04100194 CITY OF CUPERTINO BUILDING DIVISION PERNUT CONTRACTOR6INFORMATIONs
BUILDING ADDRESS: r PERMIT NO
MATHARU BHOPINDER 04100194
I91 R9R AT,t`AZAR AVF
OWNER'S NAME: .
PERMIT ISSUIEDATE
MATHARU BHOPINDRR 91 c)nn AT rA7 L AiTE! 129/2 0 _
NE:
SANITARY 0. C61CFROL NO.
1
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CON ACfOWS DECLARATION
w I hereby affirm that 1 am licensed under provisions of Chapter 9(Pammenaing _ Job Description
-z with Stem.100(l)of Division 3 of the Business and Professions Code.and my license m - -
^ rainfullforteanticffect.
Dn REVISION INIHOUSE' USE ONLY
5 q: Li d Lie.x —
License ata
Z_re Dam Contractor NO NEW PERMIT ISSUED ORIG. #04060017
rf', ARCHITECTS DECLARATION
�as i I understand my plan shall a used as public rccoNS I
''G Licensed Professional -- -^
OWNER-BUILDER DECLARATION I
.�i P I hereby affirm that 1 am exempt from the Conuana's License Law for the
O O rollowmg rtvon (Sacmn 7W 1.3,Business and Pmfessiov Cade:Any city at county .. . . ..
which roquitn a permit to construct.altar,improve,demolash.or repair any structure t
pour m its issuance.a6o requires the applicant for such permit to rile a signed statement
that W is lmevcd PUnuanito the provision of NC Conlsanmi li¢nse,Law(chapter 9 Sq.Ft. Floor Area ValuatifN1115
rd s-$ (commencing with Section 7")of Division 3 of the Business and Professions Critic)or. - r .n... 4
5_ that he u exempt thcmfrom and the basis for the alleged exemption Any-violation of
Section 7031.5 by any applicant for a parent subjects the applicant to a civil penalty of APN Number - Occupancy Type
oat mare Nan five hundred dollars(I500).
❑1,ss owner of Ne propmy,m my employeas wnN wage u their seta compensation, 35714050 . 00
Will do due work,and the suueum is not intended ar offered for 10.(Sm.9014.Business • Required aired I actions
and Professions Code:The Coerazmr's LICCnY Law does not apply re an maw of e Inspections
_ Q P
pmpeny wW builds or improvasthereon,tndwllodrcsauch work himsgforthmugh his
own employees,provided that such improvements afenot intended oro @red forage.If,
however.due budding or improvement is said whin arc year of completion,the owner- .
budder will have the Widen of pmvmg that he did not Wild or improve for purpose off i w
sale) `I
1,Ff o acr of the property am exclusively contracting¢nth licensed car omea rs to <
construct the project(Sec.1044.Biomass and Professions Code:)The Contractor's U. r-
came Law don not apply to an owner of property who builds or improves Hereon,and — - ' - - - --`-- --� '\ _
who caeracts for such projects with aconuanor(s)heaved pursuant to de Contractors 1
License Law_
1 em exempt undg
1O
'1003 `
WORKER'S COMPENS�ON DECLARN
1 hereby elilrm under pcngtY of perjury one of the toll tog de<lanuonc j
I haw and will maintain aCcnifteam of Consemuo self-insure for Worker's Compen-
sation.as provndcd for by Section 3700 of the Labor Code.for the performance of the j
work for which Nis permit is issued r
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
5100 of the Labor Code,for the performance of the work for which the permit is issued, j
My Worker's Compensation Insurance carrier and Policy number are:
Carrier Policy No ! _
CERTIFICATE OF EXEMPTION FROM WORKERS' I _.
COMPENSATION INSURANCE j
(This section need not bocomplemd iDbe permit its for one hundred dallars($IW)
ter lesx)
1 cevfv Nit in Ne performance Or the work for which this permit is issued.I shall not
employ any permit in any mannersn as m bocome subject o the Workers'Compenution
Laws of Ctldumm.Dam _
Applinr
NOTICE TO APPLICANT:IL after making this Cci ificate of Exemption,you should '-' - --- - -- - ----- .-
bocome auby0 m the Worker's Compcvauon pronsmes of the Labor Code.you cent
.,O forthwith comply with such provision Or this permit shall W deem ked
deemed mvo
Z Di CONSTRUCTION LENDING AGENCY
E~ Ihereby OEM.Nat Here W.construction tcadmg agacy fat the perfurmartce of
LL Nc work far which me perm is issued(Ste.3099,Ov.C.)
W A Undoes Nw-
=z 1<ndcrs AddR" - -
U 0 1 certify Nat I have read this appireshon and stem Nat Nc shove informant.W
FeorecL I agree 10 comply W ah all city and county ordinances and sum lava relating to
OV Wdtling,judgments,and hereby
exromonmmhmay in y way aca,to enter upon the or
G above-memuncd property for inspection purposes
(We)agree to save,indemnify and keep harmless the City Of Cupevmo against . /-
UZinto tigjudgmcnte graining cxpevesmit. mrymany wayacemc against said City
U z in consequence of Nc granting of Nos permit `(///(//d
APPLICANT UNDERSTANDS WILL COMPLY WITH PO
ALL NON- INT Issued by: Date
S � C�AT�IONS
J � Re-roofs /
azure of Applia DO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant C m(muse Municipal e,Chapter store v handle h Health a mammal
as defined io the Cupertino Munrtipal Code.Chapter 9.12,and Nc HnIN and Safety
Code.Scetron 25533(a)7 / All roofs shall be inspected prior to any roofing material being installed.
�Yas
Will Ne a bean ter mlareabtidain If a roof is installed without first obtaining n inspection,I agree to remove
pp g Occupant use equipment or devices which g P g
m"sett ha ardov air concmitants fined by the Bay Area Air Quality Management all new materials for inspection.
c'?
❑ye, _2Nu
I have real the Wait.mammals require menm under Chapter li 95 of the Cgt for.
not Health 4 SafayCedc,Se m.25505,35533 and 3553x.l understand thud the Wdding
does not cumady have a ere Nat it m my icspovNNly m Andy the Wrapant Of the
jxygremen
Each men be ma p`ace�juanccora CSVricae of Occupancy Signature of Applicant Date
/Z 9( All roof coverings to be Class r'Brr or better
Owner authorised ugcnt 7 DO. g