilding construction,and hereby authorise representatives of this city to emar upon the
W above-mentioned property for iupecdon purposes.
6. (We)agree to snw,indemnify and keep harmba the City of Cupertino against
,n liabilities.judgments.cuts and expenses which may in my ray ansa agaiut said City
U Z In conwinewe of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:, Date _ 3/ •'O G
SOURCE REGULATIONS.
�� \ 1 Z 1 D L Re-roofs
Signature of AppliesnVConBOGU �E Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Jac apPliesm or future building accupantssom or handle hmardons material
lned by the Cupordw Municipal Code.Chapter 9.13.um the Health and Safely
Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yes ❑No
Will the applicant or future building occupant uw agaipmem or Jori=which If a roof is installed without first obtaining an inspection,I agree to remove
emit harmous air ronaminsnu m defend by ore Bay Area Air Quality Management all new materials for inspection.
Dis cls?
' ❑Yea 1-1 No '
I ban mW the bemrdws materials mandoom at under Chapter 6.95 of the Califon.
meHulthk Safety Code,Ss9os,25305,25533 and 25534.1 understand mu ifthe Wilding
Jaen not cummly have a enmk met it Is my rewoasibiiity to wdfy the occupmt of Ne
requirements which must Be met micro,Issuance oracenifca of Occupmry, Signature of Applicant Date
Owner a rad cot Date All roof coverings to be Class'B"or better v