06060074 CITY OF CUPERTINO
BUILDING DIVISION
PERMIT ONTR`AC'T(TRNk'..Q.RMATIQIY;,
BUILDING ADDRESS: U RAYABHARI PERM"NO.06060074
7574 WATERFORD DR
OWNER'S NAME: PERMITESUEDATE
MADHU RAYABHARI 08/24/2006
'E: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHIIECIENOINEER:
BLDG ELECT PLUMB MECH
O E:n O
LICENSED CONfRACIOR'S DECLARATION lob DlSSCilpuOn
Ou 1 hereby Aaron that 1 em licensed under provisions of Chapter 9(commencing
with Section 7000)of Division S of the Business atl orcuioms Cade,and my lkenx;s
,may in full to.And Affect. 'A TQO 2ND STORY ADDITION 8801 AND 1ST FLOOR ADD 39 '
' � Li"nxclna L^'" REMODEL KITCHEN AND BATH 1551 '
Ih, Doo Comrseror fdkJs"..ar... i�'.a
Q ARCHITECTS DECLARATION
d I understand my plans shall he used As public memo
I WWWy U
0MLicensedProfessional
OWNER-BUILDER DECLARATION
MI hereby alRrm that I em eserepl room the Conuaunors LIeenm Law for rise
.O o following moron.(Section 71151.5,Business and Profea;ons Code:Any city m county
:90! which requires a pmmit to construct,attar.;mPmne,demnleah,nr rePnir any structure
priormitaiatuance.aburequiru Nc applicant for such permitm fileasigned mpme"' Valuation
that is licensed pursuant to the provisions of the Conuaters License^Law(Chap=9 Sq.Ft.Floor Area
$ (commencing with Section 7000)of Division 5 of the Business AM Professions Code)or $353270
Net he is euript therefrom and the bub for the alleged exemption.Any vlobdom of
Section 70515 by any applicant for a permit mbjecu rise applicat As a civil penalty of APN Number Occupancy Type
on,moss then five hundred dollars($500).
I,u omw of the pmpety.m my wployma with vagss u tWb uk compens4m.
wall do Usewart and lheauucturebwtinsendnd wo@and tarsale lSce.ION,Budneu Required Inspections
card Pro(esdans Cohn-The Caatractors Limuue Law don ort apply An An owms of
property who Wilds An improves thereon,and who doesauchwork himaelrm through his
own employes,provided that such Improvements ax nothrond oroBcrtdfarab.If.
howevm,the building m bop ewound;s sold within ox year of complation.the ow em-
bullder will have Nc burden of pmv;ng that be did rpt Wild or improve for purpose of
Asia.).
I]1,As owner of the property,am uelubely conmaeting with licensed contractors An
construct the project(Sec.704x,Business and Profusions Cade:)The Conuacters U-
cense Law does not apply An an Ammar of property who Wilds or bronchus thereon.and.
who contracts for such pmjeets with a contrsemr(s)licensed puratam An the Contrxtoes
License Law.
❑lam uemDt untln See .Be PCfmthismamn
Owner Data
WORKER'S COMPENSATION DECLARATION
I bereby aRrm under penalty of perjury^m of the following dmlarstions:
and will maintain a Ceifiub ofComent to self-Inure for WarkehCompen-
7aw
.a provided far by Section 3700 of the Labor Code,for the performanee of thefar which this permit is hated.
ive and will maintain Workers Compensation Inwrsnce.u required by Section
f the IaWr Code,far Ne performmrce ofNe work for which this permit b issued.
orkers Campensatiov les rtier cad Policy number are:
r. Policy No.: V'�
C• FRIGATE OF EXEMA"FROM W 0 CN -
COMPENSATION INSURANCE
(To seed..wd not be completed If the pemtft b future hundred dollars($100)
or less.)
1 cenify that In(he performance of the work for which this Permit is issued,I shall not
employ any person in any mother an as to become abject to the Worker'Compemadon
Laws of California.Date
Appuwnt
NOTICE TO APPLICANT:If.after making this Cenffpam of Exemption.you should
become subject in the Workers Compensation provisions of the Labor Cede,you most
,J O forthwith comply with such provisions m Nb permit atoll be accused w
rekcA.
CONSTRUCTION LENDING AGENCY
Fy
" I hereby aRrm Nat then is a eanstmctinn lcoximlagnrcy for the peffmmanRUf
fYr dm work for which this permit Is issued(See.5097,Civ.C.) `
QLender's Name
7 z Lenders Address
U 1 cenify that I have mad this application and state that the above information is
U.F correct.l agree to comply with all city and county on inances and state laws relating 10
DU building construction.ad hereby authorim mpresen AuwA of this city to enter upon the
r I8 ahovcmcnuoncdproperty for epenses whichpurposes.
(We)agree to save,indemnify cad keep hamdess the C;IY of Cupertino against
tifA'q Iiebilitiu.jMLmenta.eosu and expenses which may in any way accrue against nisi City
U z in conx9uense orth�MOngTROtn pmmit.
APPLICANT U IDERSTANDS It D WILL COMPLY WITH A N-POINT Issued by: Date Z3�a
SOURCE REQI%yA7IONS.
2
eA Re-roofs
Signeftfrota
J'fA s ntrseror Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tip apPdcwnt Or future Wilding mcupanLUM mbandic huutlous material
as UeOrxd by the Cupertirm Municipal Code.Chapter 9.11,and dN Health and Safety
Code.Sectionu53x(a)± All roofs shall be inspected prior to any roofing material being installed.
t]Yu BNd—
WIII the applicant or future Wilding aaupanr use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
.hA74omus air contaminants As dclined by the Bay Area Air Quality Management all new materials for inspection.
uictT
0 Y tffNu ,
1 have mad Ne heard.,materials mquimments under Chapbr 6.95 of cite Califor-
nisHal"SafetyCade,&.6.75505.25533 and 25534.1 undcmmnd theeiflhe building
does not currently ha Net It b my respouibdity w Audi,the oceupal of the
mqulmmen I mot Wme prior m Issuance of a Ondfpaus of Panty/ Date
dZ J6 Signature of Applicant
All roof coverings to be Class"B"or better
ownermmtharsedagcAl Date