04060158 CITY OF CUPERTINO "' '•' ' ' +' " "' ' -'—- -
BUILDING DIVISION PERMIT 'CONTRACTOR I,NFORMATION `�
,I BUILDING ADDRESS. NATIONAL CONSTRUCTION RENT ITNO04060158
x121828 ALCAZAR AVE_ -
OWNER'S NAME: PERMIT ISSUE DATE
BHOPINDER MATHARU 1355 FILIPE AVE _ _ 06/18/2004
NE: SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
m❑ I Wmby affirm Net I am licensed under provsons of Chapter 9(Commencing Job Description
�Z, with Sellon]ON))of Division 3 of NC Bucineas and Posessions Code,and my license's
'e« in faBfmceandefr«l. TEMP POWER POLE ���n 3f7�(}��
SLIa License Claw Lc.sr ALEED
ZFp Dam Cunlmmor
'o ARCHITECTS DECLARATION
w U I understand my plans matt he used rat public menace
AUG gp 2004
p� Licensed Pndcasumal
S OWNER-BUILDER DECLARATION
i3: 1 herchy affirm that I am exempt from the Comnmors License Law for the �n pl a ��
Do following easnn.(Section]1131 5,Business and Professimu Code:Any City or county I� L
$tai which.,on.a Permit m construct.a @r.improve,dcmohsh,or repast any structure
O 0
_zy prior up its issuance.also requires she appl'cantfor such permit to file a signed Comment
ppmm< that ha is licensed pursuant to the provisions of the Commit is license Law(Chapter 9 . Sq.Ft.Floor Area Valuation
y+f-� (commencing with Soetion7000)of Division 3 of the Business and Predications Code)or
y $ the W u aacmpt theefmm and the basis for the ailcged cereption.Any violation of
Section 7031.5 by my applicant for a permit subpar,the&Miami to a civil penalty to , 1yl�DTU U Occupancy Type
not mom Nan five hundred doll..(151)0). P Y YP
I,a mmrofthepmpwy,mmyemploycuwiNwg ueeirmlecomponssdon. I
willdothewoesandtheswnumisnotmmMdoroRem forsale(S .ID .Bucimss
and Praressmm Cade:Tha Canusstars License Law des not apply man owner of Required Inspections
property who builds onmprovu shemon,and who doe such work himsel f or through his
own employees.provided Natsuch improvements are not mended oroRemal for sale.If,
however,due building or improvement is sold within one year incompletion.the owner,
Wilder will have the burden of proving Nat he did net build ar improve for pugwse of
W,L
I
'�J owner of tit property,.B exelus'vdd contracting with II The mireef is i-
cpaswn the project(Sec.]OCa,Busmcst end Profece'am Code)The Conuacmr's L'-
am taw does not apply to an owner of property who builds or improve;thereon,and
who contracts for such propcu with a commicu r(s)licensed pursuant in she Contractors
Llccnse Law.
U lam veep' der Sec. .B&PCfor WSroason'am OJtr'cp v 111th ,I
Vy W00.1 OMPENSATION DE TIGN
I hereby affirm under penalty of pepury ore of Ne following delmations
1 hoe and will..Iowa a C..ficmC.fC...I m WN..m far Werkeri Compsn-
uuon,as prevldad for by Section 3700 of the labor Code,fm the performance of the
work for which this perm's is'ssmd.
1 have and will mamwn Workers Compensation Insurance,u aym ed by Section
37000f the labor Code,for the pedam once of the work for which this permit's United.
My Workers Compensation Insuranco carrier and Policy number am:
Cartier_ - _ Policy No.: ,
CERTIFICATE OF FXEMP ION MOM WORKERS'
COMPENSATION INSURANCE
(ITh section recd not hacomplced dlh perms is foram hundred dollaa(SIM)'
or less.)
1 certify Not in the perfarmane of the work for which this permit is issued.10.11 nor
employ any perma in any restrict an a in become sublet to the Workata Compensation
Laws of California.Do,-
Apphnn
NOTICE TO APPLICANT:If,afmr making this Cemf'eate of Eaerepuon,you should
bceomc subject to the Womkci s Compensation previsions of the labor Code,you must
z Forthwith comply with such provisions or this permit shall M deemed mvoked.
Z 3 CONSTRUCTION LENDING AGENCY
'r+ t� I hereby affirm Nat them is a construct inn[endingagency lotNeperformanreof
-
!Y Jm work fur which this permit is wind(SCe 3097,Cm.C.1 I C
W Q Lenders Nam- I //✓/ /\ //
z Lender's Address
U Q 1 anify that 1 have read Ws applieauon and state that the above info'mauun is
correct.1 agree in comply wish all city and county arninamca and sure laws relating to I
0 U building
(We)areeto and hmatrony anlrepresentauvesof City of tucneno age the (\'�C._/
r alrove-mentioned property for inspection purposes.
tU y b.buma uric. Itho Somme pc sporma.cl'measy'n''n eny Way y1ucruc 6 nslsaidC�yt s //
U z m APPLICANT of thegrantingof Na per m". U
" APPLICAM UNDE0.5TANDS AND WIL COMPLY WITH ALL NON-POINT ISSl10d by; Date
SOURCE REGU DNS.
—� �O4 Re-roofs Q
.S'gnmumufA 1 UCo Oct., � a
HAZARDOUS MATERIALS DISCLOSURE .J Type of Roof
Will the applicant or future building Occupant sere or handle hausrdous mamnal
defnod by the Cupertino Municipal Code,Chapter 9.13,and she Health and Safety
th de.Se❑en.1553200? All roofs shall be inspected prior to any roofing material being installed.
Yea fl Nn
WJI the applicant or future budding occupant tie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
D ha]thous air comammanntt o/JCMed by the Bay Area Air Quality Management all new materials for inspection.
U Yes Lytau
Ihavemadtheh ma ousmaerialsmqu'mmcnaunder Chapmr6.95oftheCal'for-
nu Fk.lth&Safc'yCOdc,&.=215(15.25533 and 21534 I uMCmsetd tha'fNC Wilding
does not currently hoc a tenent.Our It's my msponsshdny to nosily she Occupant of the
requirements which must be et norm anccofacomncawojoccupancy Signature Of Applicant Dale
7
Dam
All roof coverings to be Class "B"or better
Owner auth n.ad agent
CITY OF CUPERTINO
TEMP POWER OF
CUPERTINO PERMIT APPLICATION FORM
APN # 35 3 •-/tf-05z) Date: / ¢j ,vAe 2doLl
Building Address: ZI �20 }}LC�}��92 4-Je J
Owner's Name: �l /I�Nvnh /), , Phone#: W,1-1y
Contractor: 'CIS Phone: License #:
Contact: `( Phone: Cupertino Business License#:
Building Permit Info:
Elect 2
Job Description:
Residential E/ Commercial ❑
Cost of Project: 5�
•
if
hable Fee fD Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
(l /� EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
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