03020105 CITY OF CUPERTINO d r �-* rR 3',:„
BUILDING DIVISION PERMIT ��C(;1,lTRAG' OR. N01tMA ,IU,N�f%.
BUIIDINC ADDRESS: L
P 7[v]gIT(,7PERMIT NO.
10410 CASTINE AV 03020105
ER's NAME: 170 BRANNON DR PERMITLASUBDATE
VANDANA NAIK 02/25/2003
NE: (blU) 3 /6-4816 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
386 LICENSED CONTRACTORS DECLARATION O
{y 1 hereby eflirm that i em IImIUM under previsions of Chapter 9(commencing Job Description
with Secsion7000)of Divlalon3ufth it&I dPmfesslou Code,and myllcensoia
^>51�°d in full forcun.+•md aN�t'lmy,plass s V Lknd.e
f
REPLACE WATER HEATER
nlkenso CiRC CCT.,
FINALE®
DKSN
"'Wile records
cedimsed,profeatlmOa '
FEB 1 8 2003
p OWNER-BUILDER RATION
Ii 0 i 1 hereby.Sect mel 1 1. exempt f e Cssions o e:A License Lew far the
my
Do followingmoon permit
7031.5,Businessand Remoli Code:Any city or county
°�$� poor myuimsapermit recnmWcl,Alan,Improve.demolish,ore a sig sayStructure BUILDING
i5p pdormslicenits an purser nttorequthe the,pious o for such peruses Licens signed statement
< sMtheisllmnmdpurwemmNepmvidomofdeConuaw/sLkeveLaw(Chapter 9 Sq.Ft. Floor Area UlMion
S (commencing wire Section7000)of Division 3 ofthe Business and Profeulana Code)or
.. that hs Is exempt therefrom and the basis for the alleged exemption.Any violation of
Semian 7031.5 by any applicant for a permit subjeces She Applicant o a civil penalty of
nm mom them Caw hundred dollars(SIM.
- er Occupancy Type
❑1.uawaer of the property,armymnployeet with wagasu theirsotecmnpenmtiuv,
will do the work.and tha mumure isnotlntendnd onoffered forsile(See.70M.Business 502
and Professions Cade:The Co mmor's License Law doss not apply or an owner of 506 - GAS TI�tquired Inspections
property who builds Or Improve therega,and who time such work himself or through his
own employee,provided that aach Improvements Are not Intended m offered for m1e.if, 507 — FINAL PLUMBING
however.the building or improvement is sold within ore Sear of completion,the Owner-
bulkier MB Mw the burden of proving des he did pert buUd or,Impmw far purpose of
tile.).
❑1,as owner of plan property,am exclusively contracting with Ikenmd conuxetors to
cmutrucl the pmjm(Sec.7044,Business and Profession,Code:)The Contracme,LI-
cease Law done not apply to A.°weer of Woperty who build,Or improws thereon,soot,
who contracts for such projects with aeonusemr(U liceased pursuant paths C°nuutoM1
License Law.
❑tem exempt under Sec. ,B&PC for this mu°n
ar Dam
WORKERS COMPENSATION DECLARATION
1 hereby alfiem under penally of perjury one of the following dxluWons:
137.OWO
baw°ndwillnum uln aCewrimmorconwnlwul6lasumforW°rker'zCompen-
n,u providn0 for by Secdon 3700 of the labor Code,fm the performance of the
for which this permit a Weed.Mw and will maintain Worker's Compensation Insuranttu required by Sudan
of the Labor Code,far the peNermanee of die work fm which this permit le issued.
Worker's Col pens lion Imm�ntt Carrier end Policy numberam:er. Pully No.: 5�i.2
CERTIFICATEOFEX PION FROMZ?KERS
COMPENSATION INSURANCE ,
(This xectian need net becompletei little permit is fmonc hundred dollar($100)
or kw)
I«Wily that in the perfomsame of tie work for which this Permit is Issued.I shall not
imply any person in any nunmrm As in become subject to the Wo lacry Compcnssdon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject In the Worker's Compensation provisions of ale labor Code,you meat
Qforthwith comply with such provisions,or this permit ahtll le dcemW mvoked.
y CONSTRUCTION LENDING AGENCY
I hereby affirm that them Is a construction lendingagmay for W per(urmmce of
Z the work for which this permit Is Wood(Ss,.3097,Civ,C.)
V Q IandeYs Name
z landee,Addmst
Q I ttrltfy that 1 Mw read this application and sum that the show infomuliun Is
4 mmCcl.1 agree pa comply with all city and county orthnanees and Spate law,renting to
building construction.and hereby authorize representatives of this city an enter upon the
..W above-memloxd pmpeny for inspection purpoua.
L (We)atm°M sew,indemnify and keep hummss tle City of Cupenhm against
y rA Iiabilides,Judgments.eau aspartame aspewhich may in any way amus against mid City
7 In consequence of the Starting of this permit.
G APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOU EREOUL ONS.
Re-roofs
SirMumbTApplicmVContrxepar
HAZARDOUS MATE A DISCLOSURE Type Of ROOF
Will the Applicant up fuwrc builds i mmu nbmmorharedlelmamdoumemdal
AS,defend by the Ceramic, MunklW I C per 9.13.and the Health and Safety
See"-zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YCa
WIII the applicant or factum building Occupant tint cyuipmcnl or dcvicee which
If a roof is installed without first obtaining an inspection,I agree to remove
Iq hazardous air contaminants u dented by the Bey Area Air Quality Management all new materials for inspection.
U7
❑Yes 'O�No
1 hew mW the haurdws materials requirements underClupter 6.95 of the Califor.
nit Hulth&Safety Co@.Secdom 25505,25533ld 2553<.I undcmund mutfdm building
docs not carnally haw a tenant,dot It is my reapomlhilily m codify tis coupant of the
regtire `rmwhi`h b_o I of mfkaea Cm y. Signature of Applicant Date
owner ar anthoolux! int Pete All roof coverings to be Class"B"or better