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02100176 CITY OF CUPERTINO CO BUILDING DIVISION PERMITNTRACT�OR INFORMATION-.-,t, Bu10_o0+Q,%RE-,COLBY AV CHANDRASHEKHAR APPANNA & X02100176 OwOR'kNDRASHEKHAR APPANNA & SU APPLICATIjJnSpTI3TY2002 PONE: SANITARY NO. CONTROL NO. I ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 t� not, LICENSED CONTRACTOR'S DECLARATION F 1 hereby affirm than l am licensed underrevisions of Chapter 9(Commencingb � 4 with Sceion7(XXRofDivision 3ufNeBusinessandPrnfcssionaCode,molmylicens REPLAE FURNAC q� °/A/C Etn in full tome and effect. F I N B L ED z o M bin Class Lic.0 /`� `/ Om— Dale Contractor ARCHITECTS DECLARATION MAR 11 2003 �K2� lundcrstanJ my plans shall Mused as public records OyOO ((�k 3 soI- Licensed Professional Cea0�1 OWNS r,BUILDER DECLARATION BUILDIN so00 . 1 hcrchy affirm that I um exempt from the Cumncmts License Law for the m¢Q O following mason(Section 71131.5,Business and Professions Cade:Any city nr county s XSE! which requires a Iacono to construct.eller,improve,demolish,or repair any structure o ;— Prior to it.issuance, Is,,requires the applicant for such permiuo rile a signed statement I?C Nal he is licensed pursuant to the provisions of Ne Cmundenrtc LicenseLaw Chapter 9 39g6Pt8IFi4C@A@9 Valuation He, (commencing with Section 7001)of Division 3 of the Business and Professions Cmic)or Wy that he is exempt therefrom and the basis for Oe alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of minum at.five hundred delta.($500). 303P- ROUGH MECHANICAL Occupancy Type 0 Lax owner of de prot or my employees with wages as their sole compensation, 364 will do the work,and the structure is not intended or offered tousle Eii 70U,Business and Professions Cade:The Contractors License Law docs not apply to an owner of 5 O 5 — FINAL e1tlOns property who builds or improves thereon,and who does such work himself or through his own employees.prodded that such imprownsenta arc not intended oroffered for We.If. 507 — FINAL PLUMBING however,the building or improvement u sold within ane year ofeempletron.the owner- SOB — FINAL MECHANICAL builder will have Ne burden of proving that he did not build or improve for purpose of 11c.). R_I,as owner of the property,am exclusively contracting with licensed contractors to constmm the project(Sec.NW.Business and Professions Code:)The Contractor's Li- _ cense law does not apply to an owner of progeny who builds or improves Narcan,and, who contracts for such projecu with is contractor(a)licensed pursuant o the Contractor's Lice.Law. ©tem exa�m(pLQ�tt�f�Jpr�Sec..�� f� � � .Bd.PCforthisrcamn Own r —ll l+'►N-Gf�a/� Date tO �S Oti WORKER'S COMPENSATION OEL7la�st'110N I hereby in.under penalty of perjury ane of the following declarations: 1 have and will maintain a Certificam of Consent to suffusion forWorketaCompen- .non,u provided fur by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 37N)of Ne Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ITU section need nal becomplemd if IM permit is forone hundred dollar(111X)) or less.) J I certify Nat in the p�e��rmostoj)pcagy. v nk for which this permit is issued,I Nall nm employany person inlaµ[gp t e 'c'I the Workcrs'Compensation LawsofC 1'f rttir,�lY��' Ap1d�caty w6i�A - T� NOT IO({ ,a mr makin is Cenificale of Exemption,you should Meme Subject to Nc Worker's Compensation previsions of the LaMn Code.you must 0 z forthwith comply with such provisions n this permit shall M deemed revoked OCONSTRUCTION LENDING AGENCY [—i I hereby alarm Nal there is a construction lending agency for the performance of (Ssa 7 the work for which this permit is issued(Sec.3097,Co,C) aQ landcr'a Name r7 z Underi Address ys (� I certify Nat 1 have mad this city and c un and sure that the above vs aclatinn is �k 1 0 U bonding 1 agree ct comply with all city and county ordinances and sou laws reusing to /V/ V building construction, hereby action pmPocrcunutives of this city mentor upon the above-mentioned propene for inspection purposes. (e JU g rbc to cast,indemnify and kith harmhods; an the City accrue Cupertino against V) incilitiesmisc.o the buandurning ofpaneamitch may in any way e<eme against said City / V t. APPLICANTeUNDERSTANDSIhis AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 1 rSOURCETIONS. "�—��"lcZRe-roofsApplicant/Contractor DatcHAZARDOUS MATERIALS DISCLOS Type of Roof the applicant or future building occupant store or hantllc hasardous material y the Cupertino Municipal Code.Chapter 9.13,and Ne Health and Safety n 25532(°)7 All roofs shall be inspected prior to any roofing material being installed. s *a the applicant or future building occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. pito❑Yea, 1 have mad the haaardous momriele requirements under Copier 6.95 of the Calika. ria Health&SafelyCnvk.Sections 255115.25533 vat 25534.1 un tan and Our ifthc building does not cu have a mount,that it is my responsibility to notify the occupant of the "met. muanbcmelpriPrmistaanceofaccriricatcmacpaney. Signature of Applicant Date wncnnauthnrimdagent am All roof coverings to be Class "B"or better