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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
10325 ANN ARBOR AV
SRINIVASAN
LEELA V AND GMAPAT
PERMITNO.
02060013
OWNER'S NAME:
SRINIVASAN LEELA V AND ANA
AT
PERMIT ISSUE DATE
08/30/2002
a
ILIF
SANITARY NO. CONTROL NO.
ARCHITECDENOINEER:
BUILDLNa PERMIT INFO
BLDG BI.RCI' PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
I,
n'lQb;D scription
1 hereby afOrm that 1 am Recused under pans of Chapter 9 (commencing
with Section 70110) of Divi elan 3 of Ow Business and Profession, Code, and my license is
In full force and effect.
U.C.eclaxa Uc.S
ADDITION &
REMODEL OF KITCHEN
Dela_ Contractor
ARCHIT ICI'S DECLARATION
(3 4 0 SQ . FT .
)
I understand my plana shtll W used As public retard.
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contraaora License law par the
.
following mason. (Sudan 70313, But= and Professions Code: Any city or count
which requires a permit in wmWrmt. slier. Improve, demallah, m mpair any atrottum
prior in its Issue=. also requires the applicant forech permit to Ne a signed statement
that W is licensed imemant to the pmddom Of the Conuxcmes Lkamm Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Scalae 700M of Division Sof the Business and Profetanm Cadc) or
Best he la sa cept themfmm Area the hub par the alleged exemption. Any viohdan of,
APN Number
ttpaity Type
Sectan 7031.3 by any applicant for a permit ebjecu the applicant k s civil penalty of
not acme than Ove hundred dollars (5500).
O I, u owner of the property, or my employees with wages As thein sole compensation,
A9rc;c;n2?
nn
wllldo the work and the snekrs lanotinkMW mofferud fonale (Sec. 7044. Business
Required Inspections
And Profession, Cade: The Ommovior', Llmn tue Law dooat apply k an Owner or
property who bulkhor improvumereon,and whodoeatuchwork himselforduough his
101 -
FOUNDATION
none employees, provided dist such Improvements are not intended motfared foram. If,
however, the building or Improvement is sold within cam year ofeampledan, the Owner-
102 -
PIERS
builder will Mm the burden of proving that he did rot Wild or Improve for purposs or
10 3 -
LIFER
ala.),
O 1, as Owner of the property, am exclusively contracting with limned conlncbrs As
104 -
REBAR
comnct the project (Sec.7041,Basin. and Professions Code:) The Coninctm's LI-
105 -
ANCHOR BOLTS
canto law does not apply to an owner of property who Wilda an improves t eewn, and,
who conuacu for each projects with a contract licensed pursuant an the Contractors
106 -
SEWER & WATER
License Law.
I aempt under See .Bb PC fm this won
0lam
202 -
UNDERFLOOR PLUMBING
Date
203 -
UNDERFLOOR MECHANICAL
Owner
WORKERS COMPENSATION DECLARATION
204 -
UNDERFLOOR FRAME
I hereby afros under penalty of perjury am of the following decluadaee
205 -
UNDERFLOOR INSULATION
.w and wmmnnwn.cmmek car Comentk.elf-wars roe wmker',compen-
301 -
ROUGH PLUMBING
u an, An provided fm by Section 3700 of the Labor Cade, for the performance of ted
work Bar which this permit hood.
302 -
TUB & OR SHOWER
O 1 have and will maintain Warker's Compensation Insurance, As required by Section
303 -
ROUGH MECHANICAL
3700 of the labor Cade. for the performance of the work for which this permit is Issued.
304 -
ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Policy number am:
Carder: Policy No.:
305 -
FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
306 -
HOLDOWNS
COMPENSATION INSURANCE
307 -
INSULATION
mile= am mad notWcomplemd lflW pemdNafmonehundmddeRm($100)
oriess.)
308 -
SHEETROCK.
1 certify list In the performance of the work for which this Permit is luoed, I shall not
309 -
EXTERIOR LATH
employ any pecan In my manncr An As to become subject to the Workers'Compenutim
310
INTERIOR LATH
Laws of Caiifomla. Date
-
311 -
313 -
SCRATCH COAT
ROOF NAIL
Applicant
NOTICE TO APPLICANT. If. after making this Cenincak of Exemption. you should
become subject to am Worker's Compensation provisions of iW labor Code. you muss
' forthwith comply with such proHdammthis permit shall WdcemedmvokcQ
501 -
FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDINGAGENCY
502 -
FINAL PLUMBING ENERGY
1hemhyafOrm Net therslasmnsnc.3 leading agency far the performance of
' the work orwMchthtspermh4luued(Soe.R197,Civ. CJ
503 -
FINAL MECHANICAL ENERGY
Lender's
504 -
FINAL BUILDING ENERGY
Lender'sAAddrddaess
i Iunify that Ihaw mad this Application and atkthat the above information Is
505 -
FINAL ELECTRICAL
^ correct. I Agree to comply with all city and county onfinances and rots laws mining l05
6 -
GAS TE ST
building consnction, and hereby sunburn mpmscnudves of this city to enter upon the
above-mentioned property for Inspection purpose.-
0 -
FIN L PLUMB NG
(Wet) agree m save, indemnify and keep harmless 0te City of Cupertino againstg
g I AL
j IlabillticsJudgmcnes, costs and expenses which may in any way amore against old City
in consequence of the graining of this Permit.
I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
Dale
SOURCE REGULATIONS,
Re -roofs 514
Type Of Roof
INAL PUBLIC WORKS
Signature ofAppli.VConuewr D.k
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or Futuro building muopant sum, m handle hazardous m.wr)al
As defined by the Cupertino Municipal Cade. Chapter 9AZ and tie Health and Safety
COM• Sudan 355334)7
All roofs shall be inspected prior to any roofing material being installed.
OYn ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant m future building occupant use equipment or devicek which
aeMae air mnterflums As defused by the Bay Area Air Gustily Management
all new materials for inspection.
ch
❑Yes ONO
I have mad the haun)mamatedabmqulmntenu under Chapter A.95 orthe Cellar.
niaHulthlk Safety Ca@,Socuom35505,35533and35534.1undenundthuirme building
dues net currently have a tenant, %at it is my responsmilily w notify the occupant of the
mqulmmcnw which met be met poor it) iuuanca of a Ccrtfteam of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner Or.uthodyzd. ant Dam