03070231 CITY OF CUPEW11NO '"-- * '' r� �,.
BUILDING DIVISION PERMIT �tC0NTRACTOR INFORMATION'S
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BUILDING ADDRESS: ENVISION BUILDERS PERMIT ND03070231
-Rs NAME: 3940 VIA CRISTOBAL PERMIT ISSUE DAM
SURENDRA & MITRA LELE n7/';I / 003
D"E. (408) 410-9054 SANITARY N0, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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100 LICENSED CONTRACTOR'S DECLARATION Job Description
�w❑ 1 hereby affirm that 1 am lived I Oder provisions of Chapter 9(eommencing P
ZW with 5cetio,t70ry17 of xion Sof d,c ovo, d Profession.Code,end my licenx is
mu mm a erre ✓✓✓ REPLAC WONDOWS
ueensecl e a 16 /SLIDER/STAdRS C
,t- Date w Can
� FINAL 0
eeZZ AR ITE IARATION
4 K U 1 untlerstanJ my plans shall W used as public record
°oNLicensed JAN 2 2 2004
S OWNER-BUILDER DECLARATION
sf 1 hereby affirm that I am exempt from the Coronation's License Lew for the
02 following reason.(Section 703i.5,Business and Professions Codc:Any city or county
Which Mquira a ECOOR to Cmmaiuct,alter,improve,demolish,or repair any structure
�iy prior to its issuance,also requires the applicant forsuch permitso filcasigoedxulanni
x`
that WislicenutPursuonuothe pmvisionanfthe Comncwr'sLicense LAW(Chapter 9 Sq. FL Floor Area aluation
(commencing wi th Section 7(0))or Division 3 of the B usiness and Professions Code)or 35624046 . 00
Nat he A exempt therefrom and tW Amis for IM alleged Antiphon.Any violation of
Section 7031.5 by any applicant for a Permit subjects to applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). P Y YP -
❑1,ss owner of the pmpeny,or my employma with wages u theinole compensation,
will do the wort,and the motion,is not intended or aRertd for sale(Sec.704,1,Business
and Profession Code:The Convector's License Law does not apply to an owner of d Inspections
propcnywhobuildmorimpro s,thereon,and who does such wmkM1imsclforthroughhis 102 - PIERS
owncmployea,pmvidcd that such improvements are notinended orofremd formic.If. 103 - UFER
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nu he did not build or improve for purpose of 104 - REBAR
s1c')' 105 - ANCHOR BOLTS
❑ Las owner of One property,ameaclu.ivclycontracting with licensed contractors ta 106 - SEWER & WATER
construct the project(Sec.7046,Business and Professions Code:)no Contractor's Li
ttlue Law does not pply to an owner of property who Wilda or improves demon,and 202 - UNDERFLOOR PLUMBING
ho contracts for such p rjects with a contraoma(q licensed pursuam m te v
hConector's
Lgeemse Law. 203 - UNDERFLOOR MECHANICAL
Ql am exempt under See. ,B h P C far this msson 204 - UNDERFLOOR FRAME
r Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby alfimA ander penalty of perjury am of the roaowing declarations: 301 — ROUGH PLUMBING
❑ lhow unit will mahnnm a Certificate of CotenttoseE-lmare for WmkerS Campion- 302 — TUB & OR SHOWER
satian,As provided for by Section 37M of the labor Code,for d,pesfasmancc or the 3 03 - ROUGH MECHANICAL
wmrk Sur onion this permit is cured 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as Acquired by Section
nOOortheLabor cod"forthepeHoomanx,ofthe workfor which this permit l.issued. 305 - FRAME
My WorkeYs Compeaaron lnanntt artier end Polity numAer art: 306 - HOLDOWNS
Cartier: PolicyNo.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not becomplowd ifthe permit is for one hundred dollars($100) 309 - EXTERIOR LATH
te`a) 310 - INTERIOR LATH
I cony Not lin the performance or the work for whhch this permit hs issued.I shall not 311 - SCRATCH COAT
employ any }s an son
n n W 9n bjecnn IAe Workefa ComPensatian
A&PP'Aco^Calif h ate^ I � 313 - ROOF NAIL
IeCIE rTO AP, hC r7�f, teTrmakhng die Cenificem of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
me Subject to the Worker's Compoproma n pnvisrons of de labor Cade,you must
� ,Z forthwith comply with such proodons at this Permit shall W deamcd mwked. 502 - FINAL PLUMBING ENERGY
L� CONSOMICT10NLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I Wmhy afOrm that dere lis construction lending agency lnr the petition anceur 504 - FINAL BUILDING ENERGY
Y>> dodo,.faawnfonmmit
isperisissmd(scc.3(197,Civ.C.)
�rjt .&Name 505 .- FINAL ELECTRICAL
Zd
5 Z Lcndcr'sAddras 506 - GAS TEST
J O 1 certify that I ban read this application and me that the above information is 507 - FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and state laws relating to
�U building construction.and hereby authorin representatives or this city to enter upon the FINA MECHAN CAL
�+a aM1ovomonraned property mriapeman pagw:<s. 09 FIN
(We)agree to raw,indemnify and kecp harmless the City of Cupenirm against
r N
Until lilies.judgments.costs and expenses which may in any way acemc against said City 5 A NG
J'Z in eonaegnnec of the gosling of this Permit.
^ APPLIC DERS'ANDS AND WILL COMPLY WITHALL NON-POINT Issued by:5 WORKS Date
• _%
SOUlie RE lot.
/ 31 f Re-roofs
t ol'APPlica ntracto Oeste
ARDOUS MATERIALS DISCLOSURE Type of Roof
Will d,applicant sur future building occupant store or handle hr�ms material
as defined by the Cupertino Municipal Codc,Chapter 9.13,and the Health and Safety
.
Section 25532(a)7 All roofs shall be inspected prior to an roofing material beim
❑Ye. 3?NoP P Y g g installed.
Will the applicant or future building Occupant use equipment ordeviec.which If a roof is installed without first obtaining an inspection, I agree to remove
emit hayardous air contaminants As termed by the Day Arca Air Quality Management
Drsvicrl all new materials for inspection.
❑Yes Ng N. -
1 have mad lie Wvardms materials requirements underchapler 6.95 of the Califon
nix Hca"5 safety Codc,&to.a 5)5.x5533 and 2553 a.I undcrstsnd datiflW Wilding
does not currently h k t ht u a stanmy ms ancibilhry us an.fy tWmcupanl of the
rotor mentsw ' ms at orbJssranccoracerareme Signature of Applicant Date
Ow ha or aut -cd agent an I and All roof coverings to be Class "B" or better