03080128 CITY OF CUPERTINO +> ysw
BUILDING DIVISION PERMIT CONTRACTnR INFORMATION �&
BUIL DING ADDRESS: RAHAD CHANDIKA PERMIT NO 03080128
'R'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that 1 am license l under previsions of Chapter 9(commencing Job Description
SZ wish Section 7").fDOW..3of0e Rus.and Poloist..Code,andmylimmeis t]
+�N in full fume and effect D O'l'1
i$j? Licenseclan Lica
F DBIc Contractor
ARCHRECIS DECLARATION
I < 1 understand my platushallW used upuhlic retoms r
o U LironuJ Prefcamhol s
OWNER-BUILDER DECLARATION
�<I 1 herchy onium JUL I am exempt from the Contractor's License Law rot the
m 0 following moon.(Sutton 7031.5,Business and Professions Code:Any city Of County
which requires a Permit to construct,alter,improve,demolish,or repair any nracmm
32>
poor its issuance.also requires the applicant for such permiuu Glc a signed auement
-mm< that he is licensed purmanitotheprovisi....fthe Cm uuorsLicense Law(Chapicr9 Sq.Ft. Floor Area , Valuation
ZFa (commencing with Section 7000)of Division 3 of the B usiness and Professions Code)to
$ that he is exempt therefrom and she basis for the alleged exemption.Any violation of 36925024 . 00
Section 7031.5 by arty applicant for a permit subjects she applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dotlan($500).
1,u owner of the property.or my employes with wages u Heir sole compensation, (�i�T
will do the work,and the swaure is not inendeJ or offered rot auto(Sec.7064,Business — dins eCdOn$
and Profusions Code:The Contractors License,Law does not apply to.owner of 10 2 — PIERS p
property who build.or improves thereon,and who doessuch work himself orthrough his
own employce,provided that such improvements are not intended oroffered forule.If, 103 — UFER
however.the building or improvement is sold within one year of completion,the comer.
builder will have me human of proving that W aid not Wild or improve for purpose of 104 — REBAR
sash)' 105 - ANCHOR BOLTS
❑1,as owner of she property,am exclusively contracting wish licensed contractors to
construct the pmject(See.7346,Business and Formations Cade:)The Contractors U. 106 — SEWER & WATER
more Law docs not apply to an owns o(proPcrty who Wilda or improve themen,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)Ii"and punuam to the Committers
License Law. 203 - UNDERFLOOR MECHANICAL
❑Iamesempt ulersec. ,B&PCf this man
204 - UNDERFLOOR FRAME
r Date 205 - UNDERFLOOR INSULATION
ENSATION DEC TION
I hereby uRrm mr eWry of perjury one of this following dxluatfnns: 301 — ROUGH PLUMBING
I IInwand will maint,in.CerdhomofConsent tosalr-Insure for wWkenCamper. 302 - TUB & OR SHOWER
cation an provided for by Section 3700 of she lu Wr Code.for the performance of this 303 - ROUGH MECHANICAL
work roe whim this paintain issued. 304 - ROUGH ELECTRICAL
❑I oath and will ode.ren Workers ono,o the w Insurance,ss required by Section wed.
3]00 or me labor code.ter the pertormmce erne work ter whim this permnis Owed. - 305 — FRAME
My Workers Compensation lruumue carrier and Policy number art: 306 — HOLDOWNS
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 303 — S+HEETROCK .
(TMs auction Iced not he completed nhc Permit is for on hundred dollars(SIM) 309 — EXTERIOR LATH
nr less.)
1 cenify dem in the p froom..nr the work ter whmlyrlhis permit is issued.1 shell not 310 - INTERIOR LATH
employ any n nym.ner ants o c 1� mit Wmimn'Compeonathin 311 — SCRATCH COAT
Laws o(Caluo a 313 - ROOF NAIL
Ap licam
E "0 ATPUCA! uCertificateofExemption.you should 501 - FINAL ELECTRICAL ENERGY
one smjam te the W r' ompcnatlon provision of Use Lahnr Cage,you mus
.JZ rorshwhhcomplyvimaI ovnionsmthisPermitslnOWdemodrevoked. 502 — FINAL PLUMBING ENERGY
?O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(.,`Z, Ihemhyalnrmmutherei....mmuctumlending agency for meForfurmanceof 504 - FINAL BUILDING ENERGY
Lender's
x > the worknder',Nem.for which thtsp mit isiuud(5..39],Civ.C) 505 - FINAL ELECTRICAL
lel Q
= Z onaeriAd°. 506 - GAS TEST
Up lmnifythat Ihaw mad this application and sum not the aWteimromnnwnis 507 - FINAL PLUMBING
lLs correct.I agree to comply with all city and county ordinances and sate laws mixing to
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building construction.and hereby Audi reprnenmives or this city to chief upon des C.) move-menliuned properly rot Inspection purposes FIN MECHAN CAL
G (We)agree to sive,indemnify and keep hartnleu dm City of Cupertino against O 9 FIN
y Iiabilitin,judgmcnu,coats and earmuses which may in any way accrue against said City
V Z inconse,ccomofinegmntagaf suis, it. 5 NG 7
APPLIC UNDERSTANDS WILL COMPLY WITH ALL ON-POINT Issued bye WORKS Date'
OUR
RE A11 NS.
Re-roofs F PLYWOOD NAIL
sig neer p"i acta os zrae 603 - OOF BATTENS
H,2 D(USMATERIALSDISCLOSURE Type ofR 4 - ROOF IN-PROGRESS
Will de applic jpYOr forum building uccupam atom or handle havamuus material
defined by me Cupertino Municipal Code.Chapter 9.12.and tit.Health and Safety
,seaionzss3z(a)? �u All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will she applicant or Rdure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air momminanu u defined by me Bay Area Air Quality Management all new materials for inspection.
District? /
❑Ye. �Nu
I have mad the hexamous materials mquiremcuts under Chepwr6.95 of Irk:Calton.
Iia Hh.lth✓F Safety Code,Scedun 2550$.2ss33.d25.534.1 undcumnd Ihnif the Willing
dna nm cu n0y hero a encu shat it is my reaporm.1.1. m nndly coup. of the
M4.imm m eat tpriprtoin...cor.Cemnes up Signature of Applicant Date
nor urm"ch c gems are All roof coverings to be Class"B"or better