08040127 CITY OF CUPERTINO `�� ti' +- �a> rr moi°` '^ '
BUILDING DIVISION PERMIT '111 RACT " IO1�(. .
BUILDING ADDRESS: ' PERMIT NO.
22245 REGNART RD ARMANDO.CASTF.O GENERAL 08040127
NEWS NAME: PERMIT ISSUE DATE
-RAJI & SEKHAR SARUKKAI 1039 CORVETTE DR 04/17/2008
PHONE: SANITARY NO, CONTROL NO.
(408) 394-6649.
ARCHITECDENGINBER: BUILDING PERMIT INFO
-BLDGELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATION O O O O
I hereby affirm that 1 an Leaned under pmvisioa of Chapter 9(commencing Job Description
2 wiNSmW7p)(poIT) aion3ofNeBuainetrandPml��sod^,aadmylicenei. RMDL KTCHNr2BTHRMS,NONSTRUCTRL, INCLD ErM, PLMB
^< In full forte aM c(fecL
FOi Z Lice Clde Lie.N '
F De Contractor
eQ AIWTS GECLA An
rtrtt$
y Z O I underxand my Planss"e1W I he used u public co .
50 License Professional -
OW NER-BUILDER DECLARATION
2 9 1 at a?m that 1 em exempt from the Canamarsel License Law for Ne
E 0 O following reason.(Seedan 703 1.5,Business and Profession Cock:Any city or county
$ which e9uim a permit in conswck eller.improve,demolish.Or rural,any starve
_Z'y^ prim to its issuance.also requires the applicant forsuch permit to rile aligned statement
<
that he is licensed punuenuO the povisiona of the Contractor's License Law(Chapter 9Sq.Ft. Floor Area Valuation
g 9 (commancinswith Section 7000)ofDivision 3ofthat Businwand Profession,Code)oa 580000
that he u esempt therefrom and Use but$for Ne alleged exemption.Any violation of
section 7031.5 by my applicant for a permit anbj%U the&opium,m a civil penalty of Number Occupancy Type
nut more Na five hundred dollars(5300} 36647012 ,-illi
❑1,m awmr of tint property,m my mmploym with wages u Neo sole eompewtim,
will do the wart,and the structure is noHmmnded oroQered f0na4(Sec.7044,Businums Required Inspections
and Profen ion 's Cade:The CammeaLicense Law dm rot apply m an owner of Q p
papery who Wildsorimptov thereon,andwhe does cathwokbim¢Ifart Naagh his
awocmploym,provided lhauuch impmvemm s sm not intended moRnvd fmsala lr,
however,the building or improvement is sold within on year of ampledon,the owner-
builder will have the burden of proving that M did Out build or har mve for purpose of
ule,1.
❑1,as wener of the property am exclusively connecting with licensed co4aau3 in
conuvet die mica(See.7064,Business and Proposal.Cade:)The Com aemr'a U.
cause Law dm nut apply or an own.of popery who builds or improv 0erem.and,
who comacn for such ironical,ma a mommctar(s)licensed pursuant m Ne Caurnmer's
License Law.
❑I am exempt under See ,B&PCfar NbOman-
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby arum ander penalty of perjury am of the fallowing demarmoa:
❑I haw and will mainWna CeNOcamof Cmss-ntmself-IssuefmWorkersCompen-
.don,u Povided fm by Section 3700 of to Labor Cade.far use parfomartoe of the
wo,k for which this remit is issued.
❑1 have and will maintain Workers Compensation housenco,u required by Section
37W a the lsba Code,fm th or on a fore work for which this parent is lasered. '
My Wo ,C pe, tia t ins ce ca 'or and Polity n��um.bqe�r�ye •g��/ L,�A///t�
Cartier, limy Na.: RIC —r
CERTIFlCA ^OF EXEMPTION FROM WORKERS' V
COMPENSATION INSURANCE
flit$ectian mad not hecompleted If to permit Is Instant hundred dollsor($Ip)
or las)
I modify that In the Performance of rim work for which this p.mlt In WOOL l shall not
employ any pe0on in any tremor an to become subject to the WOrken'Compenutm
Lave of califomia.Gam
Applicant
NOTICE TO APPLICANT:IL after making this Carinae of Exemption,you should
become objet an the Watters Compensation provisions of Nc labor Coda you mux
.J O faMwim comply with such"east..m Nu Permit Mail he deemed reveled.
t'" CONSTRUCTION LENDING AGENCY
[ti.�-t lhereh'.M.deh mare iaa coatrucdnn lending agency for the parfumena of
C
the wart far which this Permit in issued(Sm.3097,Civ,C.)
W Lender's Name
az Lenders Address
V Q I certify that 1 have read this application and cum Most the above oforeatioe Is
ILComa I Agreecomply with all city and county ordinances and sue lava elating m
O IS J^ m building consuuniaa and hereby Maintain epesenutiv of this city m enter upon ft
W above-mentioned property,for impaction purposes.
(We)agree to taw,indemnify and kap harmless the City of Cupcnm,against
rap Iiablliia,judgmem.coati and eapsnes which may In any my scene against said City
V Z in consequence of the gaming of this pcmh,
.. APPLICANT UfIDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERr�Gy uMATIONS.
_ ( I aL4r�Ifk, DIS—/9-017 Re-roofs
Signuuo ofA IianVCamracmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dre appilcantor future building mcup net nae orhandle huandoes material
an defined by the Cuper m Municipal Code.Chapter 9.I2,and the Health and Safety
.Section svzal?
Dyne, ON. All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building Occupant use equipment or daim which If a roof is installed without first obtaining an inspection,I agree to remove
emit haomim. it amounia-u a defied by Nc Bay Arta Air QmdkY Management all new materials for inspection.
District?
Dyes u
I hew mad me hanmmu memrida rued oncnuundcr Chapter 6.95 of the Canto,
ria Haahh&S ery$ode,5redon 25505,25533 and 25534.I undenund tout if the Wilding -
dm oat cu only It a unuL On,I t$my poaibility m notify the acculmt of Ne
pamiome which1naRbe met t my ,m af.ccmflcmte fa- v Signature of Applicant Date
I All roof coverings to be Class"ry"or better
owns, on>.' ,sem Date- rT'
a_
L