02060102 1.
CITY ofcPERTINO "CONTRACTOR'INORMATION:u PERMIT :
BUILDING ADDRESS: PERMIT NO.
1133 KENTWOOD AV 02060102
OWNER'S NAME: APPLICATION SUB DATE
PANKAJ KISHORE 06/17/2002
pp� PHONE: SANITARY NO. CONTROL NO.
O Z ARCHITEC 7ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
LJ
s. LICENSED CONTRACTOR'S DECLARATION
0 O y= 1 hereby affirm that I am licensed un ar a Job Description
O Z y provi ions of Chapter mmecense
FSt� with Section 7000)ofDivision3 of the Bu' sand Professions Cale,and my license GAS STOVE ADD ON
7 is infull ftltlr��and cffcc
IS:
as 6 LicenseS IGss L
ate at N '
d a _Iv-1 Con�fc{¢
ARCHITECPBRAAii0
0 g 1 understand my plans xhall be used as public mcords
Licensed Professional
s"aa OWNER-BUILDER DECLARATION
I hereby affirm mm 1 um exempt from the Convenors License law for the
C?< following recon.(Section 703 1.5,Business and Rmfaxwom Code:Any city or county $830
8
E F O which requires a permit to conmo
xtmct,alter,improve,demolish,or repair tiny structure.
u73 _prior to its 4suareaalso requires the applicant fouuch permit to fileasigne4 statement
rlLat h�is licensed pursupnn9 slip pmsasjons of the Commcmes License Law(Chapter 9 � Valuation
(cdmmcncipg w im Secdmn.7R1)-f Oiviai°n 3 of themer:agd RpoVii.n.Code) q- j?x'; �" 'fir` :F':�'��II WfIR'a'3 t%TX'��'i°�'
o that he A ex6aipttherefrom and rhe basis for the ul%1d e�:emptloth.Any virlmmm
of Section 1.5 by any applicant for a Permit subjects the applicant to a civil penalty ,t�aaa�s{a&�' s�H:":: " Occupancy Type
of not more mon five hundred dollars(5500). 106 APN.'SLy0$E & WATER i"'
111.as owner of me property,ur my employees with wages as their sole compemonion.
will shi the rk:andsso the'omcmrc m not intended an aofferedLaw for e sale(Sec:]616. --"-'- "- ---' _- gbb
'B' mess a d Professions Code The Contractor's L cense Lew does not apply to an 301 - ROUGH PltowWMn SpeCt10HS -
o ria t f pr posy who hams or+mpr°ves thereon and who does such work himself 3 02 - TUB & OR SHOWER i
or m h h. employees provided that such improvements art not intended or _ ,
oHercdor[I ITh°waver,theWOAnge pofpratlisa°mhedidthey.of 602 - FINAL PLUMBING ENERGY
'c9mpin on,the owner Wilder will have the buNen of praising mer he did not build°r •'
improvefarptaname.fual..). 506_ - GAS TEST
t3 1,as ownerof the property,oro exclusively contracting with licensed contractors to- SQ7 - FINAL-"PLUMBING"' ',I, '
continue'
the project(Sec.7044 Bus nasi and Prafessmns Code)The Contractor's I:{ r .
License Law docs not apply to on owner of property who builds or improves thereon,
and.who commeLs.for such projats.with a.contractor(s)licensed punuantdo.the......._..._._.._._ ._. ._..__._._... _ ._.-.._- ..__._.---- -
-------
' Commnor's License Law. .
❑lam exempt under Sec: r n(8 r&P C for this reason i(" ._
- ow_eer .t. Date:, t: .. ..n.l � � �� p
.. , : ,. Iyw.r..
