05110141 CITY OF CUPERTINO ..
BUILDING DIVISION PERMIT �,cbNTRACTO NFORMATIO
BUILDING ADDRESS: PHAN CONSTRUCTION CO INC PERATT'ND'O5110141
'R'S NAME: PERMIT ISSUE DATE
NARAYAN LAKSHAM _ 870 S WOLFE ED 12 /2n /2005
PHONE: SANITARY NO. CONTROL NO.
(408) 737-8323
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
goo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby soleus Net 1 am licensed under provisions of Chapter 9(commencing
with Schon 7003)of Division 3 of NC Business and Profcsaloas Code,arW my licenm is
n in full mreeandeffece ADD 2041 (LIV. ROOM)
j t5 Lt...Cl Lie.N-
Date CommxSm_2t2X1_CdJ!iIl[Fd"(4
ARCHfrECTSDECLARATION
I understand my Plana shall he used as public records
g C� Licensed Professional
OWNER.BUILDER DECLARATION
<i I hereby affirm Net 1 em exempt from the Convenor's License Law for Ne
E
OF following reason.(Section 7(13 1.5,Business and Professions Code:My city or county
S which requires a permit to cnnstmet.alter.Improve.demolish,or repair any atrsamre $43731
prior to its issuance,also requires the applicant for such permit to file a signed statement
FE< that M is llccnsed pursuant to the provisions of the Contractor's Liecnac iaw(CMpmr 9 Sq.Ft. Floor Area Valuation
6$ (commencing with section 7(IBB)of Division 3 of the Business and ProGaeions Code)or
N
jl et he W exempt therefrom and the basis for the alleged exemption.Any vlolatlon of
Section 7031.5 by any Applicant for a permit subjects Ne applicant to a civil penalty of -3 AN x9awr= Occupancy Type
not more than Eve hundred dollars($500).
0 I,as Owner of the property,or my employee,with wages u their sole compensation.
will do the work and the suunute is not intended or offered for sets(Sa.7044,Business Required Inspections
Nd property
whlorm Cade:The Cmuaner,License law duce mat apply lf r through owner is O �� 9 P
and Pan who e,Code The Co mune,aMwheda w does A en apply As and" les L
own employees,provided that Such Improvements are not intended"offered Tamale If. FINA
however,the building or improvement Issald within arc year of completion.Ne wrrco
builder will haw IW burden of proving Nat W did not build or improve for purpose of
sale.).
0 1,ea Owner of the property,am exclusively contracting with licensed eontnaoa to
construct the project(Sec.7014,Business and Professions Code:)The Comments'.
cove taw eats not apply to an owner of progeny who Wilds or improves Nomon, 'gat D�
eche se Law.for such prokcu wlNeconuacmrts)licensed pursuant to Ne Conmc L p s
License law. N`V_
0 l em exempt soda Sec. ,B k PC for N4
Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury rete of the fallowing declarations:
❑1 ham and will maintain a Cenlficam of Consemto selNasum fa Worker's Compen.
ss0on,AS provided for by Sada.37M of the Lebec Code.far She performance of the
work for which this permit Is Issued.
0 I haw and will maintain Worker's Compensation Insurance,as acquired by Section
3700 of the labor Code,for the performance of the Werk for which this permit is issued.
My Wattages Campewtion leamonce arria end Policy number am: u
carrier.57111E fg/A-� Policy Na.: I�57�� 1 -TWA
C ;4#TEOFZXENP[ON FROM WORKERS
COMPENSATION INSURANCE
(Thissect(m used not bo completed I(Ba permit Isfaromhundn:ddollm($IOD)
or teas.)
I cenify that in Ne performance of the work for which this permit is issued,I shall not
employ any person in any meaner an As in become subject o da Warkeei Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.After making this Carolina,of Exemption,you should
become subject N the Workers Compensation provisions of Ne Labor Code,you mnst
,J O forthwith comply with such provisions or Nu permit shall W domed revoked.
,'Zn'—' CONSMUCTION LENDING AGENCY
C F I herebynRrm Met Num lsamnswc.3M.Cing agency for Me per(urmmce of
f5i theLe work for e, this Permit is Woed(Stt.309'1.Ctv.C.I
W Q Lender's Name
Dz Undoes AOdreaa
V Q 1 certify that I ban food this application AM sum that the show information U
L7.F coma l agree to comply with all city and county Ordinances and sate laws mining to
O V building construction.and herabygothourim MpMUmMIh?CA Of this City in color upon the
[$1 ahow-meMoond progeny for Inspection purposes.
(We)agree N saw,indemnify and taeep harmless the City of Caperton against
(Imitates.judgoana,coca and expenses which may in any way acerae against sold Citymcquem
() APPLLIICCANTAUN UNDERSTANDS ANDof the jimpting,of WILLWILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE REGULATI tLS. S �&o
-
J� ✓�� ����I a Re-roofs
HAZARDOUS a
Signature of AppliaHAZA Data
RDODO US MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building e,Chapter
orhandIc and Me Heardnua materia
AS,defined io the Cupertino Municipal COM.Chapar 9.It.and Ne Health and safety
Section 33532(e)? All roofs shall be inspected prior to an roofing material beim installed.
❑rat Ig No P P Y 8 g
Will the applicantor futum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Kameda,air co.tmins.a u defined by Use Bay Area Air Quality Management all new materials for inspection.
District?
0Y., 9W.
to ave mad the haraNnusmaterlals requirements under Chapard.95 of No Califon
nialicalth@Safety Cade,gecdom35505.M533md]5534.Iun Nt Wthuifthe Wilding
does not currently haw a Icons that it is my responsibility N notify the occupant of the
mqubcmcns which mug W met prior a issuanc ar,ceninatearaapmgy. _ Signature of Applicant Date
�� lLib//-u
ownei or.athadvgd,gem ma All roof coverings to be Class"B" or better