01090069 CITY DIGDEONO
BUILDING SSINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1174 SCOTLAND DR ACTION AWNING 01090069
OWNER'S NAME: APPLICATION SUB DATE
MUKHERJEE SHISHIR AND APARNA T 439 FIELDCREST DR 09/18/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 629-8007
C e5 z ARCHITECT E GINEER: BUILDING PERMIT INFO
FOF BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
5,lS p 1 hereby affirmb.,1 am licensed under provisions of Chapter 9(commencing �Job Description
L with Section71100)ofDivision3oftheBusinessandProfessionsCode.andmylicense SCREEN RM. 252, a, k'Tgg �E®
n fall force and e F @ MPJ 6w
i a Licrnse Class Lic.x
O W{. Dme r• Convenorna
a 3" 61 ARCHITECI"S DECLARAI ON
O g 1 understand my plan,shall be used as public records
OCT 2 9 2001
r
i i p p Licensed Proe,wral
' o OWNER-BUILDER DECLARATION
1 hereby affirm Cha 1 um exempt from the Contactor,License Law,far the BUILDING
3< following n n(Section 703 1.5,Business with Professions Codc:Any city or county $6500
w
x p which requires a e,.1.to cnnnWch dor,improve,demolish,or repair any structure
pnmt t ce;ala req the pplicant for such pemmnofkaagncd statement-.
wr h i' sed portuinl t the pro asimns of rbc Contrecmrs Lnttrue low ICTtapmr 9 --." - _
(commencing with Seci 7000)of Diviswn 3 ohne Brininess and Follows..Code) <,`�j'V'1`�•36'L C.O tT.3.r: V, s r.-.� (QS^y . Valuation
or than he is exempi Nnefrmm and the bads for the alleged eiemyubn.Any nmliam. '
of Section 7031.5 by any applicant for a pwrim subjects ate applicant to a civil penalty
of not am than five hundred danar.(ssBo). 10Y N f�DATION Occupancy Type
01,as owner of the property.or my employees with wages as their sale compensation, _ PTPjRq
will dm the work,and the structure is not intended or unwed for sale Isco.7014, Required Ins
'Business and Professions Code no Contractor':License Law does not apply m an 103 — UFER 9 Inspections
v
owner of property Who builds or improves Nueon,and who does soon work himself
rthrough his own employees.Provided Net such improvements arc not intended or 104 REBAR
ave:ed for sale.If.however,Ne building or impmvemem is send within one year of 10 5 — ANCHOR BOLTS
Completion,the owner-buader will have the bunde t of Proving then he did not Wild or
impmKfarpurposenfrok.). 106 - SEWER & WATER i
c—ure,wner of ecl(Seery,am Bm,m exclusively contracting whin Cadenssd contractors a
202 - UNDERFLOOR PLUMBING
amawa the project(Sec.70aa.money o aro ery%ho b Code:)The Contractor's
uttnaeLaw does nrnapply tnanmvnermrprmpenywnabuiManrimpraveathereon, 203 - UNDERFLOOR MECHANICAL '
and who contacts for such projects with a camractor(s)licensed purstrm to the 2 04 — UNDERFLOOR FRAME - -
Conwctor's Licenu Isw..
❑I am exempi under Sec. ,B&P C for this mown 205 — UNDERFLOOR INSULATION
Owner °ate 301 - ROUGH PLUMBING
+ WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby atrrmunder ena1Vof <rjuryamorNefollowing declarations: 303 — ROUGH MECHANICAL
I owe ata will maintain a Ceniceare of Cmrue a at self-brsna far workers' 3 04 - ROUGH ELECTRICAL
pensaion,'as provided for by Smion 37W of the WWr Code, for the
performance of the work for which this permit is issued. 3 05 — FRAME
O I have and will maintain Workers Compensation Insurance,in reclaims by Section 3 06 — HOLDOWNS
3700 of the IzWr Cmdc,for the performance of Ne wok far which Nis Permit is 307 - INSULATION _
issued.My Workers Compensation Insurance earl.and Pofty,numbcr aa:
carne ..F •i..'j l ` e 'TPmhty No.: 308 ,,,7t SHEETROCK_,'%%
CERTIFlCATION OF EXEMPTION FROM WORKEft$"1, ti ° 1 p309�`— rEBTERIOR LATH '
COMPENSATION INSURANCE " ' .. _.,__.__ _ .... _.. .
310;. =: INTERIOR 'LATH
This section need tai rte emnpmtm into Pamir is for one numera emlkm
311 - SCRATCH COAT
Ig 100)or legis)
. I eenify drat ins n;e Perforn amcl,or ere work for which this perinit is Issued.1 313 - ROOF NAIL.-. ..
.hall not employ any person in any meter so as to become subject to theWmkeri 501 — FINAL ELETRI CAL' ENERGY
Compensation laws of Cebfomie.Daze
Applicant502 — FINAL PLUMBING ENERGY
NOTICE TO APPLICANT.If.atter raking this Ccnifcae of Eacmp1mm.you should 503 — FINAL MECHANICAL ENERGY
become subject to Ne Workers Compensaio r provisions of the Lsbm Code,you most
O ronnwithtmmplywithwmprovieionsorthiapermhanaubeeeammavmked' . 504 - FINAL BUILDING ENERGY _
"•I CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL . �"
a'> I hereby alfinn that there a
is a covuctiun lending agency Por the performance
of Ne work for which this Permit iai.wed(Sec.3o97,Civ.C,) 506 - GAS TEST
d.Q Lender's Name '
p_z 1<nderaAddm,s 507 — FINAL PLUMBING
_U O I eenify Cha 1 Wm read Nis apPhation and roil Nv Ne anove infomution is
508 — FINAL MECHANICAL
kms' E. umrecr.1 agree to comply with all city and county ordinances and state laws miring 509 — FINAL GRADE
>, C:7 wbuilding roalimadmmlamd M1 fabyaorhodzeurposenraives of this city to rnar upon
meaW(Wc). metdprop ny rnifya dkmpbrumles, 510 — FINAL PLANNING
Its e,,judrectosovc.i and toifyandk ep which
may inthewayacruof enin.ainst.eta
U m liabilities,judgments.cons and eapenshi worm may,N may way areae agaNn.eme 514 - FINAL PU I C WORKS
C.> ti Ciry in cmnsequ<nce Of the gaming of this permit.
APPLICANT UNDERSTANDS AN9 WILL WITH PDINPp 9. ./
SOURGEItF.SSSELkJ.710N'S(� Issued by: Date
Sig areo''fA�pplicunfiCiCCffontrxmr - •' . .Doc Re-roofs
HAZARDOUS MATERIALS DISCLOSU
,., RE
NAI Ore appbceiu future Wilding pail t handl harndaus maternal .Type of Roof
a 'in
d by she Cupertta I Code Ch W 9 12.and th Health and Safety ,
Cade Set n2553Aa1 y !. •, ' ? I t, 5 't,. 's.
❑Yes
" 1 _-All roofs shall.be Inspected prior to,any roofing material being installed.
tot �IWillthe.applicantorfutumbuildingrccupantumcquipmentordeviceswhich If a roof is installed'withoutfirst obtaining aninspection„ Iagree toremove
emit hazardous air cmntaminrms a efned by the Bay Amo Air Quality Management
Di,mica all new materials for inspection. Applicant understands and will comply with
, .0 Y, No - all non-point source regulations:
I have read Ne hassrdous materials requiremena a'Mer Chapter 6.95 of Ne
Califdmia Health&Safety Code:Sections 25505.25533 and 2553x..1 understand that
ifthe building dors not urrently have a tenant,that it is my responsibility to notify the -
occupant of the requirements which must be,met prior to issuance of a Certificate of
Occupancy Signature of Applicant Date
�authorized e / All roof coverings to be Class"B”or better
Owner or auNonzea n
Har - Dem.
=_I OFFICE -