:- WORKER'S COMPENSATION DECLARATION II'k,' 'f (�"q•'•^q
. the by affirm d pct.h,of pepury.one,of following declarations:
- J�asts 1 •7 [OO`
J ❑ I h;vc and will maintain a Cenific t ofC m m'selbtmure for Workers
Compnsauon, as provided for by Section 3700-of me Labor Code. for the
pert 'c of the ulokfr whichmispc s is issued. BUIL IIV�
❑Ili m
d will' nra' Worker's C rope tmn lniunanee'.' quired by Section
3700 of the 1 unor Cad far 1M1 palfeirrama.of the wo k f i-w which this permit is
issued.'MY-WorrkersC pe 'a: nInsu rte rel r'o/adP It ynumne e:
C�pf< �?TLlE`,d Po'c a 'I/n� ��O� 1 .. !._Y._ -,_.................y.�,._._,_..I r• +t
( CEWUHCACOOMPENSA7lON INSURANCE 0FPMORKPJ�S',,. .. , �.'_O 1 i%_�Ss�''h. S^I��ti J:. .k '
_ ._.� .... ..._........._......,w...V.....__.___ _.._._..__. .___........._..._........ _ _.. _.. ....._,..
" I
(This secnon'nee l nor be completed it the Permit is for one hundred dollars -I' :I i P I'
(Sitan rla,v)
F.
' 1'ceni(Y}hat m rhe perform cc of thew rk for which m permit ii tis d 1
ih II"n t employ any person lin any manner so as to thermal,subject ro the W dmrs' 1 -
Compensation laws of California.'Date
.. ., - . .. - . .. ,..
..NOTI ani. ..
,NOTICE TOtAPPam the AN'CIL alter making rhis'Ceniticam of Exemption,you should �}�.`:•'=i - . .
Z 0 neer..auhjcdr m me Worker.Compensation provisions of the Labor Cole,you must
f'rth m emnply w m. h p si«s ar rhts permn shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '•' �1 '
I h rear firm rh t m issued(S:om IeaEing s, «y for me perform nee' I .1 .
1.Q Leine work far which mis perm t lis issued ISa 1097 Civ C) " - ..-. _.._.._ _ _._.... .__._._ .. _ ....
.LedenNm - - - .. . . _.. ._. ___. ..._.. ._.. .._.. ._ ._. _- _
�.Z LenJ Address
co p
- i Icertify treadapplication and mmotharsl information is
correct.I agree tocamply m all city d county ordinances and slam laws gU tobuilding c ones d hereby ut rcprc mvesof m' city t enter upon
W m aWe- neoproperty for pecronpry
O: (We) grcemn a ode nifyand
keep h yin ilia,ty fC pe gain
ego id
V] t
liabilities,judgments. t d pens which y . u y y arc 8a nst said
C,7'Z C ty cosy 're fine g t g of rM1 p hot
APPLICANPIyV D L COMPLYWITHALL NON POINT 1i (�/
gobRCIS>R . D - , , _/ �.�� Issued by: r Date
.np !?re'rLAPphrwV ten«,,.( l .' .. -a'Dvta _. Re-roofs
.. HAZARDOUS.MATERIALS DISCLOSURE -
W ll theapplicant f m build ng«c pate stere o hard) hated«s material Type of Roof
u d 6 d by m Citermo Municipal Cod Charter.9 12 and the Health and Safety
ty t - "• "
Care.
d qac n+ SSl2O S n t " iS t
❑Y �. t , Its �.,K q 1 I Jth It tY:s". ,.Ka !(3
All roofs gli'all be inspected prior to_any roofing material being Installed
Will the applicanto fwu afibuilding pain Ju equipment r devices inch - If a roof is installed without first obtaining an'inspection;I agree to}.move .,
<mnh Will the c m nanrs asdefined by the Bay Are Air Quality or Management
D ton _ins PP d and will comply with
.�" a new materia s or inspection. Applicant understands
all non=point source regulations.
laia read rhe hamodomonaterials regmrenmms and r Chapter 6.95 6f the
California Health&Safety Calc,Sermons 25505 25511 o d 25534 I urderstioaddain
'i r tog «s not curtcm enam.thm it is my rtsponsibilitymnficluthe
dccupom fm e q ' which mu rprior m issuance of a Certificate of
�• -' Signature of Applicant Date
°u rte rt maed agent All roof coverings to be Class"B"or better
, ;.., ,. 1.... . .:.-4- ...,.OFFICE- --. . ._ . . .._..._.... .. .. . .... . _._..._ _. ._ .
