00060082CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
RU [LDING ADDRESS'
1,1796 PINE BROOK CT
R & H HEATING
PLRMH N
a06aa82
OWNER'S NAME:
BHATT MUKULRAI,N AND ILA Ill
770 .CHESTNUT ST
APVLICAI]ON SUB DAZE
06/13/2000
IONS;
SANITARY NO. CONTROL NO.
(408)279-0722
ARCHI IEC'VENGINFLII:
BUILDING PE RMII INFO
BLDG BLUC'1 PLUMB Nice[]
1.C17NSED CONTRACTOR'S DECLARATION
Job Description
I hereby id'f;rm;hat I nn; h,ca,,d undo ptovi,ions of Chapter 9 (, nnnancing
with Section 7000) of Division 3 name nnsine..and Pole us Code, madn,y license
A/C
is in full force and of t.
[.iceuse 'lass- _ ' LLQ a 3 X 11N
.
Conm lllf
Dater=6� etm (�7�
ARCHITECTS DEcLAR. R f14
I undcrsmnd no, plans sf;;dl be uud ,,,,.bit, mconl,
I.weirwd Prof,ainnal
OWNIiR BUII.DER UfCLARATR N
I hereby affirm that 1 am exempt from the Co,nmcror's License law for the
following reason. (Section 7031.5, Business and Professions Coda Any city or county
which acquire, u pennn (o construct, lifter. In;prove, danollxh, or mpalr ony ,vu.. am
prior o its issuance. also requires the applicant for such formal to file a signed atmatent
9
Valuati
thtr Joe to h,en,,d monen, to the previsnmsoflbe Connacmrs License Lam (Chapter
Sq. Ft. Floor Area
n
�0
la„nmcocing wen; Section 70a) of Divi,Iun 3 of the Businewn and Profession, Codi,)
$ 31
or that he is exempt herefrom and the Basis rot the alleged exemption. Any violation
of Section 0031.5 by any rppl imam for a I,co-mil subjects rhe applicat to a civil penalty
APN NumberOccupancy
Type
lir pta more loan live h,ndmd dollar, (S500).
36604049. 00
O 1, as lancr of the p rop-tY Y croplaye, with wages a,t 1 peat„n
'
Required Inspections
will do the A d the t t 'to tam intended or 01cmd let -. se, 7(140
asin.: dP f.: n: Cod ThC man L I die' t ,Iy,, an
or property who brilds or imd proves hemon..mwho does such work himself
303 — ROUGH MECHANICAL
through no, own mnployo,,, provided ),at .on Intpmve;nem+are not Intended or
orr
whered for sale. if. however, the building or improvcmem is sold within one year of
304 — ROUGH ELECTRICAL
nnplcmi or Ju ownerb; i'iar will latae the bunlen of proving 0th he did not build lir
u
nit pT„sat
505 — FINAL ELECTRICAL
O Las owner oti tire pr,trrs, ant ex,Iao,ely contrasting with reer,.rd contractor, to
508 — FINAL MECHANICAL ,
con.amcl the project (Sec. 70,14. Business ;nal Prolevooro Code '.1 The C nnmclor'.s
License Law does not apply it, an owner of property who mild, or improves thereonr
and who onuuuts Rn each projcn(s with a ,mara,t,a6) Licensed pursuant It, the
Commev,d Limens, Low.
01 am exempi under See. . B & P C for his max,
Owner Dae
6l
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of pmrjim, one of he hulmorm, declarations:
/
❑ 1 have and will naim tar to Ceeilicata of Con,enl it, .self lnw;rc for Worker's
�Q
Compensation, as provided for by Section JOINT of he Labor Clde, for the
perfornance offs, work for which this permit is issued,
01 hive and will maintain Worker's Compensation Insurance. as required by Section
3700 lir the Iaha, Code, for the poturniare. of he work for which this permit is
issued. Myy Woo/rkvi''�s Clumpen,ation In,mance can icr and [';, ie, to her art•'.
li, is PoroON
Carricrl/ /-l'(1N
is OhI%WORKf:R
COMPENSAION INSURANCE
(This section need not be con,pleed if the Perini( Is for Inc hundred dollars
(SIBB)or less.)
1 certify that in the performance of the work tin which this Penni( is issued. I
.hull not employ any person in any manner ,o as to become subject to the Workers'
Contpcuwti,n, Laws of Calhiunia. Uunc
ApPlicam
NGl'ICE TO APPLICANTS IC after making his Certificate of Exemption, you should
m
been wbjeenoBt, Worker', Co;nl,lowdoupn on—t he [,;it rGale.you all
%hall
forthxfih comply with such Provisions or this Nrioat m deemed revoked.
.
CONS'rRUCI'ION LENDING AGENCY
I hereby amrm (hat rhere m a .... proton leading agency Tor the perfonnan e,
of the .,,,it for which his format is issued Nev. AMP, Civ. C.)
Lender's Not tie
Lender's Address
Iel ily lbar l lime mad this ;rr11i,alio i and '(am that heaMwoiol ralion'n
and re law, relating
cmcO. 1 .,me to,ty wall miry and county ordinates Sat
nifih
(o building emtsmrution. and hmrmhy authnrim representative, of this 611 to ems upon
the shove -mentioned propmrtr ]or Inspection purposes.
(\5'e) .,me Worse. indemnify and keep hannle„ the City of CoNmeo against
liab'deias, jrulgnren4, c.o s'and c,,enws which ntay in any way rectae ngaim( said
Cit)' in consequence of the grating oI' his permit.
APPLICANT 11 STANDS AND \ ILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RI: .ATIONS. `l
Re -roofs
nam ml, ire vurmraerar —
siga
HAZARDOUS MAHIRIALS DIS .I.OSURT7
Will the applicant or future milding oece an ,tae lir handle havmJoa,ralvrial
Type of Root _
as defined by the Cupertino Municipal Code, Chapter 9.02. and the Health and Safety
Code, Simi i25532(u)”
0 ye,All
roofs shall be inspected prior to any rooting material being installed.
Will the apple'a;tl a rmum hand';;,go,mapan( use,gngna,aa ordevice, which
If a roof is installed without first obtaining an inspection, 1 agree to remove
tit hamrdoux air contaminants as defined by the Bay Area Air Quality Managentem
all new materials for inspection. Applicant understands and will comply with
,tint?
0Ym rwr
all non -point source regulations.
I have read (lie brooir m nateriaN requirements under Chapter 6.95 of the
CaliIbmia Ikohh& Safety Code, Se,lions 2550.5,25533 t J25534 I amer,nand Ike
fiber hadding does not currently have a reran(, that it is my nesp,msibilay to nmily the
of the requir-mems which must be limn prior to issuance of a Certificate of
Ooccupant
ccapan`
Signature of Applicant Date
All roof coverings to be Class "Br' or better
Owner lir roma agent Ilam