02060104 CITY OF CUPERTINO V, ` " -"'-'
BUILDING DIVISION PERMIT `CONTRACTOR O O
BUILDING ADDRESS: PERMIT NO.
11101 BUBB RD ALL SEASONS REMODELING 02060104
OWNER'S NAME: APPLICATION SUB DATE
'.HANDRA RAJIT C AND MARIE H 219 DEMPSEY RD 06/18/2002
x ,PHONE: SANITARY NO, CONTROL NO.
qqq, (800) 834-4744
W O O ARCHITEC VENGINEER: BUILDING PERMIT NFO
8Fy BLDG ELECT PLUMB MECH
Z
b C 1-1 LJ 1--'U LJ
ss..<C LICENSED CONTRACTOR'S DECLARATION .T.,
Z o b 1 hereby affirm that I vat licensed under rovisions of Chepmr 9(commencing r�P^^'+x+b tDes [ion
C O � with Section 7000)of Division 3 of the Bum es anJ Pmlessions a e,end my license PAT-10 � v�YS�� LrRwF �•
C is in fuRRC1Cl��(rppllffe and a a. /Awy IV7-'la:aa+s11 1 t
ec < Liccnte
V - Conlmci
3 c N
0 C]j 1 understand my plans shall be used as public recoms tze `\ ,,,,✓ Id `rt
6 O O Licensed Professional V
•q,Ii, OWNER-exempt formDECLARATION
I hereby.(Sect that 11. exempt from the COnuarC s Licenu Isw for
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following reason.(Sailor]on L;Business and ve,de mom Code:Any city a co, b 1 O Q Q Q
a5.,,t❑
which requires n Permit to construct.palter,plic improve,demolish,me sig any tate 1'
t,l 3p$-.prior to iu usuvnce,also rtquircs Ne applicant for such pemdt b file uigned summers¢.
a - (carhq it,IicenWd pursuant112 p�,vamom of the Comruclnes Licenu Low(Chapar9 t1 �]p{�t•�q,,� t ! ValUatlOn
(commen.�n$ uh Sermon,oO,oOOBd fDivision 3 of thea stay pqd Prvvfarmers Code) �i 'y5 1U-0�✓.C•\�!"kU"tdigl?L•l.l`7_XN
or that a exempt'diduefmm and Ne basis forme.Ilcg¢I ekemptU6.Any violation
-of Section]031:5 by any applicant for a permit subjects she spplicantto a civil Penalty
of not...dims fiva hurmel donars(s500i 101APN�&ORATION 1:4 Occupancy Type
❑1,as owner of the property.or my employees with wages as their sale compensation. m
-"will da'the work,antl the stmemrc'is not attended or'oRercd for sale(3¢¢9044, I,
`Busm.gs enJ'Pmfess ons Code The Cormoctur s L cense Law does not apply to an 10 3 — UFER Required Ins pections `• -
ownc
r of property Who builds or impmvcs thcrcon,and who does such work himself 10 4 - REBAR
of through his own employees.prvidin that such imProvemenu art not imimW or
._6rifedfor ml..If.noweveemelhar a-aWride.ofprntissomwididmaWildof 105 — ANCHOR BOLTS �';:.•.n', ., ... , . '.n
moove for Ne owner-hiller will hay.rhe burden of proving Inas he did not build or 10 6 — SEWER & WATER
improve for puryose of sale.).
contractors_. _.__._.. l .. ... - .,_._ ......
nd
11 l a her of,Ne progeny,em¢susses vela d Professions
ng with hcensehContractro -
_ _ wine project(sec.]044,Baam«a ora Prore66mna¢nae:)The cemmemr'a
203 - UNDERFLOOR MECHANI CALI'-"'
Licenu law does not apply to an owner of propeny who Wilds or improves thereon,
... . and who.contmeblof Such prlect6 wh1b a cnmmelor s)licnued.pursuant-m tha...._... _..__. .2 04- -"-UNDERFLOOR'—FRAME
-Common,License Low.