1.
CITY ofcPERTINO "CONTRACTOR'INORMATION:u PERMIT :
BUILDING ADDRESS: PERMIT NO.
1133 KENTWOOD AV 02060102
OWNER'S NAME: APPLICATION SUB DATE
PANKAJ KISHORE 06/17/2002
pp� PHONE: SANITARY NO. CONTROL NO.
O Z ARCHITEC 7ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
LJ
s. LICENSED CONTRACTOR'S DECLARATION
0 O y= 1 hereby affirm that I am licensed un ar a Job Description
O Z y provi ions of Chapter mmecense
FSt� with Section 7000)ofDivision3 of the Bu' sand Professions Cale,and my license GAS STOVE ADD ON
7 is infull ftltlr��and cffcc
IS:
as 6 LicenseS IGss L
ate at N '
d a _Iv-1 Con�fc{¢
ARCHITECPBRAAii0
0 g 1 understand my plans xhall be used as public mcords
Licensed Professional
s"aa OWNER-BUILDER DECLARATION
I hereby affirm mm 1 um exempt from the Convenors License law for the
C?< following recon.(Section 703 1.5,Business and Rmfaxwom Code:Any city or county $830
8
E F O which requires a permit to conmo
xtmct,alter,improve,demolish,or repair tiny structure.
u73 _prior to its 4suareaalso requires the applicant fouuch permit to fileasigne4 statement
rlLat h�is licensed pursupnn9 slip pmsasjons of the Commcmes License Law(Chapter 9 � Valuation
(cdmmcncipg w im Secdmn.7R1)-f Oiviai°n 3 of themer:agd RpoVii.n.Code) q- j?x'; �" 'fir` :F':�'��II WfIR'a'3 t%TX'��'i°�'
o that he A ex6aipttherefrom and rhe basis for the ul%1d e�:emptloth.Any virlmmm
of Section 1.5 by any applicant for a Permit subjects the applicant to a civil penalty ,t�aaa�s{a&�' s�H:":: " Occupancy Type
of not more mon five hundred dollars(5500). 106 APN.'SLy0$E & WATER i"'
111.as owner of me property,ur my employees with wages as their sole compemonion.
will shi the rk:andsso the'omcmrc m not intended an aofferedLaw for e sale(Sec:]616. --"-'- "- ---' _- gbb
'B' mess a d Professions Code The Contractor's L cense Lew does not apply to an 301 - ROUGH PltowWMn SpeCt10HS -
o ria t f pr posy who hams or+mpr°ves thereon and who does such work himself 3 02 - TUB & OR SHOWER i
or m h h. employees provided that such improvements art not intended or _ ,
oHercdor[I ITh°waver,theWOAnge pofpratlisa°mhedidthey.of 602 - FINAL PLUMBING ENERGY
'c9mpin on,the owner Wilder will have the buNen of praising mer he did not build°r •'
improvefarptaname.fual..). 506_ - GAS TEST
t3 1,as ownerof the property,oro exclusively contracting with licensed contractors to- SQ7 - FINAL-"PLUMBING"' ',I, '
continue'
the project(Sec.7044 Bus nasi and Prafessmns Code)The Contractor's I:{ r .
License Law docs not apply to on owner of property who builds or improves thereon,
and.who commeLs.for such projats.with a.contractor(s)licensed punuantdo.the......._..._._.._._ ._. ._..__._._... _ ._.-.._- ..__._.---- -
-------
' Commnor's License Law. .
❑lam exempt under Sec: r n(8 r&P C for this reason i(" ._
- ow_eer .t. Date:, t: .. ..n.l � � �� p
.. , : ,. Iyw.r..
