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05110131CITY OF XPERTINO ' INFORMATIQn BUILDING DIVISION PERMIT CONTRAG�TOR Bu1LDING ADDRESS: CUPERTINO PLUMBING PIMMTT NO. 05110131 1149 STAFEORT) DR OWNER'S NAME: PERMIT ISSUE DATE KAREN NARULA 10297 S D NE: SANITARY NO, CONTROL NO. (408)253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hucby aftitm Nu 1 un li¢nsed sudor provisions of GhaPter 9 (murmuring U0 ❑ ss 'On u p ,� with Sutton ]OM1) of Division 3 of the BuaineaaM Prefutions Code, and my licerta is 11 I fu faMoatd eRca C - a-1-705— Licemc Class Lie.9 (jwf,�Jlil REPIPE DEC Dow 1L 2z oY Contractor A CHIT ECLAR ON f fy3 n av 7005 ire Is. Y I Ibo as public rtcuda 1 n /p�gl�pp if a Liacnse OWNER-BUIIDER DECLARATION by anions exempt from Nc Contactors License Law for I Wreto .them Nat 1 mft 1. Cade: Any city or county following mason. (Scrum ](D L4 Bulinus and y w. dednns which requires permit Ire m, alcor improve. demolish, ri repair any smactme rj Q Q Q issuance. trues t for such ContrarmitmienseLudsummem ! pit o, one lWvision Sq. Ft. Floor Area Valuation tour lc=alsumot of i (com ening ithSeuion700s)ofDivioion3or eBuinesaldansclsw(chapter sCode)9 of Neegedcamd Professions Code)or Section, i meth is sump, Net bo u exempt IMrtfrom and Ne basis fm Ne alleged exemption. My violation of and df basis for r Occupancy Type Section 7031.5 by am/ applicant for a permit subjccu the applicant to a civil penalty of ret more Nan fisc hundred dollar (5500). ❑ I, as owmf of dm poputy,ormY employus wlN wagessstluv halccmnpesuaumn, Required Inspections willda NewarkandthestrunumunotintendedoraQuedforsals,(Sec.7014,Bu ness and Professions Cade The Contractors Litems, law does ml apply 0 in owmr of property who builds or improves the re me and who docs such work himself or through his own emplayas, p that sixh improsentuu art ret orolfemd o�e owner - Wildinghrimprovementuhathwithinore)earofcampkhm,Neowms- Wildingori year builder will have the Widen of proving that W did not Wild or improve for purpose of salewill sale.). I, as owner of Ne pmixur, am exclusively conuaNng with licensed mnuaclor he canswct the pmject (Sec. 7044. Business and Professions Code:) The Comanors Li. _ cove Taw does not apply at an ownu of Property wbo Wilds or improves Ns,rem, and who mnuuu for such projects with a eonuaclor(f)Bce sedprmer, mthe Contractors License taw. ❑ l me exempt under See . B d P C for Nis moan owner Dam WORKERS COMPENSATION DECLARATION 1 hereby affirm under peultY of KOM ane of the following decluaimae 1 ban and will maintain aCcNOum of Consent to self-imure for Woskce.Compen- sn io t. as provided for by Section 3T110 Of the tabor code, fm Ne petfmcnance of the work for which this permit is issued. I have and will maintain Wafters Compassion ion Insurance. u required by Section 700 of the Lmos,Code. for the p 9moreaue of Ne arms, for which NU Permit is issued. ' My Wor oursrCo—mpensation haouaoce camiu and Mies /number sme: 2 Carrier. Policy CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rrbu section need nothe comphowd if Nc Permit is formic hundred dollen (5100) m las) I certify that in the performance of the wart for which this Permit u ismed. 1 shall not C.mploy my person In my romonerso as to bemma.Ll bject he the Worker' Compensation Laws of California Due Applicant NOTICE TO APPLICANT: If, after mating this Certificate of Esemption, you should becom, Subject he the Wolters Compensation provisions of the la Wr Codc, you am • faMwith comply with such provisions or Nu permit shall bo deemed revoked. i CONSmUCT10NLENDING AGENCY 1 thereby ageuy for dm performance of Nu there u a coruwc.30 whai0thi 7, Cing ' the work fur which this permit te issued (Sec. ]097. Civ. C.) Lmdera Name l<nhers Address ' I ramify that I ban read this applicstim and sum Nu Ne above information is coma 1 agree in comply with At City and coldly ordinance; Nd stale laws relating to Wilding consuunim. and hemby mmosim Mocaur ideal of Nu city an enterupnn the I above-mcnlianed property for impection pumices. (We) agree ro ave, indemnify and tttp harmless the City of Cupertino against j liabilities, judgenou. colas and capeases which an, in any ways. against said City in consegucuc of the granting of this permit. ' APPLI UNDERSTANDS A WILL COMPLY WITH ALL NON -POINT SOU Issued by: Date EG TIO — Re -roofs Q' Type of Roof � �� // 'Sign uremfApphcan✓c� f / Dam HAZARDOUS MATERIALS DISCLOSURE Will tho applicant or future Wilding occupied store or handle haatdous maurial as defined by the Cupertino Municipal Cade. Chapter 9.13. and the Health and Safely ode. Section 25532(x)? ❑Ten No All roofs shall be inspected nor to an roofing material being P P Y g g installed. Will tho applicant or future Wilding nmspanl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mit W asduu aircontamimnts as defied by the Bay Area Air Quality Management all new materials for inspection. Di tr n? ❑Yes ge]No 1 have mad the Rvadms mamoals requiremcnu under Chapter 6,95 of the C111Iaf. nia Healthh Wclyconsi, Sections 25505.25537 and 25534.1 undcnund Naz ifds Wilding dg.c nOy lira a L thu my responsibility mtify nothe cecupsm a me Ryas' wh' muss to issuer of a Qcsdf m of Occnry upe. Signature of Applicant Date All roof coverings to be Class "B" or better Gw ratadhoovadagem Date F CITY OF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADRJB S: rG/ -D y� l PERMIT # 0S//Q/3 OWNER'S NAME: I PHONE # -,�2s3 Fs S -2- 2GENERAL GENERALCONTRACTOR:/ /q FAX # o257'3 a,73 iv c I am not using any subcontractors: 23 Signat6rj Date Please check applicable subcontractors and complete the following information: L � j WE /.l�1 • dontractor Signature / -";3 . 61 - Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � j WE /.l�1 • dontractor Signature / -";3 . 61 - Date 41 • CITY OF CUPERTINO / REPIPE/SEWERS/MAIN SERVICE v PERMIT APPLICATION FORM APN# '/11P1 oL.P QIci Date: PLUMBING Building Address: l I y ri, "� ;<< . Owner's Name: r K)CL rL) CDY DI CUPEQ(�TINO 41 • CITY OF CUPERTINO / REPIPE/SEWERS/MAIN SERVICE v PERMIT APPLICATION FORM APN# '/11P1 oL.P QIci Date: PLUMBING Building Address: l I y ri, "� Re i e of Fixtures Owner's Name: r K)CL rL) Phone #: 2-45 5,7Z, Contractor: nAlp,er4n o ?l u f>'> b1 n ' L License #: (.ilq � Contact:✓r�n� Cupertino Business License #: Building Permit Info: C-e� epP-r---P, -c- Bldg ❑ Elect ❑ Plumb BPWSVCS Job Description: PLUMBING Residential Commercial ❑ Sewers Cost of Project: BPSEWAGE Qty. if ADDlicable Fee ID Fee Descrintinn Fee C;rnnn / PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING