04070051 (4) CITY OF CUPERTINO roar a:y +, ' "^ "a
CONTRACTOR INFORMATIONn
BUILDING DIVISION PERMIT 1 �
BuaDING ADDRESS: NOLASCO CONSTRUCTION PERMITN004070051
408 PERMIT ISSUE DATE
OWNER'S NAME:
BABU NOTT SANITARY 0. C RNOL NO.
IS:
(650) 282-0411
BUILDING PERMITINPO
ARCIIITECT/ENGINEER: BLDG ELECT PLUMB MECIi
Imo\ 0 0
Z, LICENSED CONTRACTOR'S DECURATION Job Description wU��
I hereby,affirm that I sm thwarted undet[plavisions of Chapter 9(commencing
wilh Sectim t 1)of that
Sof the Barompend Professions Code.rud my license is
^�d in full for,rood a !2 63 3c-- 2 NEW FACETS/1 SHOWER VALVE (BA�+FrLRM)
License Claes Lie.I
�I Date Contractor �9
ARCI IITECTS DEC LARA 10 �O
� -s 1 understand my plans.hall Wrier!as public.,.,its O yU G
GG Licensed Professional
" S OWNER-BUILDER DECLARATION
I herehy ol'firm Nm 1 am exempt form the Contractors License Law lin the
dio following mason,(Section 41131.5.Business and Professions Code:Any city fir county
11$_ which requires a permit w eonslrucl abet,improve.Jemnlixh,or repair any.lmewm
y N prior toit5issuance,also requlydothe applicant for such Permit to file a signed statement
�x�x< that he islicensed pursuant to the previsions of the Contractor's License Law(Chapter Y Sq. Ft.Floor Area Valuation
re (commencing with Section 2000)of Division 3 of the Business and Professinns Code)or
i _ Nat he or exempt therefrom and tie basis for the alleged exemption.Any violation Of
Section 9031.5 by mry.pplicam ter.permit subjects the applicant to a civil Penalty of 3 Occupancy Type
not mow than five hundred dollars(5300).
I u owner of the p"from rr my employees with largo o IM1Cir tele eompenatlon,
will dadewarc.Cardeawmunancers LimmJof ovit fonts lid,.I.im Bain as Re uired Ins ections
um
and Professions COM.:The Cnnhacwrs ri who Law do s at apply to an owner is q p
Own em who b,provi imprnws Neuron,and who antdoa.a.cht work him¢If ter through his
own employees,provided mm such improvements me net arofintended ma@red for sale.If.
however,de building orimprowmanlissold withinone year of Improve h.
doeowner
builder will have Iht burden of proving Nn he did nal build of imPmw for puTae of
ate.).
I,as owner of Ne property,am exclusively contracting with licensed connectors to
...swc the prefect(Sec.7W.Business end Profaslmm Code:)The Conuachers Li
cease Law does not apply wan owner of pmpmy,who builds or improves demon,and
who contracts for such projects with a contmcm(s)licensed pursuant do Conlranere ,
ease Law.
I am exempt under Sec. B&P C for this recon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hem',slim under penally of perjury one of the following dedantinns:
I have and will maintain a CeniOwte of Consent to self-insure for Workers Compcn-
satin,m provided for by Section 39W of the Labor Code,for the performance of the
work for which do, ornit is issued.
1 have and will mainmin Workers Compenution Imuran.,a sequined by Section
32W of de labor Code.for the performance of the work for which Ibis penis is issued.
My Wmkcrs Bran n 1 iey.nd Policy number am:
Cam'er:J �l `��IPoliry Na.:
./tet RTIFICATEO MITION FRQMWORKERS'
COMPENSATION INSURANCE
(Thu second need not 0e a orlda.d from permit is franc hundred dollars($100)
fir lase.)
I wnify that in the performance of the work for which this permit is issued,I shall not
employ any person in any _snto omc subjcn m the Workcri Compensation
Laws ofCrnia.D 4I
NT ar :7c,
l `O
NOT E APPLICANT:If,a ter making xis provisions
nwe of Exemption,you should
berth comp w the Worker's Coons or this
previsions of the lmed yokCode,you muss
Qz forth Ith comply with such previsions or this parmiuhall be deemed revnkeJ.
zO CONSTRUCTION LENDING AGENCY
Ihereby affirm dm dere is a construction lending agency for the performance of
!Yi 7 de work for which this permit is issued(Sec.3097,Civ.C.)
W Q fender's Name
IL Lcnder's Addtea
U 0 1 coolly diet 1 have read unix application and stele In.,the above information is
W correct 1 agree to comply with all city and county ordinances and state laws relating to
0U building connection,sad hereby ambition repmmmorivcs of dos city to enter upon the
r W .hove mentioned property for impemimn purposes.
4. (We)agree to save,indemnify and keep formless the City of Cupertino against
fA liabilities.judgments.costs no espcnses which may in any way accrue against said City /rvx,
U in consequence of de Booming of this Permit.
.. APPLICANT UNDERST DS AND COMP WITH A ON-^POINT Issued by: Date
SOUR UL �7j 4,/
Re-roofs
ig Ire afApplicaData
HAZARDOUS
Type of Roof
HAZARDOO LS US MATERIADISCLOSURE
Will da applicant or furore building Chat erre or handle hazardous material
a dclmed by do CupeninO Municipal Code.
e.Chappter 9.12,and the Heald and Safety
Coda,Scoria 35531(.)? �/ All roofs shall be inspected prior to any roofing material being installed.
❑Yes 1TYu
Will the applicant or future building occupant use equipment or Ilcviccs which
Coda,
a roof is installed without first obtaining an inspection,I agree to remove
n haxmdnux if comamiin az JcfineJ by the Bay Area Air Quality Management all new materials for inspection.
Durno"? �tHys`•
❑Yes
1 have mad the haardous materials requircroms unJer Chapmr6.95 of the Califur.
nix Heald&Safmy Cale.Secit 2M5,25533 and 25534.1 understood thmif Ju building
Joos I cunnll how a¢rant, tit is my respons ility w notify ft wcuPant a do
re�ut e pc wW my81 Berm .ane ccrulas (Occo enc. Si nature of Applicant Date
owners.altered agent Date All roof coverings to be Class "B" or better