02040154 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:.
BUILDING ADDRESS: PERMIT NO.
1199 YORKSHIRE DR A PERFECT CLIMATE 02040154
ONNEWS NAME: APPLICATION SyB DATE
VENKY RAMCHANDRAN 10570 S DEANZA BLVD 04/29/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 861-9545
C O p ARCHITHCT/ENGINEER: BUILDING PERMIT INFO
u p BLDG ELECT PLUMB MECH
��m u [_I L.") I I
m w LICENSED CONTRACTOR'S DECLARATION
v I herth affirm that I sm licensed underprovisions of Chat 9lmmmencin Job Description
� "" g INSTALL CENTRAL SYSTEM (HVAC)
Ft}. with'inS«tien]Oo0)of Division3 ofthc Business antl Professions Code.and my license
is in full ford d c ct .s,
Ore-,u Lze Conn(` n Lic.X 1
3 L v Da k. Cnntr -
ARCHITECf'S DEC RATI N
C 3 I i ndcrsmnd ar plans shall be used as public records
T
rc
.0o Licensed Professional
c a OWNER-BUILDER DECLARATION
'—+ I Deasy affirm mi 11. exempt from the Contractor's A nu Law ror the $8400
C 3 a allowing reason permit
to
]o3L5.Business and ve.demolish.aro Code:Any city or coupe
a. p which requiresperost mrorasthealine improv,h permitsfirepair any structure
a.3$ don be is,licadua puquav`tiodii thovisioso for sucCommicmit Licensle ae ned Law
- ........
the of theC B.Sinirs ss east profession;
Isw Cna 9 --
gxn provisions (Chapter r "
«w s issuance.pu also
IcommrneIs 'shythInn]OOan of Div dthebasisoofeallegidexmdion.Anyvilode) t,;; 'ii'13��P 4 _I,.POr;'6,FP''�. ' Valuation
or that he is ckembi any applicant
and the beer for the alleged exemption.Any l Peveimn - -
"of Section]OJ I:3 nY any applicam!or a permit mblcns the applicant to.civil Penalty
tint not more me�rve mm�arte ealars fzsooj. 301IPN NIU49H PLUMBING Occupancy Type
❑I,aamxpergrmepropnv.«p empinyposwhnwagexasmeirxolecnmpn din, 303 - ROUGH MECHANICAL
-it)will da me'-work:and he de:T e C"not i for S Lie e Lredaw far Sake applyto3 0 4 - ROUGH
due Professions Code:The Contractor License Law docs not apply man +-
ow«rorpmpcnyWho WiI&.1ipprovesthereon,aadwho C«s such work himself 505 - FINAL ELECTRICAL
or through his own employees.provided that such imprP.cmems ace not intended or
... building p - - - year'if ._. Leer ._._.... Leer
completion.
om edtm� an BnT.W rheaveo m �rs- la No not 507 - FINAL
improve on,the purpose
of ds.).will hese the burden of pricing that he did not build or
imjnmc for paryou of Salcey 508 - FINAL MECHANICAL
— --'-- -'-- -' ---
-r f. ❑1:as owner of propene opene ammes cxclusivcly contracting with licensed comranrs oto -_.. _.__._ _.Leer. L..'..:P•.:+'•.': ---- - --
.- conswct the project fSes.700.1.Business and Professions Codc:)The Connector's
License Law class not apply In of propenY who Wilds or improyes thereon,
and ho.contrces for such.projecu im a convatmfs),Ic sW pa......the-. _. ..__
Contractors License Law.,
❑I amcempl under Sec '' - •'BAPCfornE'sreason
Ower - ° • , + - s�
'WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjary'one of the following declarations:'
.i ❑ 1 have aad wiU maivofni'a Ccnifcmd of Conscm to self-insure for Worker'.