:- WORKER'S COMPENSATION DECLARATION II'k,' 'f (�"q•'•^q
. the by affirm d pct.h,of pepury.one,of following declarations:
- J�asts 1 •7 [OO`
J ❑ I h;vc and will maintain a Cenific t ofC m m'selbtmure for Workers
Compnsauon, as provided for by Section 3700-of me Labor Code. for the
pert 'c of the ulokfr whichmispc s is issued. BUIL IIV�
❑Ili m
d will' nra' Worker's C rope tmn lniunanee'.' quired by Section
3700 of the 1 unor Cad far 1M1 palfeirrama.of the wo k f i-w which this permit is
issued.'MY-WorrkersC pe 'a: nInsu rte rel r'o/adP It ynumne e:
C�pf< �?TLlE`,d Po'c a 'I/n� ��O� 1 .. !._Y._ -,_.................y.�,._._,_..I r• +t
( CEWUHCACOOMPENSA7lON INSURANCE 0FPMORKPJ�S',,. .. , �.'_O 1 i%_�Ss�''h. S^I��ti J:. .k '
_ ._.� .... ..._........._......,w...V.....__.___ _.._._..__. .___........._..._........ _ _.. _.. ....._,..
" I
(This secnon'nee l nor be completed it the Permit is for one hundred dollars -I' :I i P I'
(Sitan rla,v)
F.
' 1'ceni(Y}hat m rhe perform cc of thew rk for which m permit ii tis d 1
ih II"n t employ any person lin any manner so as to thermal,subject ro the W dmrs' 1 -
Compensation laws of California.'Date
.. ., - . .. - . .. ,..
..NOTI ani. ..
,NOTICE TOtAPPam the AN'CIL alter making rhis'Ceniticam of Exemption,you should �}�.`:•'=i - . .
Z 0 neer..auhjcdr m me Worker.Compensation provisions of the Labor Cole,you must
f'rth m emnply w m. h p si«s ar rhts permn shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '•' �1 '
I h rear firm rh t m issued(S:om IeaEing s, «y for me perform nee' I .1 .
1.Q Leine work far which mis perm t lis issued ISa 1097 Civ C) " - ..-. _.._.._ _ _._.... .__._._ .. _ ....
.LedenNm - - - .. . . _.. ._. ___. ..._.. ._.. .._.. ._ ._. _- _
�.Z LenJ Address
co p
- i Icertify treadapplication and mmotharsl information is
correct.I agree tocamply m all city d county ordinances and slam laws gU tobuilding c ones d hereby ut rcprc mvesof m' city t enter upon
W m aWe- neoproperty for pecronpry
O: (We) grcemn a ode nifyand
keep h yin ilia,ty fC pe gain
ego id
V] t
liabilities,judgments. t d pens which y . u y y arc 8a nst said
C,7'Z C ty cosy 're fine g t g of rM1 p hot
APPLICANPIyV D L COMPLYWITHALL NON POINT 1i (�/
gobRCIS>R . D - , , _/ �.�� Issued by: r Date
.np !?re'rLAPphrwV ten«,,.( l .' .. -a'Dvta _. Re-roofs
.. HAZARDOUS.MATERIALS DISCLOSURE -
W ll theapplicant f m build ng«c pate stere o hard) hated«s material Type of Roof
u d 6 d by m Citermo Municipal Cod Charter.9 12 and the Health and Safety
ty t - "• "
Care.
d qac n+ SSl2O S n t " iS t
❑Y �. t , Its �.,K q 1 I Jth It tY:s". ,.Ka !(3
All roofs gli'all be inspected prior to_any roofing material being Installed
Will the applicanto fwu afibuilding pain Ju equipment r devices inch - If a roof is installed without first obtaining an'inspection;I agree to}.move .,
<mnh Will the c m nanrs asdefined by the Bay Are Air Quality or Management
D ton _ins PP d and will comply with
.�" a new materia s or inspection. Applicant understands
all non=point source regulations.
laia read rhe hamodomonaterials regmrenmms and r Chapter 6.95 6f the
California Health&Safety Calc,Sermons 25505 25511 o d 25534 I urderstioaddain
'i r tog «s not curtcm enam.thm it is my rtsponsibilitymnficluthe
dccupom fm e q ' which mu rprior m issuance of a Certificate of
�• -' Signature of Applicant Date
°u rte rt maed agent All roof coverings to be Class"B"or better
, ;.., ,. 1.... . .:.-4- ...,.OFFICE- --. . ._ . . .._..._.... .. .. . .... . _._..._ _. ._ .