04060163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR I,NFORiVIATION:
BUILDING ADDRESS: -- ---- -- ---- PERMTr NO— -
BHOPINDER MATHARU 04060153
OWNER'SNAM ALL--ZAP r5rE -- - PERMIT 65IIE DATE 2"1110
E ATSf1DTTTTIT,'D M DTT SANITARY N%3 1?r
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u a o LICENSED CONTRACTOR'S DEsion of TUN
Mmby affirm that l em uQnxd under and Promo of s Code. 9(mmmense is l Job Description
with Section and Cif of Division 3 of the Business;eM Professions Code.and my license is
^�,a m full tome end effttn
,pz LbcnxClass Lm.k DEMO (E) HOUSE
iii Dam crmnmo
,dC ARCHITECTS OEC.a1RAT10N
%0 E.e I undcrsund my plans¢MIL be tired u public records;
�yU
tar LmcnxU professional
5 OWNER-BUILDER DECLARATION for F.00 1 hereby.(firm Thal 1 I.S.exempt from the Conran Chi License c ty o co the
p a (allowing moon.(Stttiun 707 L Baroness and Nafessions Code:Any coy or county
F.°o� which requires a permit to construct.alter,improve,demolish,or repair any structure O O ra n n
iii prior to its Issuance.also mymres(be applicant for such Permit o Ole a signed statement 4_ _ _
< thatheis Ran,edpatsuanitothepmasnnsa fmacantrecLaCCnavw(Chapter9 ' Sq.Ft.FloorArea Valuation
z�a (commencing with Section 70M)Of Division 3 of the Business and Pmfassans Code)or
that he is exempt d ercfrum and the bssis for the alleged exemption.Any violation of 9Tvi
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penally of 3�a l,T,T.,,�l. O Q -
no,mamNan6ve hundred dollam(SSW). NT Ver Occupancy Type
❑l,uownv ofJe pmprny,or my employes with wsgautM"v sole compenactian, I Will do the work end the¢wcmm is not intended oroffemd fusel.(Sm.7044.Business .
and Professions Cade:The Contravenes L,cove Law Ibex not apply of m owner of Required Inspections
Property who buldsmurn,ores thereon,end whtdoessuchwork himselforthofgh his
own employes,provided Nat such Impmvementa are not intended oroBOed treacle.If,
Wilder doe have building of proving smt he did one year of cprove frdoeawe of C \
aware-
Wilder however.M Mss doe burden improvement i WI within not hued or improve to he purpose awes e-
c.).
011.as owner of the property,.Business o and cofessi ns wM Oeerued ronv¢ms¢m a.
ccnstma doe es noel(Sec.o in onr of and Professions Cade:)The Conmemn.Lo- 1 \
cenx law does not apply to an owner of property who builds or improves Oerwn,and
who canmcOfors IfpmleaswM aeo usemr(s)licensed pursuant m the Contractors
Leenx law
❑ lam exe n Sec BkPC( this n
Owne Date 2
W RK S SATION DECLARATION '
1 hereby aRrm under penalty of perjury rue of the following dttivasons:
a an and will maintain v Certificate of concert m self-msum for Workers Compere
inn,as provided for by Section 37M of the labor Cade,for the penfonnanre of the
work for which has permit a Issued.
0 1 have and will mainum Worker's Compensation Insurance,as required by Section
37W of doe labor Code,for Nc performance of be walk forod eh this pe..I is issued.
My Worker's Compensator Iassum.carer and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' I
COMPENSATION INSURANCE
(Thu sttnao need rim W completed rf tk permit is i.e.hundred doll.(SIM)
nr less)
1 comfy that In the perfarmaeoc of the work far which Nu permn u issued,I shall not r
employ any pccon in any manner so as to b m
ecoe rob,.,m the Warren'Compensation
Laws of California.D a- :
Appltc,
NOTICE TO APPLICANT:IL after making Nu Cam&ale of Exemption.you should I
become Subject to the Worker's Compensation provisions of the fabar Code,you must
.J ,Z faMwM comply with Such Previsions or thus permit shall be deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
[-: 1 hereby oRrm Nat here...rif.dnn leading a,mmy one the peformance of
C the work fur which door permit is issued(Sec.M7,Cm C)
W A Under's None
cl, Z csneers Adl
U Q 1 certify doet I have read this applicanan and stale door the above..fmmarun is �
W F wilds 1 agree m comply with all city and roomy ntamenai and Sole laws relating m
p U busdmgommusecnogand hereby authon pu,Mexnuuva militia city in cater upon dlc
FW ahcvc-mcnn*AUND pcny for inspection purpoxs.
o. (We)agree to xis,indemnify and keep hoicks,the City of Cupemno against n
fA coati antl expenses when meymany way accrue against said City
(„) ,Z cg t fires peered.
^ ER A 5 AND WILL COMPLY WITH AL NON-POINT Issued by: D ate
TIO
Re-roofs nVConuxm>•�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building desupxl vain of handle haardous national
as defined by he Cupertino Municipal Code.Chapter 9 11,and the Healdo and Safety
COJe,Section 25532(a)'
❑Yes A�F- All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining n inspection,I agree to remove
Will the applicant or future building occupant tax cympmcm or devices which g P
.`„aardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
10ric” l
❑Yes WNu
vc mad the hvallouuss materials requirements under Chapter 695 of Nc Califor-
nuHCa SafelyCode.SCCUmu]5505,25533 and 15534.1 undcswvb Our ifdc Wilson,
Jars n c city have a loom.oat it a my responsibility m Out de as Pant o(de
mq ) kwhich MUM hcmm prior bissuancc Ufa C role eupanyP Signature of Applicant Date
�ew�cyaramhad d agent ( � „C ' All roof coverings to be Class "B"or better