06080070 (2) CITY OF CUPERTINO 's +�re '`-"'Y �° ,x:•' '� "'
BUILDING DIVISION PERMIT <CUNTRACT(iRINFOitMA.aTION
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BUILDING ADDRESS: BABU KATCHAPALAYAM PERMITNO.060B007O
514 CO
R'S NAME: PERMIT ISSUE DATE
11 , BABU KATCHAPALAYAM
PHONE: SANITARY NO,
CONTROL N0.
ARCNITELT/ENGINEER: BUILDING PERMIT INFO
BLDG EO PLO O
!86 LICENSED CONTRACTOR'S DECLARATION Job Description
UW 1 hereby afflrm that 1 am licensed under Provisions of Chapter 9(Comm ns ng
.zjg with Section 700D)of Diviam 3 of the Budeass and Propellant Code,and my Manse is
,mon mtell fo=*.itaffect. MOVING INTERIOR EXISTING WALL, REPLACING 7 WIND
LianseClass Lm'aDow-Onummu AND REMODELING KITCHEN. TOTAL REMODEL 165 '
ARCHITECTS used
DECLARATION
I umlemm�J my plans shellall h J u public records
yU
•G Licensed Pmfessianal
y OWNER-BUILDERm Ce ConveON
I hereby IIBm on I am exempt from the Coausemr,License Low for the
;00 fallowing reason.(Section 7031.5.Business and Professions Cade:Any city of county
2$ which abduc o..emit m Coma use eller.improve.demolish, fill
repair any urocture
I�w
poor toitsisswnce.eas requires use fonwheemttmicamen Law
.I Q this h is licensed pummuo tk provisions of the Corrector's licetsse law(CNpur 9 Sq.F[. Floor Area ValU#ft 0 0 0
a (Commemdng with Section 7000)of Division 3 of the Business and Poefeuious Code)or
Nu he is eacmpt threfrem and the basis for the alleged lacmption.My violation of
Section 70313 by arty applicant for a permit subjects the applicant to a mvti Puu10y of APN Number Occupancy Type
not more than few handled clothes($300} 35623055 . 00
❑1,es Owner of the Property,or my employees with wages u duh sole compensation,
will do do,wmrk,and the structure Is an,inumeled or offered for sale(Ste.7W.Business Required Inspections
aM Profession Code:The Contractor's Litewe Law dues not apply to an owner of q P
property who build,Or improv ductun,and wha does such wok himself or ltuough his
own employees,prodded that such Improwmanu ace twtinunded"alpinist fwsde.IL
however,the building or impmvemmt i„Old within aro yearof Completion,the m mr-
build.will ha”the ham.of pouring quit he did MI bull!M Improwe or plemset of
Z1,es ownm a c e property am a ilawely...laming wide licensed commuors in
construct the project(Set.7041.Business and Preteadctes Code:)The Comeausts U.
ccwc law does out apply W we owner of property who WIWI or hnprem threctn,and.
who concis for such projects with a Contactar(s)Becnsed puramnt to the Contractor,
License law.
I otogyc/m�ptu a .B&PCF Ild reawn
r -Ol a Dau
WORKER'S COMPENSATION DECLARATION
I hereby ieffim under penalty of perjury tote of the following decimations:
❑IhamandwillmalnumatcaNfieaWof Cctusentioself-imureforwoftescorepm.
sation,as provided for by Section 7700 of the labor Cade.for the performance of the
work for which this permit is located.
❑1 have and will maintain Wormfs Compcati firsomanm.at required by Scct
3700 of the labor Code,for the performance of the wile for which this permit is iumd.
My Worker's Concrumatim Iwtrutne anise and Policy number are:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section reed action completed duh permit is foram hundreddetlam(5100)
less)
1 unify that in me performance of the work for which this permit Is blood,I shall not
employ any person in any mism one bjecI tothe Woskem'CoCommand.an
Lows of Caliia.�aau• - A5
AOPllcmt
NOT7CE TOA PU ANT:If.ager ma3ng this CeniOceW of Exemption,you should
become subject to the Worker's Compensation provWurts of dee labor Code,you muse
.J O forthwith Comply with such provinces or this Permit shall h dmmed revoked.
Z^ CONSTRUCTION LENDING AGENCY
H (hereby from that there u a mnstraman lending agency fnr the penomerre of
a the work for which this permit is issued(Sec.3097,Cls.C.)
W Q lender's Name '
2 lender's Address
V 0 I ecnify that 1 have read this application and surto that the shove information Is
it, comma 1 agree to comply with all City and County ordinances and stem lawn willing to
O(, building construction,and hereby authorim representuiws of this city to enter open the
Uabout-nunu.ncd property for inspection purposes.
t-+ (We)agree to aw,indemnify and keep bundles the City of Cupertino against
h Iiabilhia.judgments,costs and carousal which may In any my secmc against aid City
U Z in consequence of the granting of this remit.
S4t(2�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CER GU TIONS.
Re-roofs
Sigiffiall.of Appliang(Conuacul wific
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupanntere or handle hamdow material
flood by qts Cuper ire Municipal Code.Chapter 9.13,and qts Health and Safety
Section 05532/.)7 � All roofs shall be inspected prior to any roofing material being installed.
Cl Yes 9No
Will the applicant or future building occupant use equipment or dcvima which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contsmimnu as depmW by the Bay Area Air chatty Mamgcmcnt all new materials for inspection.
Distnm? a�
❑Yes Qnu
I hoc real the haraNtusmaunau requirements undefChap en A.95 ofde Califor•
nia Hralth&SafctyCodc.Smlmts255D5,25533 and 25534.1 understand thatifNt building
does not currently haw a unant,than it is my responsibility In notify qts occupant of the
requ'Irgmentsw' hmh hmet poor an issuance of.Certificauof Cowry Signature of Applicant Date
�1rrrr//!!/J I Of all/1�6
Owner authorized egcnt � All roof coverings to be Class"B"or better