.k Compemn..; as provided for by Section 37W of the Lalni, Cade; for the
performance of the work for which pis permit IIIssued..,
O 1 hale and will r Coadcln Worker ie Comaince of thesworkf r iry h thi by Section '
3]0o'or the orker'Code,for the ncrfmmnc of the work for which finis permit is
iuuetl My Workers Co pe' tl n Insurance'-mer and Polley nombefam;
.ct�_ rorerno.l�ICU(7VC`fl •.1'• 11' ''. 5 ' Vh.I I... -
,i,,, TIFl ATIO OF EXEMPTION OM WORKER I
CER
-,. ,. :COMPENSATION INSURANCE'"; ",; ,. „- ,, ... .Leer_. _._.,.,....�
_.._.__.._..� _ _.......Leer. .__...,
•i2h missnuon need int lie completed if the penitis for one hundred dollars \ 'J'• e fir Ltl_',„'C� '(4•:n
(5100)or Icss.) ,
t r nfile thatintrsiani any end thew k!r hathnibsPermit c issued1 I ':..i'1f," ' r
Shot]Dol employ,ono person to any manner an as to become iubjact m me Workers
Cppinanion9 __' .La of e,l -Dain`
_,NOTICET .'_•'. •::_•.._Cert.._ :Leer _n,your .
NOTICE TO APect PLICANT.If 0rmaking this Certificate of Exemption.you + •:'n "^ ( ^.;•
beec comply
the NodeRCoivns or
pro voniob al Lobo Cod you muss
Q 0 forthwith comply vim such provisions or m s Permit mall be dee N rewind s
; i ,rm 1'CONSTRUCTION LENDING AGENCY 1 —1' - — --
a'; ;O1 1 h rtby affirm that th "s a consi coon lend n6 agency forMc performance- ._bL ,+ +
Wtr of the rk fo' hichthspermu snsived(Sec.3091,C,C) _
Q LeodesName—
:;),Z Lend sAddi si".
V Q .., s. s
I comfy that I have ad thisppl cat o ard vat thathe abase fOM into
tsX E.. connect 1 gree to comply with nil city and Q- countyre,ordinances and sat h missing U no Wilting conswcton and hereby ta honu p sensitives ornhs city to enter upon
.rte the above-pemloned progeny for inspection purposes.,• .
'.,p. INre)'egree'io save indimnifY and keep harmless the City of Cupeninu against
y liabilities,Its Instant.costs and expenses which may in any way accrue against Said
U,.•Z Ciry in Iraq race of the yrvming a foispermir;•;;."
APP 4NT
RDERSf%T AND Wn,L COh1PLY N' 'ALL•[:ON:POB.T ! `�
s t Al Issued by: Date
Sij ,c AppIi= onuactei•.•• .r. ..,.. . _:' Re-roofs
HAZARDOUSM'TERIALS DISCLOSURE
AdI the l0pl¢ant or future in ir$«c pint Sion of handl hapsMous material- Type of Roof _. :v •...•-... .•....c .- : : :.-..-.
asdefined by the Cupeniao Model Cod Ch on 9 12 and me H elm and Safe,,
s .,, •,
Code ❑Yesn25532(q t t r No f h.y �� •• � , '
fa r '1; A1Lroofs shall be.Inspected.priorito any roofing material being installed.. ._ _ .. . ...
(Will She applicant future w ingoccupart use equipment ordevices which If a roof is installed without first obtaining an inspection Iagree to remove
emit hazardous a it cminumprousi as fraud by use Bay Area Ali Quality Mans,,no t
Dnmct7 all new materials for inspection. Applicant understands and will comply.with
❑Yes t t No, , + ,'.t �'i "all non-point source regulations, P
L
rted_she baaWo s'mntedtls mqu mmensi under Chipte 695 of the
alth&Safety Code.Sections 25505:25533 arta 25530.1 andcmand that _
mein l veglyh <et Da t thI t smY resPo sb'liyt ii(Ythe- - _ - _rw Its x h ch must be inn p o no i Baan f Cenificam of
Signature ofApplicant Date� All roof coverings to be Class"B" or'better
equonud igem n.1„ T 0, Datc,� ,
., .. r. ..� ..-., ..,,.:
OFFICE
_:Leer-.•