❑lamexemvt nndef sec; '' ;B&Pe(or this rcasor 205 - UNDERFLOOR`";INSULATION
'nor 1 1. , 301 - ROUGH PLUMBING
Ow Dame
'WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby a(Sfm under penalty of perjury one of the following declamtimse:
303 - ROUGH MECHANICAL
r F ={ ❑ 1 have andWill maintain'b Cenificiac'm Cdamm to self-insure for Workers 304 - ROUGH ELECTRICAL
n' Compensation, u provided for by Section 37M
ofthe lsr toCoda-far the
- performance of the work for,which this permit is k,med. 305 - FRAME
OI hale and will maimain Worker',Compeniuticalnshrance,as required by Section 306 - HOLDOWNS
3100 of the LaWr'Curb far the performance of Ire work far Which this permit n
307 - INSULATION
_ mss W My Worke s Compenwuo inxu er d Pol cy n mbar art
1, t�CERTIPICATION qF EXEMPTIb 'ttPM WORKEfGS +.ftJ�j i.X30.9 2-.,I.EXT•ERTORI `I�ATH"`
_ COMPENSATION INSURANCE � 1 L 1 '
- _ ...-.. ._.• .3.10..,_,...INTERI'OR--LATH....... ....
lThu s Tan need not W pli
comed d thepermit is for one hundred Dollars '' •' -
(SIW)one,s.i 311 - * SCRATCH COAT
313—`-"-ROOF---NAIL• .. "__..
I eemfy Ihes m Ne pert siva ce fah rk f r h M1 Nu perm t issued,1 1 t-. ,
nann as mJcnirm ysummerma6mbegm , blerm.newek i 501 - FINAL ELEGTRICAli' ENERGY
Co ppm un Laws f C.hfbmu,Dae,
..Appenam " , " '� '•. ' - ..502. -_ .FINAL...PLUMBING.._ENERGY.-.-.._ _
NOTICE TO'APPLICAN 1%It.after making this Cernfcae of Exemption,you should 503 - FINAL MECHANICAL ENERGY '
O Cbecome subject to the Workers Compensation provisions of the Labor Code,you must
forthwithcomplywith such provisions or this Permit shall Wdecmedrevoked. .. _. ...__.. .504 . -.FINAL _BUILDING,_ENERGY_:_.____.. __..
i� _ r' JCONSTRGCTION LENDING AGENCY " 505 — FINAL ELECTRICAL
1 hereby affirm that there a construction lending ag ncy for the perfmmence 1 1
W > anhe work forwhich thisamin issued Ise 30'n Cm.C) 506 — GAS TEST
0.,O ...Lenders Name_ .. _. ..... _....- ... .. ___. ..._. _._..
507 - 'FINAL-PLUMING ,
r7.z Londe Address .
U O 1 comfy that 1 have read this application and mate that the above information u
508 - FINAL MECHANICAL
W r cbriecr l agree to comply with all city and county ordinances and mate law,relating 509 - FINAL GRADE
O to buildingconm coon:andheresyauModzereprcunmtivesofthiscitymenmrupon
w dreabove.ma,ntmoolpropertyforimpecurinperpa.e,:, 510 - FINAL PLANNING
;a; (we)agree msae mdeam fy and keep ha nl.a eche City f Cupenino ajuinx,
G. rn liabilities,t dgmems Itsand expenses which may,in any ay accme agmass said 514 - FINAL UB C WORKS
U:^ Cny q ence f tit 'pant g of N permit.
APPLICANT UNDERSTANDS AND WILLCOMPLYWRH ALL NON-POLY ISSUedb r` Date
S U CE RLGULA I;L " y'
ignamrc of Applican r mrcr .' 3,D a Re-roofs
MATERIALS TERIALS DISCLOSIIRF
Type.Of.ROOf.
Will the applicant or future building oc para'tort or he dIe haipN us maiuial
as defib dby Cup.m M p,l Cod Ch pt 912, dtheH hit antl Sefiy t. I
Chili.
ode Sero 2557-1Y s t t t n t f s •♦ l..ip p+l,..+r.+a5 L 1
Alhroofs shall be inspected p[tor.to-any roofing,matertal being_Installed _Will she applicanto lutyreWimngge.erpan�.seequipmentofaevmma.wnsA If a roof is installed'without first obtaining an,inspection; I agree to remove
suit h amour air contaminants as defin.J by the Bay Area Air Quality Management
District, all new materials for inspection. Applicant understands and will comply with
mye, _ No ..-. . _ . -.. . .. ... .._- __. ....-.
N• . all non-poiilt`source regulations ,
I have read M M1azamous materials requirements under Chapter 6.45 4 the
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that -
-iflhebuilding thetime nmmentsyhh mum,ant,that it i is myresponsibilityof,a to notify the, '" - '- •• t
'dcpu nnl of the requirements which mus[be for prior to issuance oLa Certificate of
Occupancy,
��f �� Signature of Applicant Date
w.Finaatnn sag ctrl, m All roof coverings to be Class"B"or'better,
OFFICE... ._-